I've been following this bill for awhile now but never got around to writing about it until after it passed through both chambers of the Illinois legislature. That's a shame, because it's a pretty Big F*cking Deal for Illinois residents.
The Illinois House passed the Healthcare Protection Act Saturday to help curb predatory insurance practices and protect consumers.
Gov. JB Pritzker's monumental plan could make Illinois the first state to ban prior authorization for in-patient adult and children's mental healthcare. The legislation also bans step therapy, or the fail first method, where insurers force people to receive less effective treatment before moving to options initially recommended by doctors.
...The measure requires prior approval from the Department of Insurance before large group insurance plans can increase rates and states premiums must align with the actual cost of providing care as well.
Provides that beginning before or on May 1, 2026, and each May 1 thereafter, the Department of Insurance shall report to the Governor and the General Assembly on health insurance coverage, affordability, and cost trends.
Amends the Illinois Insurance Code.
Provides that any forms and rates filed for large employer group accident and health insurance shall be automatically deemed approved after 90 days after filing.
Provides that beginning plan year 2026, rate increases for all individual and small group accident and health insurance policies must be filed with the Department for approval.
Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
Provides that beginning plan year 2025, the Department shall post all insurers' rate filings and summaries on the Department's website.
Back in February, I wrote about a bill introduced into the Illinois State Senate by Sen. Laura Fine (SD-09) which made my heart sing:
Amends the Department of Insurance Law.
Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate.
Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance.
Amends the Illinois Insurance Code and the Health Maintenance Organization Act.
Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department for approval.
Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved.
Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website.
Provides that the Department shall post all insurers' rate filings and summaries on the Department's website.
Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website.
...With the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
I had heard that this was in the works, and with the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:
Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.
I'd never heard of Illinois state Senator Laura Fine before now. I know absolutely nothing else about her besides her being a Democrat who represents IL Senate District 9.
MICHIGAN: Another One (Mostly) Bites The Dust; 12th CO-OP Drops Off Exchange, May Go Belly-Up
It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.
But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.
Consumers Mutual CEO Dennis Litos said: "We are reviewing our situation (financial condition) with DIFS and should conclude on a future direction this week.”
While Eich said he could not disclose the options, he said one is “winding down” the company, which has 28,000 members, including about 6,000 on the exchange.
Unfortuantely, Illinois is another state which doesn't make it easy to analyze annual health insurance premium rate filings.
There's no details on their insurance department website, their SERFF listings don't seem to include the actuarial memos or URRT forms, and even the federal Rate Review listings only include the average requested rate changes; the actuarial memos there are mostly heavily redacted.
Illinois' total individual market enrollment should be roughly 330,000 people. Fortunately, three of the carriers do reveal their 2022 enrollment, including the biggest one in the state (Blue Cross). This allows me to make an educated guess as the the enrollment of the other 7, which in turn means I can make an estimate of the weighted rate increase of roughly 6.9%. The unweighted average is 8.9%.
For the small group market I have to go with the fully unweighted average of 6.8%.
UPDATE 11/03/22: With the official 2023 Open Enrollment Period underway, Illinois final/approved rate filings have been posted to the federal rate review website. Not much changed, however...most of the filings have been approved as is, with the exception of MercyCare HMO and Oscar Health Plan.
