SB2873 HEALTH CARE FOR ALL | Illinois Bill

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB2873

Introduced 1/16/2026, by Sen. Mike Simmons

SYNOPSIS AS INTRODUCED:

New Act

Creates the Health Care for All Illinois Act. Provides that all
individuals residing in this State are covered under the Illinois Health
Services Program for health insurance. Sets forth requirements and
qualifications of participating health care providers. Sets forth the
specific standards for provider reimbursement. Provides that it is
unlawful for private health insurers to sell health insurance coverage
that duplicates the coverage of the program. Requires the State to
establish the Illinois Health Services Trust to provide financing for the
program. Sets forth the specific requirements for claims billed under the
program. Provides that the program shall include funding for long-term
care services and mental health services. Creates the Pharmaceutical and
Durable Medical Goods Committee to negotiate the prices of pharmaceuticals
and durable medical goods with suppliers or manufacturers on an open bid
competitive basis. Provides that patients in the program shall have the
same rights and privacy as they are entitled to under current State and
federal law. Establishes the Illinois Health Services Governing Board to
administer the program. Provides that the Commissioner, the Chief Medical
Officer, the public board members, and employees of the program shall be
compensated in accordance with the current pay scale for State employees
and as deemed professionally appropriate by the General Assembly.
Effective January 1, 2027.
LRB104 17901 BAB 31337 b

A BILL FOR

SB2873
LRB104 17901 BAB 31337 b
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AN ACT concerning health.

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

Section 1.
Short title.
This Act may be cited as the
Health
5
Care for All Illinois Act.

Section 5.
Purposes.
It is the purpose of this Act to
7
provide universal access to health care for all individuals
8
within the State, to promote and improve the health of all its
9
citizens, to stress the importance of good public health
10
through treatment and prevention of diseases, and to contain
11
costs to make the delivery of this care affordable. Should
12
legislation of this kind be enacted on a federal level, it is
13
the intent of this Act to become a part of a nationwide system.

Section 10.
Definitions.
In this Act:
15

"Board" means the Illinois Health Services Governing Board
16
created under this Act.
17

"IHST" means the Illinois Health Services Trust created
18
under this Act.
19

"Program" means the Illinois Health Services Program
20
created under this Act.

Section 15.
Eligibility; registration.
All individuals

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residing in this State are covered under the Illinois Health
2
Services Program for health insurance and shall receive a card
3
with a unique number in the mail. An individual's social
4
security number shall not be used for purposes of registration
5
under this Section. Individuals and families shall receive an
6
Illinois Health Services Insurance Card in the mail after
7
filling out a program application form at a health care
8
provider. Such application form shall be no more than 2 pages
9
long. Individuals who present themselves for covered services
10
from a participating provider shall be presumed to be eligible
11
for benefits under this Act, but shall complete an application
12
for benefits in order to receive an Illinois Health Services
13
Insurance Card and have payment made for such benefits.

Section 20.
Benefits and portability.

(a) The health coverage benefits under this Act cover all
16
medically necessary services, including:
17

(1) primary care and prevention;
18

(2) specialty care, other than what is deemed elective
19

cosmetic;
20

(3) inpatient care;
21

(4) outpatient care;
22

(5) emergency care;
23

(6) prescription drugs;
24

(7) durable medical equipment;
25

(8) long-term care;

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(9) mental health services;
2

(10) the full scope of dental services, other than
3

elective cosmetic dentistry;
4

(11) substance abuse treatment services;
5

(12) chiropractic services; and
6

(13) basic vision care and vision correction.
7

(b) Health coverage benefits under this Act are available
8
through any licensed health care provider anywhere in the
9
State that is legally qualified to provide such benefits and
10
for emergency care anywhere in the United States.
11

(c) No deductibles, copayments, coinsurance, or other cost
12
sharing shall be imposed with respect to covered benefits,
13
except for those goods or services that exceed basic covered
14
benefits, as defined by the Board.

Section 25.
Qualification of participating providers.
16

(a) Health care delivery facilities must meet regional and
17
State quality and licensing guidelines as a condition of
18
participation under the program, including guidelines
19
regarding safe staffing and quality of care.
20

(b) A participating health care provider must be licensed
21
by the State. No health care provider whose license is under
22
suspension or has been revoked may participate in the program.
23

(c) Only nonprofit health maintenance organizations that
24
actually deliver care in their own facilities and directly
25
employ clinicians may participate in the program.

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(d) Patients shall have free choice of participating
2
eligible providers, hospitals, and inpatient care facilities.

