Latest news with #IllinoisLife&HealthInsuranceCouncil
Chicago Tribune
5 days ago
- Health
- Chicago Tribune
Letters: Primary care is undervalued by insurance companies. This threatens the health of our communities.
As a family physician practicing in Illinois, I have witnessed firsthand the growing challenges facing primary care providers. Despite being the cornerstone of our healthcare system, primary care is increasingly undervalued, leading to a silent crisis that threatens the health of our communities. Insurance companies are increasingly employing algorithms to downcode evaluation and management (E/M) services, often without thorough chart reviews. This practice reduces reimbursement for primary care services, undermining the financial viability of independent practices. The result is a healthcare landscape where primary care physicians are disincentivized, leading to decreased access for patients and higher long-term costs due to preventable hospitalizations and emergency care. Moreover, the consolidation of healthcare systems has created monopolistic entities that prioritize high-revenue specialties over primary care. This shift not only inflates healthcare costs but also diminishes patient choice and continuity of care. The market's failure to appropriately value primary care services contradicts the principles of efficient resource allocation and consumer welfare. To rectify this, policymakers and insurers must recalibrate reimbursement models to reflect the true value of primary care. Emphasizing preventive care and chronic disease management can lead to substantial cost savings and improved patient outcomes. Additionally, fostering competition by supporting independent practices can enhance service quality and accessibility. The economic rationale is clear: investing in primary care is not just a moral imperative but a fiscal necessity. Addressing this market failure is essential for creating a sustainable and equitable healthcare uncertain times have left many on edge, both in Washington, D.C., and Springfield. We urge Illinois lawmakers to take a cautious approach when legislating health coverage mandates, particularly given the challenges ahead with the still-developing congressional budget proposal. A healthy, competitive market benefits consumers by providing more choices and lowering costs. This is especially crucial as Illinois works to establish its own health insurance marketplace. As a result, Illinois Life & Health Insurance Council (ILHIC) is deeply concerned about the congressional budget proposal taking shape in Washington, D.C., and its devastating impact on public and private health insurance in Illinois. The loss of enhanced premium tax credits coupled with the potential rollback of Medicaid expansion could further lead to widespread coverage losses. According to a preliminary review of the proposed federal budget by the Congressional Budget Office, more than 13 million Americans are at risk of being further priced out of private health insurance or losing their Medicaid coverage, including up to 800,000 or more Illinoisans. We cannot afford to jeopardize the health and well-being of more than three-quarters of a million Illinois residents. Even in Illinois, vigilance is key. The Healthcare Protection Act expansion proposal, now House Bill 3019, initially included an 87% Medical Loss Ratio for private market insurers — a change that threatened to further disrupt the state individual and small-group insurance market. Illinois is already facing the exit of two insurers from the individual market in 2026 — Health Alliance and Aetna — and four insurers have already left or will leave the small group market by next year. Fortunately, ILHIC's discussions with Gov. JB Pritzker's office and the Illinois Department of Insurance have yielded results – the 87% MLR provision in the bill has been removed. We appreciate the governor's commitment to engaging stakeholders and addressing concerns about the future of the state's health insurance market. As the state's leading advocate for a strong and sustainable health insurance industry, ILHIC will continue working in good faith with the governor's office and the Illinois Department of Insurance as a reliable partner dedicated to ensuring that Illinois residents continue to have access to affordable, high-quality health care and life insurance.I have a lot of respect for the Rev. Michael Pfleger and what he is doing. Sixty-two years ago, I was a caseworker in a district that included part of Orleans St. Talking to a landlord, who was not your typical slumlord, I realized that the kids in the area had no summer activities, unlike the kids in the areas we lived in. The outcome of that conversation was that we and the two priests at the neighborhood Catholic church started a youth group. The mayor's commission on youth welfare got involved later, so I understand what Pfleger is trying to do. He can't do it alone and I understand his anguish and frustration over the shooting that happened Saturday. ('This is personal': 7 teens wounded in drive-by shooting in Auburn Gresham after St. Sabina graduation party', June 1) These are my suggestions for what can be done by the legislature, educators, physicians, families, neighbors, and social media influencers: Maybe if everybody pulls together this senseless violence can I concur with the sentiment of Edward Keegan's column proposing a park at the Lincoln Yards site, I feel a well-regulated campground with modest fees and well-maintained water and bathing facilities — comparable to the fieldhouse at Rosedale Park — and with respectful security, would ultimately stabilize Chicago's housing infrastructure. ('Chicago should turn Lincoln Yards development into a public park', June 1) It would also improve access to the city for seasonal employment, alleviate the effects of the housing shortage and enrich the city's cultural experience as campers participate in the city's not-inconsiderable summer economy in a way far superior to a park without such amenities. This use would limit the environmental impact of the development and provide a focus on natural and official co-living spaces within the city limits. I am also not aware of a development like this in another major city. Cook County has had such a campground in or near Orland Park. It was beautiful last time I visited. We have many examples of the civic successes of such campsites, with the most obvious being the national parks — which could serve as a model for such a campground. There could be cabins and a general store featuring local produce and goods.
