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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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November 29, 2012 at 6:03 pm

Yes, but I am a happy IDIOT, while you are a miserable genius. It's good to be on the winning team, eh? I'll just keep watching the shadows on the cave wall. By the way, that is you're not your.

November 29, 2012 at 5:57 pm

Well all you people who voted for Romney.... welcome to my world.. I live in Massachusetts and already deal with this ? So what are you complaining about .. Im paying for what your candidate pushed on Massachusetts!

November 29, 2012 at 5:52 pm

I don't see how this can hurt me. I pay 280.00 a month for insurance with a 5000.00 deductible. It is barbaric for those that are fortunate to have employer paid insurance to not admit that insurance needs to be affordable for everyone.

old guy
November 29, 2012 at 5:41 pm

I see special considerations for everyone and asssurances from Obamaland that there is language written to protect us from insurance companies charging rates for prior conditions, loafers living with their parents until 25, women's health, bith control, everything except the real discrimination - age. Us old dud will not pay more than you young idealists - why, because we're smarter than you.

Laughing Is A IDIOT
November 29, 2012 at 5:39 pm

Laughing your an IDIOT just like all the other people who voted for the biggest IDIOT.

November 29, 2012 at 5:28 pm

Just remember, this is just like a pregency from rape. This is obviously what God intended. So you people crying about it really need to do a little self introspection and get yourself back on the path. Obama and Obamacare is God's intention obviously.

November 29, 2012 at 5:15 pm

The only people that the new rules will be good for are the 30 million people who do not have insurance and the 40 percent of Americans that are already getting Goverment assistance. The remaining 60 percent will see their health care coverage go down and their premiums go up. Welcome to socialized medicine. There is nothing that is free and when the 60 percent are taxed in poverty and can no longer support the 40 percent, the nation will fall. Just look how well socialism did in Russia.Free hand outs have gone from helping someone for a short period of need to a way of life and can't be sustained. For those of you that believe it can, keep drinking the Obama koolaide

November 29, 2012 at 4:59 pm

Here we go again with the same bull $%^& as if it ain't bad enough the dictator was re elected again to do more of the same tear this country apart. What the hell were you people who voted this jerk back in thinking that he was your best friend because of the free stuff that he was handing out that will soon go away this system will not work but because god Obama sets on his thrown and says that's the law of the land bull $%^&! You people are fools and idiots and all liberals think the same,so welcome to the beginning of the end of our country!

November 29, 2012 at 4:58 pm

Gary, sorry you have to find another job, but third party payments are the number one reason for such ridiculous cost of healthcare. Your industry has absolutely been an abysmal failure but it's free enterprise so it must be effiecient, lol. While Obamacare may not bring down medical costs, it can hardly do worse than what we have at the present. You people act like these other countries don't have medical care when in actuality they are rated better. Even if you want to debate the methodolgy of those rating, these system are still very viable. You all run around like chicken little. Either you are insane or delusional, or more likely, you just don't want to look at the facts. All you want to do is chant America is the Greatest. Yes, we do have a great country, but truth is other countries are also great and may have come up with a more equatable solution. And yes, I could move to another country, but we actually used the democratic process of America to make America better. Exactly as the constitution intended, right? If the poor were like the rich and totally acted on self interest, this would have happened a long time ago. The rich act in self interest and are lauded for it, but God forbid the poor actually look after themselves. There is a much greater majority of poor to rich and the middle class have been suckers for a couple of decades as their standard of living was headed down hill. The rich are mostly pigs and miserable people. I know them more than most here. I have money, but nowhere what I would call rich, the 1%. I have a number for clients and they never do anything except out of self interest. Even their charitable giving is calculated for a return. “We have now done 12 separate studies measuring empathy in every way imaginable, social behavior in every way, and some work on compassion and it’s the same story,” he said. “Lower class people just show more empathy, more prosocial behavior, more compassion, no matter how you look at it... In other words, rich people are more likely to think about themselves.” So if it makes you feel better, you can view this as the poor and middle class acting as if they were rich and making an intelligent self interested decision. There is going to be a price to pay for the this blatant money grab by the 1%. You can cry and stomp your feet, but it has started. The progressive movement takes small but constant steps and it doesn't give back its gains. That's why the Democrats could careless what universal healthcare they got passed. They knew that once they got that foot in the door, it was just a matter of time. So, cry, whine, stomp your feet, call your representative, it doesn't matter. The horses have left the barn. There is a word for you however: acceptance. Also, you can become the rich, because they will still have A-one healthcare. So quit whining here and get to work. If you worked hard, you wouldn't have to be on here whining. Just ask Hannity, if you work hard you can have anything you want, so basically, it is your laziness that has you on here crying because you are only middle class and not rich.

November 29, 2012 at 4:57 pm

I live in Massachusetts (MA) where we've had Romneycare (the GOP model for Obamacare, despite all they may say to the contrary) for a few years now.

Here's our situation. Under Romneycare we have a state health exchange. It only provides a menu of health insurance plans: you have go get dental insurance on your own.

On a combined net income (I'm retired collecting a pension, spouse still works,but with no insurance coverage so we purcahse all our own insurance) of about $48K we're paying for our state health exchange health insurance and our private dental insurance about $16K per year. Btw, there are modest co-pays (~$35.00) and HUGE deductibles any time you do anything health care wise, while the dental plan doesn't have any co-pay and fairly reasonable deductibles. Both of us have several chronic health issues so those heath insurance co-pays and deductibles hit us pretty hard. Fortunately for us the only routine dental care we've sought while we been providing our own dental insurance have resulted in any deductibles to date.

Bottom line. So, depending on the varying co-pay and deductible totals we're paying an estimated 33-37% of our net income for health and dental insurance and care.

For those who are hopeful that the government will help control the costs of health care the MA Romneycare experience is NOT where you'll go for evidence of that. See: It's the MA State report for the last full year of Romneycare, which went into effect in 2007.

The cost control bottom line. See the report, but in a nutshell costs have skyrocketed, when comapared against any milestone, particularly for those privately insured.

For further reading on the MA experience see

So moral of the story. Romneycare, Obamacare, Call-it-what-you-like-care is exspensive for individual citizens. The upside is almost everyone will be insured. The downside is until the government (state under Romneycare, federal under Obamacare) actually does something to control costs it will be very expensive for individual citizens. And the probable long term solution is single payer, with whoever is doing it mandated to first and foremost control and contain costs.