Section 30.
Provider reimbursement.
4

(a) The program shall pay all health care providers
5
according to the following standards:
6

(1) Physicians and other practitioners can choose to
7

be paid fee-for-service, salaried by institutions
8

receiving global budgets, or salaried by group practices
9

or health maintenance organizations receiving capitation
10

payments. Investor-owned health maintenance organizations
11

and group practices shall be converted to not-for-profit
12

status. Only institutions that deliver care shall be
13

eligible for program payments.
14

(2) The program shall pay each hospital and providing
15

institution a monthly lump sum (global budget) to cover
16

all operating expenses. The hospital and program shall
17

negotiate the amount of this payment annually based on
18

past budgets, clinical performance, projected changes in
19

demand for services and input costs, and proposed new
20

programs. Hospitals shall not bill patients for services
21

covered by the program and cannot use any of their
22

operating budgets for expansion, profit, excessive
23

executive income, marketing, or major capital purchases or
24

leases.
25

(3) The program budget shall fund major capital

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expenditures, including the construction of new health
2

facilities and the purchase of expensive equipment. The
3

regional health planning districts shall allocate these
4

capital funds and oversee capital projects funded from
5

private donations.
6

(b) The program shall reimburse physicians choosing to be
7
paid fee-for-service according to a fee schedule negotiated
8
between physician representatives and the program on at least
9
an annual basis.
10

(c) Hospitals, nursing homes, community health centers,
11
nonprofit staff model health maintenance organizations, and
12
home health care agencies shall receive a global budget to
13
cover operating expenses, negotiated annually with the program
14
based on past expenditures, past budgets, clinical
15
performance, projected changes in demand for services and
16
input costs, and proposed new programs. Expansions and other
17
substantive capital investments shall be funded separately.
18

(d) All covered prescription drugs and durable medical
19
supplies shall be paid for according to a fee schedule
20
negotiated between manufacturers and the program on at least
21
an annual basis. Price reductions shall be achieved by bulk
22
purchasing whenever possible. Where therapeutically equivalent
23
drugs are available, the formulary shall specify the use of
24
the lowest-cost medication, with exceptions available in the
25
case of medical necessity.

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Section 35.
Prohibition against duplicating coverage;
2
investor-ownership of health delivery facilities.
3

(a) It is unlawful for a private health insurer to sell
4
health insurance coverage that duplicates the benefits
5
provided under this Act. Nothing in this Act shall be
6
construed as prohibiting the sale of health insurance coverage
7
for any additional benefits not covered by this Act.
8

(b) Investor-ownership of health delivery facilities,
9
including hospitals, health maintenance organizations, nursing
10
homes, and clinics is unlawful. Investor-owners of health
11
delivery facilities at the time of the effective date of this
12
Act shall be compensated for the loss of their facilities, but
13
not for the loss of business opportunities or for
14
administrative capacity not used by the program.

Section 40.
Illinois Health Services Trust.
16

(a) The State shall establish the Illinois Health Services
17
Trust (IHST), the sole purpose of which shall be to provide the
18
financing reserve for the purposes outlined in this Act.
19
Specifically, the IHST shall provide all of the following:
20

(1) The funds for the general operating budget of the
21

program.
22

(2) Reimbursement for those benefits outlined in
23

Section 20 of this Act.
24

(3) Public health services.
25

(4) Capital expenditures for construction or

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renovation of health care facilities or major equipment
2

purchases deemed necessary throughout the State and
3

approved by the Board.
4

(5) Re-education and job placement of persons who have
5

lost their jobs as a result of this transition, limited to
6

the first 5 years after the effective date of this Act.
7

(b) The General Assembly or the Governor may provide funds
8
to the IHST, but may not remove or borrow funds from the IHST.
9

(d) Funding of the IHST shall include, but is not limited
12
to, all of the following:
13

(1) Funds appropriated as outlined by the General
14

Assembly on a yearly basis.
15

(2) A progressive set of graduated income
16

contributions; 20% paid by individuals, 20% paid by
17

businesses, and 60% paid by the government.
18

(3) All federal moneys that are designated for health
19

care, including, but not limited to, all moneys designated
20

for Medicaid. The Secretary of Human Services shall be
21

authorized to negotiate with the federal government for
22

funding of Medicare recipients.
23

(4) Grants and contributions, both public and private.
24

(5) Any other tax revenues designated by the General
25

Assembly.
26

(6) Any other funds specifically earmarked for health

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care or health care education, such as settlements from
2

litigation.
3

(e) The total overhead and administrative portion of the
4
program budget may not exceed 12% of the total operating
5
budget of the program for the first 2 years that the program is
6
in operation; 8% for the following 2 years; and 5% for each
7
year thereafter.
8

(f) The program may be divided into regional districts for
9
the purposes of local administration and oversight of programs
10
that are specific to each region's needs.
11

(g) Claims billing from all providers must be submitted
12
electronically and in compliance with current State and
13
federal privacy laws within 5 years after the effective date
14
of this Act. Electronic claims and billing must be uniform
15
across the State. The Board shall create and implement a
16
statewide uniform system of electronic medical records that is
17
in compliance with current State and federal privacy laws
18
within 7 years after the effective date of this Act. Payments
19
to providers must be made in a timely fashion as outlined under
20
current State and federal law. Providers who accept payment
21
from the program for services rendered may not bill any
22
patient for covered services. Providers may elect either to
23
participate fully, or not at all, in the program.

