SPRINGFIELD – A health insurance initiative promoted by Gov. J.B. Pritzker passed the Illinois House of Representatives on Saturday, paving the way for a ban on controversial insurance industry practices such as requiring patients to receive treatments other than those prescribed by their doctor.
The bill’s passage following approval by the state Senate marks a victory for Governor Pritzker, who has vowed to spend political capital going after insurance practices that he criticized as “predatory” in his February budget address. The governor has since toured the state to promote the bill.
“Today we celebrate a victory for Illinois families and health care providers everywhere. We are saving lives and making the path to health care easier for everyone,” the governor said in a statement Saturday.
After the bill was amended multiple times, the insurance industry dropped its opposition to most of the governor’s proposals in the bill, except for a ban on certain short-term, high-cost insurance plans.
One key provision of the bill lawmakers passed would ban so-called step therapy, in which insurers ask patients to try cheaper alternative treatments before a doctor-recommended one. The practice has been criticized by doctors and patients who say it delays needed care and can make patients worse. The insurance industry portrays it as a cost-cutting measure.
In the bills passed by both chambers, stepped-care provisions for prescription drugs would apply to drugs already covered by insurance plans, Laura Minzer, president of the Illinois Council of Life Insurance Agents, said Saturday.
For example, if a doctor wants a patient to try Ozempic, they can prescribe it right away if it’s already on the list of medications covered by the patient’s insurance.
Even if Ozempic wasn’t on that list, there would be additional steps to get an exemption, such as if a patient had been taking a certain drug for a long time and found it effective, which Minzer said could keep costs down.
The step therapy provisions, along with many of the other provisions in the bill, would take effect in 2026.
The bill would cost the state health system $35 million and Medicaid $30 million, according to Democratic Rep. Anna Mohler of Elgin, the bill’s lead sponsor.
Mohler has previously said many of the reforms would lead to long-term cost savings and increased access to health care.
The bill, which included a ban on step therapy, passed the House 83-23-1 and the Senate 45-14 with bipartisan support.
Another of Pritzker’s proposals, which was originally packaged with other provisions but was bundled into a separate bill for the final vote, would ban short-term insurance plans that can be financially risky for consumers. Known as short-term limited-duration plans, these plans offer coverage for a short period of time but can make treatment prohibitively expensive. Pritzker calls them “junk plans.”
Rep. Bob Morgan, D-Deerfield, said on the House floor Saturday that the plan “gives people who are, in many cases, out of work a false sense of security when in fact they’re flying without a parachute.”
The Illinois Council of Life Insurance, which represents some of the companies selling short-term plans banned in the bill, opposed the ban, and it passed the House 72-35, split nearly along party lines.
“These plans are not junk plans. Some of them are bare bones. The vast majority of plans being sold have proper and appropriate limitations that provide value to Illinoisans,” said Rep. Jeff Keicher, a Republican from Sycamore.
He said the plan could be less expensive than the temporary coverage extension option known as COBRA.
The bill banning step-treatment passed Saturday would also ban prior authorizations, which require patients to get permission from their insurance company before receiving inpatient mental health care.
Other provisions, such as stricter standards for updating directories and listing covered drugs, are aimed at improving transparency. The law also aims to address price hikes for large group plans.
“For too long, insurance companies, not doctors, have decided what treatment options patients should get and how quickly they should get them,” Pritzker said at one of several press conferences promoting the bill in recent weeks. “This bill puts the power back in the hands of patients and their doctors.”
