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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 10:24 am

To all those people that now want dental insurance, where does it end? You should have been responsible enough to take care of your teeth and now I have to help pay for that too? Get a job or a 2nd or 3rd job (oh, theres an idea!) as I have done and quit asking the taxpayers to pay for EVERYTHING!!! You're all so pathetic, that's why our country is going down the drain, don't you get it? Figure it out

December 02, 2012 at 9:18 am

Any state that agrees to set up Medicaid exchanges is making a BIG, BIG mistake.

The initial federal govt funding does NOT EXIST. It musr be BORROWED from China. And the initial government is just a COME ON.

After a year, the States will just Pay, and Pay, and Pay, until they go BANKRUPT.
Just like California.


December 02, 2012 at 9:14 am

Can the fact that DENTAL insurance is just as necessary as medical be addressed? I'm 37 years old and have lost all my teeth in the back that forces me to use my front teeth for everything. I am in dire need of serious dental care. I'm very apprehensive about interviewing for a job because I'm ashamed to really open up my mouth.

December 02, 2012 at 8:42 am

I have the same problem as Julie! When are they gonna do something about adult dental! I'm 55 years old and have been on so many different drugs, they have really hurt my teeth.

I was in the hospital and they had to insert a fibulater down my throat. Of course the medical team knocked my front 2 teeth. Oh
course I can't afford to have a partical or anything done about

It seems to be a major problem that no one has addressed. I also pray every day about this issue and many other as well.

December 02, 2012 at 8:36 am

Sharon, there is help available for seniors but sitting in your house compklaining will not bring it to you, you must be active in seeking help. Call, or go see, your local Council on Aging, call or go see one or two senior communities (not all of them are for people who can pay their own way, call or go see your local Social Security office and ask about disability, Medicaid and other programs for the low income, find out where you need to go in your community to get help with rent and utilities. This might not be the life you expected at age 69 but it can be a good life nevertheless. There is help but you must be willing to change your lifestyle, go ask for help and maybe even move to an area where more options are available to low income seniors. You have to be aggressive or find someone who will be aggressive on your behalf. Please do not continue to sit and complain when help is available to those who actively seek it.

Marie T
December 02, 2012 at 8:25 am

I am approaching retirement and I am apprehensive with Medicare under Obama. I know of for a fact that certain doctors are not taking Medicare patients and that further cuts to Medicare will be starting in January 2013. Grant you, everyone should be insured but why do senior citizens have to suffer when they worked all their lives and now the country that they paid into for years via Medicare is not taking care of them. A large amount of money was taken from Medicare to support Obamacare. When you are raising kids how can you save for retirement? As a result of raising kids,a large majority of seniors do not have adequate savings for retirement. I am fortunate to work at a good place with good benefits and I do not take this for granted. I just pray and help when I can.

December 02, 2012 at 8:11 am

hello. what about dental?? I am only 43 and my teeth are so bad. I think sooner than later they are gunna fall out of my mouth. I dont hardly ever smile and it sux. When is someone going to do something about our teeth? They are clearly a health issue. When you are on aid you only get dental until you are 21 years of age. then what happens? Well your teeth fall out. I am on ssi...i cant afford dental.

December 02, 2012 at 7:52 am

I am A 69 yr old Senior Citizen~~~~I at one time, was well off, then my husband passed, since then I have been on my own, my sole income is Social Security, now I So many health problems some due to not having food to eat 3weeks out of a month, I get 29.00 n Food stamps, so when that is gone , thats it, I have to fight each year to continue to receive medicare part B, in order to be able to buy my meds and pay DR. I Pray for all those who are without, and I THINK OBAMA, should help the people here in the US, before sending help elsewhere. I feel and Fractured my several vertbra from neck down so will not ever be able to work again. It takes all I get In SSecurity to pay my bills, so broke from one paydayday to next month. I have no where to turn for help, so what are myself and others in this Position suppose to do. I PRAY Every Day and Night for answere, I donot celebrate Holidays, as there is no Food, PLEASE LORD SEND HELP TO ALL THE ELDERLY, AND THE YOUNG AS WELL.

December 02, 2012 at 7:17 am

I live in a state where auto insurance is not an option. If you do not have insurance on your car it can be towed even if it is parked in a public lot. Many states saw the need for and implemented a mandatory auto insurance policy because people eventually for whatever reason need it. Nobody lost their minds and called the government communists when this happened. This health care reform is the same concept. Everyone at some point in their life needs medical insurance to have any kind of quality of life, however many people in the middle class, who work everyday are cut just short of the hours necessary to qualify them for their employer's group insurance plan. And anyone making minimum wage who has ever tried to get an individual insurance plan for themselves let alone their family knows it is not an affordable feat to accomplish especially if you have preexisting health conditions. I think it is important for people of all walks of life to have access to affordable health insurance. All these people are on here screaming that they don't want to pay higher taxes for all these bums who sit at home and suck the system...well hate to break it to you but you've been doing that for decades. The people sitting home sucking the system wont be out shopping for these newly formed and affordable policies, they are the ones on medicaid which has been around and isn't new. The people being helped by this reform are not those people. They are the blue collar minimum wage workers of America that work hard daily and cannot get group plans (whether due to limited hours or lack of an employer offering a plan) or afford private insurance.

December 02, 2012 at 7:13 am

Obama is also half white