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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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December 01, 2012 at 10:17 pm

if one person is on the new healthcare all should be on it this includes the president and all elected officials, unions no one should be exempt.

walter golden
December 01, 2012 at 10:13 pm

Brent is a probably a very intelligent individual who has his brains in his feet. Tell me Brent, what has the feds done recently to improve our life? Please don't say OBAMA care. I am out of medicine because of your friend, Obama.

brent messner
December 01, 2012 at 9:51 pm

I'm a well off government employee, and I feel this is a great idea. I am all for it. We need to help each other no matter what. You people make me sick. Look up what this about before making comments. You all let the media drain your brain and mind wash you. Get off your ass and research this system.If you dont know what your talking about. Please stop.You all will see, and look dumb when this turns out to a great thing.He is on the right track for america. Back your commanderin cheif, or leave if its so much better someplace else. GO RED WHITE AND BLUE.We are making moves in the new country way above your heads.

yours truly,

Army Corps Of Engineers
Water Structure Engineer

cherie Vach
December 01, 2012 at 9:46 pm

Larry T. I totally agree with you!

December 01, 2012 at 9:33 pm

I have to say how tired I am of people talking about how they deserve the health care they get because they have worked so hard for it. I too have worked hard my entire adult life and I feel I deserve mine. Rather than going to the extreme of adults playing electronic games, why not mention all those adults who can't work. Better yet the adults that do work with no healthcare. I can remember a time when, if you had a full time job you also had health insurance. Now they say if you work 32 hours your considered full time but you don't qualify for health coverage.Our employer provided health care system ranks 37 out of 42 modern countries. Why, you ask, because they value quality of life more than money. They have public health care for all.Health insurance is a business and being in business is about making a profit. When did profits become more important than human suffering?

December 01, 2012 at 9:22 pm

What happens to those of us who are staying with their current ins company? Will that company be under the "Obama blanket of national health welfare"? Which way is cheaper? will there be any signifant benefit changes for most of us? And most importantly, will they leave me alone if I so choose to not participate??

December 01, 2012 at 8:55 pm

I grew up on a farm, one of ten children. Dental and other health care were unheard of. At times we did not have sufficient food. I decided to have a better living. I joined the military after graduation from High School. It was during the Korean conflict and I managed to enroll in Officer training, and after 15 months of gruelling training, I became a navigator on a combat crew. At times our lives we in peril, however, I stayed the course and retired after 20 years. I then worked 19 years for Boeing. During this time I paid into Social Security and Medicare. I feel that I have earned a right to health care as a result of my military service and other delayed benefits. If everyone is entitled to the same provisions, why did I put myself thru all this. Now they want to increase my taxes to help pay for others. The next generation will be smarter and will be able to sleep past nine oclock each morning, staying home and playing games on their I-Pad instead of working. Are things really going this way in this country?

December 01, 2012 at 8:53 pm

it's obvious someone needs to take charge of these insurance companies and drug manufacturers. i didn't find out i was diabetic until i was in my 40's, now the employer i work for doesn't offer insurance, i can't afford the "high risk" plan i am offered on my own. yes, i am aware of health issuses, i am now under control due to pills and dieting with my sugar, yes, i am a smoker, my choice, we should still have rights too. all should have insurance. sr. citizens, like my parents are not getting exactly what they need either. if we didn't help them, they either would have to pay mom's meds and not eat or do thge opposite. come president, do what you need to do, take care of the usa, forget these other countries.

December 01, 2012 at 8:52 pm

Thid country is in so distress, the people are making a mountain out of a mole hill. People need to realize the work world is changing, the way life was when we were young, is verry different now. All of this bickering, and not trying to unite as a country. What goes around comes around. Dont be so hatefull. In Washington, Smart and Brilant minds are all in one place, why cant we change old ways, and work together. U.S.A. would be untouchable.

Larry T.
December 01, 2012 at 8:38 pm

I am 71 years old. I am thankful that I don't have much time left to endure what is happening to this country.

I have lived thru the best of times. For that I am thankful. The worst of times in our generation are yet to come!