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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 10:26 pm


November 29, 2012 at 10:24 pm

Your right too, Penny!

November 29, 2012 at 10:19 pm

just another way for our government to obtain more power & control, with benefits for some which are forced on others. until they are on the same benefit tracks as every other American, it is easy to rule from above instead of along side.

November 29, 2012 at 10:18 pm

You got that right, David Kelly!

David Kelley
November 29, 2012 at 9:16 pm

Can't we force all of our government workers from top to bottom to get the same health insurance we have? Nothing more and nothing less. And by the way, I feel it was the government that got us into this mess, whose going to pay for all this extra health care? We are through higher taxes on services and goods. Why don't we decress all government workers salaries and benefits to help pay for this high deficit THEY got us into?

November 29, 2012 at 8:47 pm

The problem with health care is care cost not insurance companies. I went to a MRI facility because it advertised the cost was only $400 but when they saw I had insurance they billed the insurance co. $1,500 instead. I of course did not know this because my insurace co. recieved the bill and payed it. When my receipt came I notified the insurance co. they over paid and they said the facility charges more for filing with insurance. That's 3x more! All this administration has managed to do is find away to CONTROL EVERYONE not bring down our health care cost. We all are forced to blindly follow them as they tell us what's in the bill on a need to know bases like we are a bunch of idiots!

November 29, 2012 at 8:35 pm

This is for Glenn (whose comment was posted at 7:26) You got your house modified, at (my) the tax-payers expense! That is another reason our deficit is so high and will now go much higher!

November 29, 2012 at 8:25 pm

I'm waiting for a reply from LAUGHING! Whats the matter, Laughing? Cat got your tongue now?

November 29, 2012 at 8:18 pm

Just one more comment for Laughing (all the wat to hell!). YOU need to read the HOLY BIBLE! We are living in THE end time! You are obviously NOT a Christian! Would you like to accept JESUS CHRIST as YOUR SAVIOUR? I'd LOVE to help you!!! Trust me, YOU NEED HIM!!!

November 29, 2012 at 8:14 pm

I really don't think it matters who won,the American people lose.World is in a mess right now and we can vote but in the end we don't have a say so.