If you’re able to read this at home, it’s probably because you signed a contract with a provider that allows you to get high-speed internet all the time. Or you signed a contract with the Sun-Times that puts the paper at your doorstep every day.
In either case, you pay a fee in exchange for that service. That’s how contracts work.
Not so simple in health care. If you have commercial health coverage in Illinois, the plan you signed up for may not be the plan you ultimately receive.
Here in Illinois, your health insurer can change your prescription benefits on a whim, at any point during the year. And if they do, you have nowhere to go because you’re locked into your policy for the duration of the year. You have to honor the contract, but your insurer doesn’t.
This situation is commonly referred to as “non-medical switching,” when a health insurer reduces or completely eliminates coverage for a prescription drug benefit in the middle of the policy year.
Nothing prohibits this practice here, leaving people vulnerable to insurance coverage changes that can have an impact on their health, financial wellbeing and overall quality of life.
The effects can be serious, especially for people who are managing a chronic condition.
One study found that over 40 percent of patients with rheumatoid arthritis who experience a non-medical switch have increased emergency room visits. Not only is this an indication of declining overall health, it results in an increased cost to the patient and time spent away from work or their loved ones.
Despite claims by insurers that these measures are meant to control costs, the end-result is often a cost increase, both to individuals and to the health care system more broadly.
As a mental health advocate, I have seen too many people with serious mental illnesses end up in the hospital because their medication was switched even though it was working well for them.
Thankfully, there is legislation in the Illinois House that could end this dangerous practice once-and-for-all in our state, and it has bipartisan support.
House Bill 4146 would hold commercial health plans accountable by requiring them to deliver the prescription benefits they marketed and sold to consumers. If passed, this bill would prohibit insurers from increasing your out-of-pocket costs, moving a prescription drug to a more restrictive tier, or completely removing a drug from your plan.
More than 60 members from both parties of the Illinois House of Representatives have signed on as cosponsors to the bill that would end these greedy insurer practices. The bill’s chief sponsors are Rep. Laura Fine, D-Glenview, Rep. David Harris, R-Mount Prospect, Rep. Patti Bellock, R-Westmont, and Rep. Deb Conroy, D-Villa Park. Co-sponsors include Majority Leader Barbara Flynn Currie, D-Chicago, Deputy Majority Leader Lou Lang, D-Skokie, and Republican Leader Jim Durkin, R-Burr Ridge.
Illinoisans would be protected in a commonsense way that allows them and their doctor to make the best health care decision available to them and have peace of mind that, if and when they need it, the benefits they signed up for will be available.
Imagine if you lost internet access today and couldn’t do anything about it for the rest of the year. It would hurt.
Now imagine that same scenario, instead in this case you can’t access a prescription medication you need.
Illinois needs a fix. This bill is the answer.
Mark J. Heyrman is facilitator of the Mental Health Summit, a coalition in Illinois of advocacy organizations, professional societies and trade associations in the behavior health field.