New Legislation Targets Practices Limiting Healthcare Access
SPRINGFIELD – Governor JB Pritzker signed pivotal health insurance reform legislation on Wednesday, introducing new regulations to the state’s health insurance industry. The new laws prohibit certain cost-cutting measures that have previously restricted patient access to healthcare services.
The Health Care Protection Act, House Bill 5395, emerged as one of Pritzker’s top legislative priorities in the recently concluded session. Additionally, Pritzker signed House Bill 2499, which bans the sale of short-term, limited-duration insurance plans in Illinois, often criticized as “junk insurance” due to their failure to meet federal Affordable Care Act standards.
“Insurance companies have long exploited predatory tactics to maximize profits at the expense of Illinois consumers,” Pritzker stated at a signing ceremony in Chicago. “Patients have faced delays or denials of essential treatments due to profit-driven utilization management practices, while inadequate networks and price gouging obstructed access to necessary care. Today, with my signature, Illinois takes a stand to rectify these issues.”
The Health Care Protection Act specifically outlaws “step therapy” or “fail first” provisions, which mandate patients to attempt and fail cheaper treatments before accessing physician-recommended ones. It also eliminates the requirement for prior authorization for emergency inpatient psychiatric treatment, making Illinois the first state to implement such a rule for both adults and children.
Furthermore, the law mandates insurers maintain up-to-date provider lists and grants the Illinois Department of Insurance the authority to approve or reject proposed premium rate changes for large-group health insurance plans, extending powers it already holds over small-group plans.
Pritzker initially introduced these reforms in his State of the State address in February, anticipating strong opposition from the insurance industry but pledging significant political effort to ensure the legislation’s passage.
Despite intense negotiations involving the administration, insurance industry representatives, healthcare providers, and other stakeholders, the final version of the act faced minimal opposition, garnering some bipartisan support. It passed the Senate with a 45-14 vote and the House with an 83-23 vote.
The more contentious ban on short-term, limited-duration insurance plans was separated into House Bill 2499 to facilitate smoother passage of the main reform bill. Critics argue these plans often result in inadequate coverage and significant medical expenses, while some Republicans maintain they offer a cost-effective option for certain individuals. This measure passed along party lines, 40-19 in the Senate and 72-35 in the House.
Governor Pritzker signed both bills at Rush University Medical Center in Chicago, accompanied by supportive lawmakers and healthcare providers.
“The reforms passed by Illinois lawmakers will eliminate administrative delays caused by insurance companies and the issues with their inadequate ‘ghost networks,'” said Piyush Vyas, president of the Illinois State Medical Society.
