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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 02, 2012 at 6:11 am

All of you government bashers always say things like "WE" Americans. "WE" need to fix things. "AMERICANS" need to figure things out.

You say we constantly, but you don't really mean that. When you say we, you mean people like you. You're fine with voting for things that help long as those Americans aren't poor or sick or might need help in any way.

You're all hypocrites any way. Why is it ok to tax for fire and police services, but not for health care? Of an even better example is the military. Why is it ok for the citizens to pay for PROTECTION from danger in the form of a physical attack, but it's not ok for the citizens to pay for PROTECTION from danger in the form of disease and sickness?

You look at the possibility of paying a little extra out of your pocketbook and immediately dismiss it. You fail to realize that a healthier population (including the poor) means a more productive population. The benefits of everyone having health care far outweigh the initial cost.

You don't have a leg to stand on. Unless you're a borderline Anarchist who doesn't think the government should pay for anything that helps it's citizens, you're a hypocrite for claiming the government shouldn't try to provide health insurance for everyone.

Vickie Baker
December 02, 2012 at 12:43 am

Chris, I agree with u and Rena. Rena same thing happen to me and my brother due to people being messed up on drugs or alcohol. I can no longer drive and it took Allstate 6 yrs to settle my claim. Went from owning my own home nurse, and 2 vehicles to sitting in my home 24/7 because I can't drive. Chris that black ass couldn't exist without. I don't think this is not what Martin Luther King was speaking for just equality.
To heck with the rest we must take care of our own first before even thinking about the rest of mankind or we will not survive!!!!!!!!!!!

Tony S.
December 02, 2012 at 12:22 am

I support single payer and would feel a lot better if we were getting that in 2014. Time to move to Vermont, everyone.

December 01, 2012 at 11:41 pm

....And so the great machine starts to collapse....

December 01, 2012 at 11:29 pm

America gave up it's freedom, and killed this country. With the government and the supreme court agree that it is constitutional to tell citizens of this great country, as a condition of citizenship, you will pay for a product. In addition, you will only be allowed to use whatever the government thinks you should have, at a price that the government establishes, and for as long as it is benificial for their re-election. We are dead!

December 01, 2012 at 10:54 pm

I have spent most of my life with insurance coverage and good medical care. As a result of a series of unfortunate events starting with my husband divorcing me, I entered the world of no health insurance. I went from upper middle class to poverty-food stamps, government health care, a life that is far less healthy in so many ways. Most folks don't even realize the things in their life that they are blessed to have. Poor people can not eat food that is best for them. My health has declined more in the past three years than over the rest of my life as a result of my situation, which does not include dental visits, vitamin and mineral supplementation, or healthy food. I have lived on both sides and I can tell you that being without health care is a trip to a quicker death. I agree with someone else who said lets take care of Americans before we go forcing our ways of life on other countries. I am not a person who would deny that their our other countries that are worse off than the United States and need their basic needs met. But I challenge the government to see if the citizens of the United States have had their basic needs met. I don't think American's basic needs are being met. I truly believe that abuse of narcotics is a symptom of poor or non existent health care. I lost a loved one to narcotic overdose. He had been in the emergency room and hospital several times and discovered that he had a hole in his heart. He was discharged without that or any other medical problems being addressed. I have worked in the medical field for more than 15 years and I was disgusted by the way my loved one was treated because he had no insurance. He was on narcotics for two accidents that he did not cause but were not handled properly medically in young adulthood. For those of you who are against government healthcare, try being without healthcare altogether and then see how you feel. Try losing someone you love because no one will help them beyond insuring that they don't die while they are at their hospital. Americans take so much for granted. How can we help other countries when we can't even help ourselves? How can you let a child be homeless, hungry, and likely ill here in America while we fight to try to find weapons of destruction that don't even exist in another country? I watch the animal rescue commercials and it seems like we value the animals lives more than humans lives. I am an animal lover and have rescued many, but what about human beings? Does anyone care about people who truly fall on bad times and are not scheming the system but truly need help? Someone needs to get our country's priorities straight and keep American people strong and healthy. People have to come first.

Janet Stevens
December 01, 2012 at 10:51 pm

I am a senior citizen. I remember when the school did not provide insurance and with two children and one on the way, we teachers, bought our own insurance. Our family was not supported in the manner in which employees were later on. Yes later on, the school had group insurance which allowed us to pay a smaller premium than the insurance we sought on our own. We never were medically served without paying for our care and medication. We never received anything free or paid partial. We paid for everything that was not covered by the premium we paid to our insurance company. So, I wonder when seniors no longer are capable to work, do we have to pay for young able bodied people who say "they can't get a job." There are jobs but they aren't the "jobs they want." I didn't start at the top or without an education could I progress. Now young people think they should start as supervisors instead of laborers. Quit being such babies! My husband worked at the mill shoveling and getting sparks that burned his clothes in order to pay for college. He wasn't lazy like a lot of people. I don't mind paying for developmentally disabled and I would pay for prisons for those who commit a crime. But I won't pay for people to sit and play on I-phones and collect with a link card. Get a job cleaning the streets, washing cars, mowing lawns, washing windows, etc.

December 01, 2012 at 10:39 pm

obama can take his health care and shove it up his skinny black ass

December 01, 2012 at 10:22 pm

I agree with Brent 100%. I spent over 30 years in healthcare
finance and this is the best thing for the american people.

December 01, 2012 at 10:20 pm

@Brent messner I am glad you accept that you are nothing but a worthless "well off" midget mind government employee! I am a business owner, unfortunately I pay for your do nothing midget mind couldn't get a real job ass! And I'd rather not pay for more of your kind sucking off the lives of the "Real Americans" in this country that have actually done something to create jobs, livelihoods, products and income! YOU Sir are a PUKE!!! Well off government employee??? I'd hope to see a few "well off government employees" curb stomped in the streets before my time is up!!! You dirt bag aren't worth minimum wage!!! It's no surprise you support a socialist pro regulation pro tax puke like Obama! I got news for you "well off" no matter how well off you become working for the government YOU'LL ALWAYS just be another LOWLIFE government employee!!!