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New health reform rules unveiled

By Jay MacDonald · Bankrate.com
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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288 Comments
Elvira
November 30, 2012 at 6:23 am

I am 77 years old, have worked and paid taxes all my life (since age 14)and due to unfortunate health problems, am now in the same position as Bonnie Turner in her comments above. I don't see where I and others in our position will benefit any from this health care reform, and more so if each state will be setting up their own limitations. I am in such a bad financial position that I once sought (quite reluctantly) some temporary aid from the Department of Children and Family Services. I almost dropped when told that because I don't have any minor children and that my social security check was above $500 something dollars, that I did not qualify for aid. What was upsetting was to see mothers and fathers with a bunch of kids sitting in that welfare office. The first thing that came to mind was that those mothers and fathers looked healthy enough to work, so why weren't they? Also, if they were so bad off, how come they came to the welfare office driving late model cars? I no longer drive a car because I cannot afford the gas and insurance. What really took the cake in that office was a hand written sign that read, "Cash assistance for immigrants." Because these moochers keep having more and more kids, they continue to collect welfare and medicaid which is draining resources that rightly belong to those who have worked and paid taxes. I very often see these people in Walmart with multiple wagons loaded to the brim with groceries and then present the cashier with a 'food card'. Am I envious? Yes, I am when I can't even afford to buy enough food to last until my next social security check. 'Nuff said.

Mike
November 30, 2012 at 5:59 am

The way I understood the health care plan, EVERYONE would have to purchase insurance or pay a fine. Now they're saying people can get free medicaid? What's up with that?

georgetta underwood
November 30, 2012 at 5:18 am

It's about time for health care reform of some kind. Most of the large countries already have socialized medicine. I too am concerned as to what some of the changes might entail... However, it's time for all people to be more responsible for themselves & stop trying to live off the government & us, the taxpayers. People would rather not work if they can get a free ride. There are people out there that really need help, but for the most part it's a lot of freeloaders... I for one, am SICK of it.. Some of the young people are having multiple babies & are sitting on their backsides, & even their boyfriends live with them. Stuff like this has to stop! Those that have low paying jobs & find it difficult to live have no one to blame, but themselves. They should have continued on in school and tried to learn something.... My husband has worked hard all his life. At one point he was laid off for the third time. He got a job digging ditches for new construction!! He said he'd do whatever he could to see that his family had a roof over our heads & food in our mouth. He was almost 40 years of age, but he did it. We sold our house & moved into a small place. I was so proud of him for having the guts to get out there & do whatever he could... It seems that many today don't want to work if it's not a job they want to do... No, just stay on unemployment as long as possible. To me, if they're not in the work force, then shut up. You could find something to do. Or get two jobs.. My husband is 68 years old and still works full-time. He's saved & saved all his life, so that maybe we can make it when we're old.. Well, we're there now & yet he continues on.. All I can say is that I hope the up-coming generation will see the need to stay in school, go to college, and learn as much as you can. It's a necessity, and even then one will have their ups and downs in life, That's part of living... Everyone just needs to go out and 'do' something, anything, but for gosh sakes don't think you can always depend on others.. One more bit if info - there was a woman I would always see working at Walmart. She had no legs at all, but she was always working in her wheel chair. She once told me "I can always find a job"... Wonder if she's still there, or if Walmart has laid her off too.???.. Anyway, good luck to all who really need it, and for those that don't, just get some pride and get out there and do something!!

Bonnie Turner
November 30, 2012 at 3:42 am

I see good and bad in this new health care reform - and we don't all know what it entails.
Getting decent health care has been difficult for me ever since I became disabled. I now have a supplemental insurance plan and Medicare - but it still costs me a lot. They take $99 a month out of my disability check of about $1100 a month for Medicare, then I pay $39 a month in premiums. The killer for me, for the last few months has been the copay part. I needed to have some physical therapy, so each day of therapy I paid a copay of $35 - so you do the math. If I go twice or three times a week, that is a lot of money for me - and plus every time I see a "specialist" it's a $35 copay. I see a pain specialist, a rheumatologist, and about 3 other doctors for various things. I have one brand name medication that is $96 a month copay (I get it from Costco, so it's $80). Right now I'm very close to falling into the coverage gap, so I'm only taking one of this med a day instead of the prescribed two a day. I can't afford to pay for this med - and even when I'm not in the "donut hole", it's very hard to find the money for this med. This is one med that is actually working for me.
The other part of the insurance deal is that even when your doctor wants you to have a test - the insurance company can deny it. They don't seem to care how much pain I'm in or how important it is to find out what's wrong to bring down my pain levels. I'd like to tell them to try living with pain levels of 7,8,9 on a scale of 10 on a daily basis. They want me to try more meds like anti-inflammatories and pain meds. But I've been on NSAID's for about 20 years and a recent blood test told my doctor that my kidney is borderline, so I was taken off all NSAIDs. As for pain meds - none of them work for me - no OTCs, no narcotic ones, and some other types - nothing works. I think it unconscienable (I know, it's not spelled right) for insurance companies to second guess doctors.
I don't see this new reform helping bring down my costs, I only see it going up. I've already been informed that my monthly premium is going up $5 - doesn't sound like much unless you are struggling to pay for basic stuff.

