In the latest push for health insurance reform, Governor JB Pritzker is taking aim at what he calls "predatory health insurance practices" with the introduction of the Healthcare Protection Act (HPA). The act seeks to empower patients by banning certain insurer protocols that often delay or deny care. Among these are step therapy and prior authorization for mental health emergencies, which Pritzker and his supporters believe should be immediately accessible.
"Illinoisans who are suffering should not have to jump over hurdle after hurdle to get the care they need to survive," Pritzker stated, advocating for a healthcare system where medical professionals and patients are the primary decision-makers. Critics of current insurance practices argue that these often place more weight on company profit than on patient well-being. "The only people who should be making decisions about patient care are doctors and patients themselves — not an insurance employee with no medical background," the governor said in a statement obtained by Illinois Government News.
Pritzker's reforms target utilization management tactics employed by insurers, designed to control costs, but which also result in making it difficult for consumers to quickly and easily access the treatments their doctors recommend. The HPA would require insurance companies to clearly outline treatments that demand prior authorization, effectively bringing more transparency to the process.
Moreover, Pritzker's administration aims to quickly ensure that access to in-patient behavioral health care is not hampered by red tape. As part of the reform, "HPA will ban 'step therapy' processes in Illinois, and require insurance companies to align definitions of medical necessity to match that of doctors," according to Illinois Department of Insurance Director Dana Popish Severinghaus. Such changes are to decisively put patients' needs before profit-driven insurance models.
Meanwhile, advocates for the bill such as State Senator Robert Peters and Rep. Anna Moeller have expressed strong support for the measures. The bill is seen as a means to reduce health disparities and bolster equity in healthcare coverage. "Everyone, no matter who they are or where they live, deserves access to safe and effective care across all aspects of their health, maternal and mental health included," Peters told Illinois Government News.
Healthcare and family services officials, along with the medical community at large, are welcoming the proposed reforms. Hospitals and healthcare providers are particularly keen on the elimination of barriers that presently delay patient care. A.J. Wilhelmi, President and CEO of Illinois Health and Hospital Association (IHA), asserts that current prior authorization processes severely hamper the delivery of vital healthcare services. With these proposed reforms, the hope is to streamline access to care ensuring that patients receive the treatments they need without unnecessary delay or denial by insurance companies.
