Two Springfield doctors are part of Gov. JB Pritzker’s push to reform what he called “predatory health insurance practices.”
The Democratic governor’s proposed Healthcare Protection Act would ban “step therapy,” which can delay patients’ access to more-expensive medicines until cheaper medicines are tried first.
House Bill 5395 also would ban prior authorization for inpatient admissions involving crisis mental health care, and it would impose more rules and harsher penalties for insurance companies to prevent the promotion of “ghost networks” of medical providers.
The bill also would make Illinois the first state in the nation to have the right to turn down premium increases proposed by insurers for the “large-group” market, which covers places of employment with 51 or more workers.
The bill “puts power back in the hands of patients and their doctors, where it belongs,” Pritzker said at a news conference March 13 after a hearing on the bill in front of an Illinois House committee.
But Laura Minzer, president of the Springfield-based Illinois Life and Health Insurance Council – a group advocating on behalf of the health insurance industry – said the 45-page bill could lead to “significant cost increases” for patients and employers without necessarily improving care.
She said the ban on some prior authorizations “threaten unintended consequences for the patient if the insurer, upon retrospective review of the services and treatments rendered, determines that some of those services are not covered by their policy, leaving the patient on the hook for hundreds if not thousands of dollars in medical expenses at a time they least need that added stress.”
Minzer testified that the insurance industry seeks “solutions, not quarrels. We seek progress, not regression.” Minzer told Illinois Times on March 19, “There’s a potential to get a good compromise, but it’s a lot of details.”
She noted that the bill wouldn’t affect the 60% or more of patients in Illinois’ private insurance market because those patients are covered through large employers with self-funded plans. Such plans are regulated by the federal government and exempt from state insurance regulations. The bill also wouldn’t affect the rules governing coverage of Medicaid patients.
Dr. Leslie Dignan-Moore, an obstetrician/gynecologist at Springfield Clinic, testified in committee about the provider directories made available to patients insured by Blue Cross and Blue Shield of Illinois after Blue Cross removed the clinic as an in-network provider in 2021.
The directories purported to list alternate providers ready to serve patients, she said. But she said the list “can only be described as a ghost network.”
The directories were a “robust-looking list of providers that ultimately provided dead end after dead end for our patients,” she said.
Dr. Mary Dobbins, a pediatrician and child psychiatrist at Southern Illinois University School of Medicine, also testified and said at the news conference that the bill “literally addresses life-and-death issues.”
She said the ongoing shortage of mental-health professionals is “artificially magnified” by insurance requirements and restrictions. “Care is commonly delayed, inaccessible, inadequate or even completely denied,” she said.
The chief sponsors of the bill, which hasn’t yet been voted on by the House or Senate, are state Rep. Anna Moeller, D-Elgin, and state Sen. Robert Peters, D-Chicago. Supporters of the bill said they hope it receives backing from Republicans, as well, and Pritzker said protecting patients shouldn’t be a partisan issue.
The “utilization management” practices targeted by the legislation are designed by insurers to “boost profits” and have “never been about supporting patients,” Pritzker said. “The sole purpose is the corporate bottom line.”
Illinois joined the majority of states a year ago in giving Illinois officials the right to turn down proposed premium increases in the small-employer and individual market. That provision takes effect in 2026.
State oversight of premiums “prevents insurance companies from unfairly jacking up rates on consumers,” Pritzker said.
“Illinoisans who are suffering should not have to jump through hurdle after hurdle after hurdle to get the care that they need to survive,” he said. “I know the insurance companies will fight us on this, but I’m not willing to play political games with the health of Illinoisans.”
Chicago-based Blue Cross and Blue Shield of Illinois, which restored Springfield Clinic to in-network status in January for many but not all people covered by Blue Cross plans, declined to comment on the bill.
Dignan-Moore didn’t refer to Blue Cross by name in her comments but said most of the listed 99 providers for obstetrical and gynecological care outside of Springfield Clinic didn’t deliver babies, were farther away from patients than what state rules allowed, weren’t accepting new patients or were otherwise unavailable.
“Of the 99 listed, only four were accepting patients within the time and distance requirements,” she said. “The helplessness that swept over our patients as they realized the lack of alternative options was overwhelming.”
The result was that many patients delayed pregnancies, mammograms and gynecological exams, Dignan-Moore said.
There also were “major issues” with the number of alternative providers to patients outside Springfield Clinic in rheumatology, radiation oncology, ophthalmology, allergy, nephrology, gastroenterology and dermatology, Dignan-Moore said.
Dobbins, who spoke on behalf of the Illinois chapter of the American Academy of Pediatrics, recounted the case of a 12-year-old patient in need of mental-health hospitalization who had to remain in an emergency room for four days while doctors sought prior authorization for admission.
Dobbins said a 14-year-old patient was denied a hospital admission during a mental-health emergency because the suicide note she wrote that her father brought in had been written three days earlier.
A teen with an eating disorder who was deteriorating physically couldn’t be hospitalized because an insurance company wouldn’t pay for it “until she was medically compromised and in danger,” Dobbins said.
Dean Olsen is a senior staff writer at Illinois Times. He can be reached at 217-679-7810, [email protected] or twitter.com/DeanOlsenIT.