Tresser
November 30, 2012 at 3:14 am

WAKE UP AMERICA! And STOP blaming everything on others! We are a GREAT NATION!! But we are NOT PERFECT! Just like the rest of the world.. We LIE, STEAL, CHEAT, KILL, RAPE, PILLAGE, WORK, DREAM, LIVE, LAUGH and LOVE! Very few BUSINESS OWNERS cares if you make enough money to care of your family! SOO lets BLAME the GOVERNMENT who some times do 1 good thing to HELP (we) the little people who pays more TAXES than the wealth and their salaries!

I feel it's about time for America to have health reform. And I feel bad for those Americans who have lost full-time employment just because their company is to cheap to pay for HEALTH care for the people who keep their company going! Maybe they should do like their counter parts and move their company to some other country where they will pay .18 a hour so that they will have a sweat shop LOOK to match their sweat shop PAY! OOOH OK! And then they would say Obama made them do it..TOO! These business owners wantes to become the next TRUMP, CUBANE, Jay-Z and so on!! And know that they can't do it they are FARE!

linda
November 30, 2012 at 1:45 am

in response to sickntiredofbeinsickntired

"The only reform this nation needs is "lazy people reform".They sit around mooching off of the government"

PLEASE- take the time to do a little research about just who is "mooching off the government"in this country. While you are quite correct that for those in poverty, the pay off is "barely enough to live off" this is most certainly NOT the case for the REAL government moochers in this country. Corporate welfare, that is, subsidies to agribusiness, oil companies, drug manufacturers, and bailouts for "too big to fail businesses" such as the banking industry.

TANF or what you refer to as the money going to the moochers, accounts for less than 1% of the federal budget- around 17 billion is spent annually on this program. Compare that figure to the amount spent on corporate welfare-- "According to a 2011 report from Citizens for Tax Justice, for the tax years of 2008 to 2010--just three years--the United States government gave away $223 billion in corporate welfare" (reference:http://justicebeforecharity.org/welfare.php)

Why are we subsidizing the oil industry, or verizon, when they are making record profits? Maybe if the corporations spent more of their record profits on guaranteeing that their employees made liveable wages, we could end this conversation.

Look at it this way- the wealthy in this country are experiencing a rate of income growth that has never been seen before while those in poverty are forced to struggle to survive on less and less income.

Do your research. Here's an idea: Turn off fox news for an hour and use that time to read the article referenced above.

even if its barely enough to live off of,versus going out and trying to find work.They could get a job making more than what they would get on assisted living and still turn the job down...Why?...because they'd actually have to do something!This is why, not just health cares out of whack but everything you pull your wallet out for.This is why ,some not all,jobs are moved over seas.The workforce here is pitiful.I'm a plant manager and i see it first hand.You'd think in this economy they would be lined out the door waiting for a job.It will never stop until you start denying some of these people all of their free perks and make them realize"you know if I want to get ahead I might need to go look for work"because albeit slim its out there but its not gonna find you.

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martin
November 30, 2012 at 12:10 am

I was informed by my employer that my full time job will now be part time so they do not have to pay my health care...... I have found out that there are many other companies planning to do the same.... thanks to this new "Affordable" health care plan I am being forced into poverty.

I just want to personally thank Mr obama for forcing me into working multiple jobs and 6-7 day work weeks, just to make ends meet....... and I still have no clue where my health care will be coming from?

I still do not see where the health care problem was to begin with? It has been quoted that only 30 million people are uninsured (in this article) that is less than 10% of the nations population!

What will it be next? will I have to share my car so people that do not have a car will get that for free too?

I wish I could have something positive to say about all of this, I really do... but c'mon... us little guys continue to get squished and it just is not fair.

sickntiredofbeinsickntired
November 29, 2012 at 11:18 pm

The only reform this nation needs is "lazy people reform".They sit around mooching off of the government,even if its barely enough to live off of,versus going out and trying to find work.They could get a job making more than what they would get on assisted living and still turn the job down...Why?...because they'd actually have to do something!This is why, not just health cares out of whack but everything you pull your wallet out for.This is why ,some not all,jobs are moved over seas.The workforce here is pitiful.I'm a plant manager and i see it first hand.You'd think in this economy they would be lined out the door waiting for a job.It will never stop until you start denying some of these people all of their free perks and make them realize"you know if I want to get ahead I might need to go look for work"because albeit slim its out there but its not gonna find you.

Stacey
November 29, 2012 at 11:14 pm

Our country needs health care reform and I am glad that something was done. I do not think it went far enough but it is a start.

Janice
November 29, 2012 at 10:37 pm

This ia exactly why all you fools, who voted for Obama, need to WAKE UP!!!Mitt Romney would have given this power to the states, NOT THE GOVERNMENT! Besides the fact that Obama is a liar and an African-born Muslim, pretending to be an American Christian! Why do you think it took so long to produce a birth certificate? Because It WAS BEING MADE, by all the presidents men!