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New health reform rules unveiled

By Jay MacDonald ·
Wednesday, November 28, 2012
Posted: 6 pm ET

The federal government has unveiled proposed rules under health care reform that will have broad implications for states, health insurance companies, small businesses and uninsured Americans within the next 12 months.

In a conference call with reporters last week, Secretary of Health and Human Services Kathleen Sebelius spelled out the long-awaited "essential health benefits" that insurers must include in their individual plans when state health insurance exchanges open Jan. 1, 2014. Insurers have been anxiously awaiting the definitions in order to finalize the policies they'll offer when open enrollment begins next October.

The rules specify that 10 categories of benefits be included in all individual and small-group policies but leave it to each state to set its own benefit minimums. The categories include: ambulatory services; emergency services; hospitalization; laboratory services; maternity and newborn care; mental health and substance abuse services; pediatric services; prescription drugs; preventive and wellness care and chronic disease management; and rehabilitative and "habilitative" services for conditions such as autism and cerebral palsy.

The rules also prohibit insurers from denying coverage due to a preexisting condition or charging higher premiums due to occupation, current or past health problems, or gender. Studies show that women often pay more for health insurance than men.

The feds have provided more guidance to employer-based wellness programs, giving employers greater leeway to offer larger rewards to employees who quit smoking or adopt healthier lifestyles. And the rules protect employees from unfair underwriting practices that could reduce their benefits because of health issues.

In addition, Sebelius extended until Dec. 14 the deadline for states to inform HHS whether they plan to set up their own state health exchanges, which are designed to offer individuals and small businesses easy-to-shop-for health insurance at subsidized rates. To date, roughly 17 states have committed to set up their own exchanges. Those that don't can choose to partner with the federal government or allow the feds to establish and operate the state's exchange, which is required under health care reform.

About half of the nation's 30 million uninsured are expected to purchase health insurance through the exchanges, while the remainder would be covered under the federal-state Medicaid program for low-income Americans.

Recent reports from states that have opposed the Affordable Care Act indicate that some may be reassessing their options now that the law's sponsor-in-chief, President Barack Obama, has been re-elected.

Want to become involved? You have 30 to 60 days to comment on the proposals before they become final.

Follow me on Twitter: @omnisaurus.

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August 26, 2013 at 1:20 pm

If any one believes what the liar obama says they are a fool to began with and if they do not believe this is going to them a fortune they are not only a fool but an idiot at the same time 'AS FOR MY SELF I REFUSE TO SIGN UP FOR IT I AM A FREE AMERICAN AND I AT THIS TIME STILL HAVE THE RIGHT TO CHOOSE WHAT I WANT OR SOME ONE WILL BE GOING TO COURT

Metastase foie
December 29, 2012 at 3:38 pm

Remarkable things here. I am very happy to look your article. Thank you a lot and I'm taking a look ahead to touch you. Will you kindly drop me a mail?

Cathi Lauperi
December 14, 2012 at 4:00 pm

Blah, blah, blah...spoken like a person who has always had health care coverage. Being self-employed, I am grateful that as I approach my 50's and 60's the insurance industry won't be able to drop my coverage. Fact: The U.S. spends more money now -before Obamacare implementation - than any country in the world and places 37th in the world in health outcomes.

Budro, you must be assuming everyone else is as ignorant as you are...Obama won both the electoral college and the popular vote...quit getting all of your news from Fox.

December 14, 2012 at 9:13 am

GREAT comments Budro! I agree with each and every one of them!!

December 06, 2012 at 9:52 am

I heard Obama say that according to the “Unaffordable Care Act”, insurance companies must spend at least 80% (varies in different states) of the premiums they receive on health care services; and if they don’t then we will receive a portion of our premiums back in the form of a rebate. He is preaching this as if all Americans that pay premiums but don’t receive health care services or receive l
ittle health care services within the year will actually get part of their premiums back. This is known as the Medical Loss Ratio (MLR). Well I just received the Mandatory notice regarding my rebate. What a farce. I spend about $7800 a year for individual insurance (up from $4800 1.5 years ago). Last year the insurance company spent less than 1500 on my benefits. The notice said that I WILL NOT be receiving a rebate because the State's MLR was met. It is calculated " for each State's individual, small group, and large group markets in which the health insu
rer offers health insurance". So it is not the "individual" MLR like Obama is preaching but the State’s MLR for that group that needs to be met. To make matters worse, according to my notice, the notice states that insurance companies have to spend 80% of premiums they receive on health care services AND ACTIVITIES TO IMPROVE HEALTH CARE. So it is not a rebate based on just health care benefits received like Obama wants us to believe but a combination of health care benefits and activities to improve health care. What Activities? Does this allow the insurance companies to buy computers and say it is an activity to improve health care services? Can they increase salaries and say this will give us better service? What does improve activities really mean? Can an insurance company spend it on anything they deem as activities just to meet the MLR? Mitt Romney MUST know about this and investigate the truth. What a deception this administration is giving us."

December 04, 2012 at 10:42 am

Jim Crow? Really? Because some people don't like his decision we play the race card again? This is one of the biggest reasons racism still exist. People like you sit there and play the card just because you can, and not for any kind of legitimate reason. Know matter? Really? Go back to grade school and tell them you want your school taxes back! And lastly, let me educate you on the fact that 'The people' do NOT elect their president in this country. The electoral college does that. To be honest, the electoral college is an antiquated object of necessity when we did not have the technology to have every single person vote in this country. If "The people" elected their president, Obama would have lost. Obama is one of the few presidents in history to have lost the public vote and won the electoral college vote.

As far as blaming the president for all things people don't like, that just goes with the program. He has taken credit for things he never even thought of that have been a boon to the U.S., as well (just like every other president in history, whether Dem. or Repl.).

December 03, 2012 at 6:09 am

Why is it that all of the things that some people doesnt like its the presidents fault? Come on people lets go Forward and please leave all the hatred in the grave with Jim Crow,And let us Love one another,Know matter who we are,The people has spoke in the Election so get with the program.Mr.President stand your ground,We The People has your back.Amos