State Rep. Sue Scherer, D-Decatur, speaks during debate in the Illinois House on April 6 before the House voted on House Bill 1463.
Photo courtesy Illinois House Democratic Caucus” class=”uk-display-block uk-position-relative uk-visible-toggle”>
State Representative Sue Scherer asked her fellow lawmakers on April 6 to vote for legislation that she says would protect patients harmed by the contract dispute between Blue Cross and Blue Shield of Illinois and Springfield Clinic.
Scherer, a Democrat from Decatur, whose 96th House district includes parts of the east side of Springfield and eastern Sangamon County, failed to pass House Bill 1463, though he described the vote as a test of the character of the legislators.
“I hope that people in this room have the courage to stand up to the ‘bad guys,’ because tomorrow it’s pretty clear if I want to answer who is owned by the insurance companies, guess what? I’m giving them a roll call to vote.” Scherer said, his voice cracking with emotion at the end of the 45-minute debate on the measure.
The roll call showed that 40 members of the House voted “yes”, 21 voted “no”, seven voted “present” and 46 did not vote, which meant that the bill failed because it did not receive the necessary 60 or more votes. to pass and advance to the Senate.
Among those who did not vote were Republicans and members of Scherer’s own party, which control the House and Senate. Joining Scherer in support of the legislation were Reps. Tim Butler and Sandy Hamilton, both Republicans from Springfield; and House Speaker Emanuel “Chris” Welch, D-Hillside.
Those who did not vote included Rep. CD Davidsmeyer, R-Jacksonville, and House Minority Leader Jim Durkin, R-Western Springs.
Scherer said he doesn’t know if he will try to pass the legislation in the future. The bill was supported by Governor JB Pritzker, a Democrat, and the Pritzker administration’s Illinois Department of Insurance.
Scherer said Illinois Times she will go on to speak about the need to hold health insurance providers more accountable.
“My bill was called to bring transparency and accountability to the big insurance companies,” he said. “I care deeply about providing affordable and accessible health care to the residents of my district, and I will continue to work toward that goal and fight for my constituents, as always.”
HB 1463 covers 102 pages and would amend the state’s Network Adequacy and Transparency Act, which passed in 2017 and began affecting insurance plans in 2019.
The bill would allow state officials to confirm the existence of investigations of insurance companies. The bill would also create stricter standards for insurance providers to maintain accurate online lists of doctors in their networks and more quickly adopt annual federal recommendations on the number of specialty doctors needed for “network adequacy.”
A news release from the state insurance department said the bill would give the department “the authority to implement more stringent time/distance standards than current federal requirements for many specialties to ensure consumers can access providers network close to home”.
Scherer, the bill’s sponsor, said the state insurance department proposed the bill late in the spring legislative session because of regulatory loopholes highlighted during Blue Cross’s one-year contract dispute with Springfield Clinic. .
Scherer arranged a hearing on the contract dispute in front of a House committee on March 30 in hopes of prodding both sides toward a deal. But he said the bill was not intended to hinder the negotiation of a private contract.
Rep. Thaddeus Jones, D-Calumet City, chairman of the House Insurance Committee, criticized Scherer’s bill in debate on the House floor, saying he should have brought the bill back to his committee so that consider it instead of another House committee.
He also said Scherer didn’t do enough to get a deal on the insurance industry bill. Scherer said he tried to get industry and other organizations involved, but not all responded to his invitations.
Jones said Scherer was “misleading” in her description of the bill negotiation process, a claim Scherer denied.
“Not only is this bill excessive, but this bill doesn’t solve the problem it’s trying to solve,” he said.
He noted that the Department of Insurance says it would cost the department $836,500 a year to carry out the legislation by hiring additional state workers, plus software and contract costs.
Jones, who has received more than $24,000 in campaign contributions from the Illinois insurance industry since the beginning of 2018, according to the nonprofit Reform for Illinois, did not return a phone call from Illinois Times.
The insurance industry opposed the bill. Laura Minzer, president of the Illinois Health and Life Insurance Council, said her organization would support some parts of the bill, including publishing research on insurance plans, but not other parts of the bill. The council would be willing to negotiate future legislation with Scherer, Minzer said.
Jones and other lawmakers who oppose HB 1463 said the legislation would not result in a contract agreement between Blue Cross and Springfield Clinic, but Scherer said that was not his goal with the legislation.
Other lawmakers questioned the need for the bill when the insurance department recently proposed administrative rules to clarify parts of the current Network Adequacy and Transparency Law and could take effect in several months.
But Scherer said his bill would complement the proposed rules.
He said on the House floor that passage of the bill would let lawmakers know they “spoke up” for their constituents and “had the courage to stand up to insurance lobbyists, and we all know that’s no small feat.”
The dispute between Blue Cross and Springfield Clinic has caused thousands of central Illinois residents to lose in-network access to their doctors, physician assistants, advanced practice nurses and other providers.
Officials at the Springfield Clinic said last year that the dispute threatened to disrupt care for more than 100,000 patients. Blue Cross officials disputed that number, saying about 55,000 Springfield Clinic patients, at most, were affected by the change.
Since then, some employers have switched insurance carriers to keep the clinic an in-network provider and protect employees from higher out-of-pocket costs when seeking care from clinic providers.
The dispute has not been resolved.
Chicago-based Blue Cross, the state’s largest insurance company, recently agreed to pay a $339,000 penalty to the Department of Insurance for delaying the filing of documents supporting Blue Cross’s claim that it has an adequate network even with the loss of more than 600 Springfield Clinic providers.
The department continues to evaluate Blue Cross’s “network adequacy” filing, department spokeswoman Caron Brookens said.
Dean Olsen is a senior staff writer for Illinois Times. He can be reached at email@example.com or 217-679-7810.