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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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Cortney Havens
December 01, 2012 at 8:22 pm

Glad to see that its including some coverage for children with autism. It will help so many families.
that is an answered prayer
December 01, 2012 at 8:19 pm

Get over it people. Everyone deserves health care especially the needy. Thats what America is all about, helping those less fortunate. About time all the freeloaders will have to get healthcare. One unfortunate accident or some severe long term medical condition will bankroll you and if you have no health insurance guess who pays? We do ! You dont complain about insurance for driving a car so why complain about health insurance, sooner or later everyone will use it.

December 01, 2012 at 12:06 pm

I don't understand how in this country only the elite and the poorest of the poor can receive medical attention. In the United States, medical help should be a right and not for just for select groups. I work in retail, an industry that makes it a point of giving hours just under what would be considered full time; meaning no medical insurance. These employees never receive medical insurance and certainly can't afford a private policy on their minimal wages of $7:50 - $9:00 per hour. Most of these people work two jobs,and never see a doctor because they can't afford to. Who said that as citizens of this country, these people are less worthy and don't deserve medical assistance? I'm sorry, but all citizens in the country deserve to have medical coverage, not just you and people like you.

November 30, 2012 at 11:24 am

Dear Laughing. WOW, what a pessimist. People are venting because they are upset over the election and they know that life might get worse for them. The healthcare bill, though a variation of other countries healthcare plans, most, if not all, have been healthcare disasters. Even Canada with one of the better programs finds ways to send their cardiac patients here. Compainly may be uncomfortable to hear, but can be cathardic. Understand, Obama is pushing us harder towards communism than all the other presidents pushed us towards socialism. You can listen to radio talk show hosts out the wazoo and hear them all upset just like most of the commenters on this blog. Nobody who knows what our country is turning into really wants this. And to voice their opinion and hear from others of like mind helps to relieve the feeling of loneliness that this type of politics promotes. Work is something we all must do to stay alive. The constant hunt for success is ingrained in the teachings of our representative republic. Democracy is misleading. And the democrats continue to push it as though it is the salvation of the world. Our founders were right, only God holds that power.If you want to accept this transformational change, maybe somewhere that has already adopted Democracy and Socialism would be Euphoria.

November 30, 2012 at 11:06 am

This is a fine bill and just like the PCIP guarantee issue plans that were introduced in 2008 you will have open access to healthcare. The Gov said that 10 million would sign up and in four years they only have 500,000 members with a loss ration of 500%. We can't afford this bill and the states can't pay for 15 million new people on medicaid. The net gain in insured people will be a negative number in the tens of millions as a service industry is not going to support these growing cost and demands. We need manufacturing jobs and less government containment.

Brenda DiTrapani
November 30, 2012 at 10:36 am

You are right about this nation being in distress, but it has nothing to do with the Affordable Care Act. The American people are getting medical help where for some it never existed before. Even if you disagree with it, you will probably use it in the near future. If you want to drive a car you need insurance, and yet people usually don't complain about that, it's just a fact. I'm already benefitting from this insurance because I have a chronic disease and had to go a year without insurance. Since then I have had a plan which covers my treatment. So far the only problem I am having with my plan is that I've reached (The Doughnut Hole) so my medicine is not covered for the rest of this year. Hopefully this will end with the Affordable Care Act.

November 30, 2012 at 10:10 am

I agree but not enough people know what Flying your flag upside down means and why it was done. With only 1% of Americans serving in the Military it will only get worse. I am 70, retired Navy from the Vietnam era and I probably want live to see this country turn into a third world nation, however, it is coming. God help our Grand Children.

don key
November 30, 2012 at 9:24 am

Unfortunately there is no health care reform in the Affordable Care Act, better known as Obamacare. This country stopped being an industrial nation some 50 years ago, we have since become a consumer nation. And what do we consume? Food and drugs! This smoke and mirror act is here to take control of the food and drugs and monies therein, and just like smoke and mirrors there is nothing there! What are you and I getting from this Care Act? A bunch of laws that says you must get and you must pay and we will control it! B.S.!! They can not get tax dollars from the industries that have closed or moved so they've gone after what is left.-You and I! Fly your flags upside down, we are a nation in distress....

November 30, 2012 at 9:19 am

The price we pay for free is expensive.

Oh No – Not Another 4 Years!!!!
November 30, 2012 at 9:17 am

I am so sorry "Martin." I am sure you are one of millions this will happen to and that our wonderful President didn't figure this into into his "theory." I believe he thinks everyone is hard working and only the ones that have true hardship is the ones needing this health reform. Well I wish he would walk the true streets and neighborhoods at all levels of wealth, from the extremely poor to the very wealthy and really have a conversation with them. To walk and talk and truly LIVE for a week in their shoes. Not something that is preplanned and that works for a photo-op. I want him to live it and have a TRUE comment. MR. PRESIDENT BARACK OBAMA DOESN'T HAVE A CLUE ABOUT THE REAL NEED OF HEALTHCARE or the basic needs of our wonderful country! His best work is making the national debt skyrocket and it will continue upward even more with this plan!