Yahoo
11-03-2025
- Health
- Yahoo
Bill in State Capitol would require insurance companies to cover stuttering for children
SPRINGFIELD, Ill. (WCIA) — Stuttering can be triggered by trauma and sometimes develops over time, leaving many young people to struggle with communication due to inaccessible treatment. A new bill filed by Senator Willie Preston (D-Chicago) would require private, public, and state health plans including Medicaid who cover habilitative or rehabilitative speech therapy to provide healthcare coverage for children struggling with stuttering, no matter the cause. Broad coalition lays out impacts of potential cuts to Illinois Medicaid Preston, who struggled with stuttering at a young age, said that providing coverage to kids early will help them overcome the challenges and make them more productive members of society. 'We want to ensure that regardless of anybody's economic situation, that every child in Illinois has an opportunity to overcome the speech issue that they are faced with through no fault of their own, including stuttering,' Preston said. Under the state's current law, speech therapy is covered by insurance for habilitative service for individuals under 19 with congenital or genetic stuttering only if it is deemed medically necessary in order to help them learn and improve their speech skills. However, some insurance plans have limitations that could exclude stuttering treatments, leaving many families paying out of pocket. Proposed bill seeks increased oversight for homeschool families The Illinois Life and Health Insurance Council was in opposition at the committee hearing. Kate Morthland, director of policy and advocacy at the Illinois Life & Health Insurance Council, said they are not against the intent of the bill, rather they are concerned about the confusion it would create with current state mandates. 'We're not opposed to the underlying mandate. We just want to make sure that we're operating within existing law compliance,' said Morthland. ' If the bill were to pass now, there would be conflicting definitions within the insurance code, which would lead to compliance issues from insurance companies because they wouldn't know how to handle coverage for two conflicting definitions.' The Illinois Life and Health Insurance Council said they want to work with legislators to expand the existing statute instead of creating a new mandate which they said could create confusion on coverage requirements and make it difficult for insurers to properly do their job. A couple of Democrats backed the bill including Senator Laura M. Murphy (D-Des Plaines). She talked about her experience with her son who also needed therapy but insurance would not cover it unless he was born with it. She said the full coverage will help children receive better treatment and help their development. DOJ gets involved in lawsuit over new Illinois law 'I tried to explain that babies can't speak, babies can't talk. How do you know if it's congenital or not? Because they can't speak and they don't speak really clearly until they're three to four years old,' Murphy said. 'They impede their educational development because of a language problem that could be prevented. It's simply an issue that can be corrected and for our insurance companies not to provide full and comprehensive coverage for speech therapy, regardless of the diagnosis, it's criminal.' The average speech therapy session costs between $100 to $250 per session, and with some appointments even higher based on the location. The bill has been assigned to the Senate Insurance Committee. If it passes it will take effect at the beginning of 2027. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
