Eye On Illinois: If insurance coverage expands, provider count will need to increase

Expanded coverage.

That phrase has popped up repeatedly during the current legislative session as lawmakers and Gov. JB Pritzker’s administration push to reform the state’s physical and mental care climate.

The big headline grabber is House Bill 5395, the Health Care Protection Act. Among many other reforms, that plan would bar insurance companies from requiring preauthorization before someone can get inpatient mental health attention. It also would eliminate prescription “step therapy,” which forces patients to cycle through less expensive medications and treatments before an insurer will authorize what a doctor prescribed in the first place.

But there are several other ideas on the table. Senate Bill 2639 addresses coverage for infertility treatments. House Bill 5142 would mandate expanded coverage for pregnancy and postpartum care like doulas and lactation consultants. Senate Bill 2573 makes providers cover wigs for people whose hair loss has a medical reason, like chemotherapy or alopecia. Senate Bill 2967 would insist on coverage for susceptibility and prevention screening, including genetic testing, for all cancer types for anyone with a family history.

Those aren’t all the proposals, and each is more detailed than a brief summary may suggest. But they can all fall under the umbrella of dictating how private insurers write policies in Illinois and – at least from one political perspective – doing so in the name of trying to increase access to medical care.

Capitol News Illinois last week reported on a Springfield panel discussion at which Pritzker and Lt. Gov. Juliana Stratton touted plans to improve behavioral health services. They are among those pushing to give mental health care equal attention to strictly physical issues, but added attention on either front can lead to the same problematic outcome:

“As stigma continues to decrease for those seeking mental health care, existing practitioners can’t keep up with the rising need,” according to reporting from CNI’s Dilpreet Raju. “More than half of respondents – 56% – to the American Psychological Association’s 2023 “Pulse” survey, said they had no openings for new patients.”

You can change the phrase “mental health care” to another medical term, like “colonoscopy” or “melanoma screening” and land in a similar place. Perhaps the rate of people who can’t get a prostate exam or mammogram in a reasonable timeframe isn’t 56%, but as the state lowers access hurdles while the public accepts the importance of care, it will get harder to match patients and providers, especially in areas with lesser population densities.

That’s all before discussing Ililnois’ inability to process license and renewal applications, but lawmakers have attempted some meaningful steps to add professionals to the pipeline.

Maintaining a healthy population is a worthy goal. Government can pull many levers, but each action has the potential to create another downstream challenge.

• Scott T. Holland writes about state government issues for Shaw Local News Network. Follow him on X @sth749. He can be reached at sholland@shawmedia.com.