Democrats’ bill puts controls on health insurance. Some metro-east Republicans support it

When state Rep. Kevin Schmidt, a Republican from Millstadt, voted for a proposed bill that would change the way medical insurance companies approve prescribed health care treatments, he broke ranks with some party colleagues in the metro-east.

“I’m one of the bipartisan ones that crossed over,” Schmidt said Monday in a news conference conducted by Gov. J.B. Pritzker at the Memorial Hospital Orthopedic and Neurosciences Center in Belleville to publicize the bill known as the Healthcare Protection Act, or House Bill 5395. The bill is backed by Pritzker, a Democrat, and it was filed by a Democrat.

Schmidt said as chiropractor, he sees the reason for the bill to be enacted.

“When I became a chiropractor, I swore to the oath to do what’s best for the patient,” Schmidt said. “That’s why I voted yes.”

“This is what we’ve needed for a long time,” he said.

Schmidt, who represents the 114th District, said he was able to talk to some other Republicans and get them to back the bill as well. State Rep. Amy Elik of Godfrey in the 111th District was another metro-east Republican who voted with Schmidt in favor of the bill.

The House voted 81-25 last week to advance House Bill 5397 to the state Senate, where Pritzker believes it will be approved.

Pritzker said highlights of the plan include:

▪ It would tackle the issue of “prior authorization,” which forces patients to get approval from an insurance company before getting services or a prescription filled. This bill would require insurance companies to use the same “treatment criteria” to determine medical necessity that doctors do, Pritzker said.

“For far too long insurance companies and not doctors have been free to determine what treatment options patients should have and how quickly they can receive it,” Pritzker said. “With this bill, we’re putting power back in the hands of doctors and patients.”

▪ The practice of “step therapy” would be banned in Illinois for fully insured and Medicaid plans, Pritzker said. This system calls for patients to use a cheaper prescription drug before going to a more expensive one.

▪ The bill would prevent large group insurance companies from “unfairly” increasing their rates, the governor said. The state previously took action on this issue in the small group insurance market, Pritzker said.

▪ If House Bill 5395 becomes law, Illinois would be the first state to ban prior authorization for persons getting treatment for mental health care in a hospital, the governor said.

The area Republicans who voted against it include state Reps. David Friess of Red Bud in the 115th District, Charlie Meier of Okawville in the 109th District and Blaine Wilhour of Beecher City in the 110th District.

Meier said he opposed the bill because he believes “non-citizens” of Illinois will be included in the bill’s requirements once the implementation rules are written by state officials although he noted that Republicans were told this would not happen.

“We know how they’ve added them on other … policies,” Meier said. “We as taxpayers are watching our most vulnerable residents and the disabled and others not get the services they need.

“We do not want this going for the people who are non-citizens of Illinois.”

Critics of the plan have said they were concerned about the added costs people could see on their health care insurance premiums.

Pritzker responded to this criticism by noting that health care providers as well as insurance companies would see “efficiencies that are brought on by a system that is more streamlined.”

“This bill will save lives and lower health care costs for millions of Illinoisans,” said Pritzker, who plans to travel across the state to promote the bill.

Area Democrats who supported the bill include Reps. Jay Hoffman of Swansea in the 113th District and Katie Stuart of Edwardsville in the 112th District.