HEALTHCARE Summary The 104th General Assembly started out in a lot of ways right where the 103rd left off during Lame Duck ses- sion. The general feeling was that, while this is a completely new General Assembly, almost nothing was substantially different on Inauguration Day than the day before. In no place was that truer than in the health- care space. The big-ticket items from last year, PBMs, Healthcare Protection Act, PDAB, etc., were the same big-ticket items this year. To further prove the point of what’s old is new again, the Governor used a significant portion of his combined State of the State and Budget Address to highlight his healthcare priorities, just as he did in 2024. Like last year, he wanted to continue going after health insurance providers by expanding his Healthcare Protection Act to remove prior authorization for mental health, behavioral health, and substance use treatment, as well as increase the medical loss ratio to 87% for both small and large group plans. The Governor did not stop there. He also adopted the PBM issue as his own and put them directly in the cross- hairs, calling PBMs true middlemen that did not add value but extracted it from the system. PBMs, according to the Governor and others, are the true source of rising prescription drug costs and the downfall of indepen- dent pharmacies across the state. To them, anything short of a complete overhaul of the system would not be sufficient. Aside from the Governor’s healthcare priorities, many members of the General Assembly entered the 104th with their own priorities in this issue area. These priorities ranged from another attempt at a state-run pre- scription drug advisory board (PDAB) to a myriad of insurance coverage mandates to trying to rein in the use of AI in healthcare coverage determinations. Most of these proposals would either fizzle out completely or be worked to a point of neutrality from the re- spective industry. Of the roughly 250 bills the Illinois Chamber was tracking at the onset of the 104th General Assembly, only 31 would make it pass both houses. Below you will find a summary of some of the bills the Illinois Chamber was engaged on. In no way is the list a complete universe of every healthcare-related bill or even every healthcare bill the Chamber “cares” about. The list should be seen as representative of the trend the Illinois General Assembly is taking in the space, and those bills that will have, or would have had, the most significant impact on businesses operating in the State. Perhaps the most impactful piece of legislation to pass both houses (and will undoubtedly become law) is HB 1697, the Prescription Drug Affordability Act. Governor’s Healthcare Priorities As mentioned above, the Governor once again used a significant portion of his State of the State and Budget Address to highlight his healthcare priorities for the first year of the 104th General Assembly. Governor Pritz- ker took up the pharmacy benefit manager fight and announced an expansion to the Healthcare Protection Act that he helped usher through the legislature last year. The Healthcare Protection Act was signed into law last July, and while portions of the newly minted law are only just going into effect, and the ink is barely dry, the Governor indicated the law had not gone far enough. This time, prior authorization for mental and behavioral health and substance use treatments, and increasing the medical loss ratio would do the trick. The other priority, targeting PBMs, was carried over from the 103rd General Assembly, where several subject matter hearings had taken place, both during regular session and throughout the summer in Chicago. What the Governor, his staff, the Illinois Department of Insurance, and other stakeholders would propose and eventually pass would be a much harsher rebuke of the industry than what was originally proposed. 2025 END OF SESSION 11 | END OF SESSION REPORT
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