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* Our old buddy Mark Maxwell questioned the governor today about the Senate prospects for his Healthcare Protection Act, which passed the House with a bipartisan majority last week….
Q: I don’t know that you can get through the Senate without the approval of the Insurance Chair Napoleon Harris. The insurance industry has invested a lot in his political career. In fact, no other industry has given more to his campaigns than insurance has. How do you convince him that he should put your political agenda before that of his and his allies?
Pritzker: Well, let’s be clear, first that Senator Harris fights hard for the people of his district. And we share a lot in common in terms of wanting to lift up, particularly in patients and those who may be suffering.
And I’ve talked to him about this bill. He understands and believes that there are important advances that need to be made. So I’m anticipating, actually his support for this bill. I’m hopeful that the people that are on the committee, or on the committees that will consider this all understand that this is something that is very popular, it’s something that’s very important for the future of health care in the state of Illinois and that it will pass one way or the other.
And I’ve said, I’m not going to give up on this. We’re putting shoulder to the wheel. I don’t think we’re going to have to go into another session in order to get this done.
I actually think there’s great momentum for this. And as we’ve seen, there’s bipartisanship, too, and I’m very pleased about that.
The bill could also be sent to the Senate Executive Committee.
* Sen. Sara Feigenholtz was asked about the Healthcare Protection Act on Paul Lisnek’s WGN show…
This is a universal problem of having claims rejected, prior authorization. It’s probably the number one stressor for our doctors and it’s not a productive way for them to spend their time. The bill is gonna fly out of the Senate, I predict.
* If you haven’t yet, I’d highly recommend reading Peter Hancock’s Healthcare Protection Act explainer…
Pritzker first outlined the initiative during his State of the State address in February. It targets many of the “utilization management” practices insurance companies use to hold down costs by either denying claims or steering patients toward lower-cost options.
For example, the bill would require health insurers to use “generally accepted standards of care” when deciding whether to cover treatments recommended by a doctor.
It also bans a practice known as step therapy that is used in some prescription drug plans. That, practice, sometimes referred to as “fail first” therapy, requires patients to demonstrate that a lower-cost drug that is part of an insurance company’s preferred drug list is ineffective before the company will approve paying for a different drug prescribed by the patient’s doctor.
It also prohibits insurance companies from requiring prior authorization before covering the cost of in-patient psychiatric treatment. In circumstances where prior authorization is necessary, companies would be required to publicly post it on their websites.
In addition to those restrictions, the bill would require insurance companies to conduct internal audits of their own provider networks every 90 days. Those audits would ensure that the providers listed still participate in the network and that the network has enough providers in various practice areas to meet the needs of patients.
There’s lots more, so go read the rest.
posted by Rich Miller
Monday, Apr 22, 24 @ 12:02 pm
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Mark Maxwell doesn’t care about the actual legislation it’s all about his political gotcha.
Comment by Frida's boss Monday, Apr 22, 24 @ 12:31 pm
===Mark Maxwell doesn’t care about the actual legislation===
It’s not his job to care about legislation. He’s not a lobbyist.
===it’s all about his political gotcha. ===
That would assume what he said about NaPo isn’t true. In which case, you’d be wrong.
Comment by Rich Miller Monday, Apr 22, 24 @ 1:01 pm
==It’s not his job to care about legislation==
Just told on yourself and your whole profession, Rich.
Comment by Drury's Missing Clock Monday, Apr 22, 24 @ 1:22 pm
===Just told on yourself and your whole profession===
Tell me you have absolutely no idea what reporting is about without telling me.
Comment by Rich Miller Monday, Apr 22, 24 @ 1:50 pm
“Those audits would ensure that the providers listed still participate in the network”
Good, it’s frustrating to select a doctor in a network who’s no longer there.
Comment by Grandson of Man Monday, Apr 22, 24 @ 2:11 pm
The bill was sent to the Human Services Committee in the House, not the Insurance Committee. I certainly don’t make Senate bill assignments but a precedent has been set in the other chamber to not send this to Insurance.
Comment by Jeremy Rosen Monday, Apr 22, 24 @ 10:18 pm