Section 45.
Long-term care payment.
The Board shall
25
establish funding for long-term care services, including

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in-home, nursing home, and community-based care. A local
2
public agency shall be established in each community to
3
determine eligibility and coordinate home and nursing home
4
long-term care. This agency may contract with long-term care
5
providers for the full range of needed long-term care
6
services.

Section 50.
Mental health services.
The program shall
8
provide coverage for all medically necessary mental health
9
care on the same basis as the coverage for other conditions.
10
The program shall cover supportive residences, occupational
11
therapy, and ongoing mental health and counseling services
12
outside the hospital for patients with serious mental illness.
13
In all cases the highest quality and most effective care shall
14
be delivered, including institutional care.

Section 55.
Payment for prescription medications, medical
16
supplies, and medically necessary assistive equipment.
17

(a) The program shall establish a single prescription drug
18
formulary and list of approved durable medical goods and
19
supplies. The Board shall, by itself or by a committee of
20
health professionals and related individuals appointed by the
21
Board and called the Pharmaceutical and Durable Medical Goods
22
Committee, meet on a quarterly basis to discuss, reverse, add
23
to, or remove items from the formulary according to sound
24
medical practice.

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(b) The Pharmaceutical and Durable Medical Goods Committee
2
shall negotiate the prices of pharmaceuticals and durable
3
medical goods with suppliers or manufacturers on an open bid
4
competitive basis. Prices shall be reviewed, negotiated, or
5
renegotiated on no less than an annual basis. The
6
Pharmaceutical and Durable Medical Goods Committee shall
7
establish a process of open forum to the public for the
8
purposes of grievance and petition from suppliers, provider
9
groups, and the public regarding the formulary no less than 2
10
times a year.
11

(c) All pharmacy and durable medical goods vendors must be
12
licensed to distribute medical goods through the regulations
13
outlined by the Board.
14

(d) All decisions and determinations of the Pharmaceutical
15
and Durable Medical Goods Committee must be presented to and
16
approved by the Board on an annual basis.

Section 60.
Illinois Health Services Governing Board.
18

(a) The program shall be administered by an independent
19
agency known as the Illinois Health Services Governing Board.
20
The Board shall consist of a Commissioner, a Chief Medical
21
Officer, and 15 other public board members as follows:
22

(1) five members appointed by the Governor, two being
23

consumer representatives, one being the Commissioner of
24

the Board, and one being the Chief Medical Officer;
25

(2) five members appointed by the Lieutenant Governor,

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two of which shall be consumer representatives;
2

(3) five members elected in statewide elections by the
3

People of Illinois, one of which shall be a consumer
4

representative;
5

(4) one member appointed by the Speaker of the House;
6

and
7

(5) one member appointed by the President of the
8

Senate.
9

(b) The Board is responsible for administration of the
10
program, including:
11

(1) implementation of eligibility standards and
12

program enrollment;
13

(2) adoption of the benefits package;
14

(3) establishing formulas for setting health
15

expenditure budgets;
16

(4) administration of global budgets, capital
17

expenditure budgets, and prompt reimbursement of
18

providers;
19

(5) negotiations of service fee schedules and prices
20

for prescription drugs and durable medical supplies;
21

(6) recommending evidence-based changes to benefits;
22

and
23

(7) quality and planning functions, including criteria
24

for capital expansion and infrastructure development,
25

measurement and evaluation of health quality indicators,
26

and the establishment of regions for long-term care

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integration.

Section 65.
Patients' rights.
The program shall protect
3
the rights and privacy of the patients that it serves in
4
accordance with all current State and federal statutes. With
5
the development of the electronic medical records, patients
6
shall be afforded the right and option of keeping any portion
7
of their medical records separate from the electronic medical
8
records. Patients have the right to access their medical
9
records upon demand.

Section 70.
Compensation.
The Commissioner, the Chief
11
Medical Officer, public board members, and employees of the
12
program shall be compensated in accordance with the current
13
pay scale for State employees and as deemed professionally
14
appropriate by the General Assembly and reviewed in accordance
15
with all other State employees.

Section 99.
Effective date.
This Act takes effect January
17
1, 2027.

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HEALTH CARE FOR ALL

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HEALTH CARE FOR ALL

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