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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 5:43 pm

So, in the past three years since implemented, My Premium has gone up only 20%, but my Deductible has gone from zero to 1500.00, and is expected to go to 2000 next year. Add on top of that covered services are now being "Reclassified" by the taxation via Obama Care, I have paid now this year for lab test that I get every year, approx 900 dollars compared to the 45 dollars prior to the Healthcare changes. When I called my insurance and asked why, they Blatantly stated that the procedures (Cholesterol checks and diabetes bloodwork)are now being classified by the government a different class of test to make them taxed to the insurance companies and they are now passing that cost onto us. and only approx 10% of all the proposed changes to pay for this have come to fruition with 0% left to go... I expect to pay approx 7-10 thousand a year for my healthcare. Oh, by the way, I am paying fully out of pocket as I was laid off a few months ago, and there is no program in place for me as I worked for a non profit for 10 years.... Hmmm, How do I get the benefits of the healthcare????!??!?!?!

December 02, 2012 at 5:20 pm

This law is going to cause healthcare costs to skyrocket.
People are already losing thir jobs because of it. Has anyone seen a decrease in their own healthhcare costs? Medicare patients who have paid into the system, are going to suffer the most. Our government has no money to pay for this. This law was only passed for political reasons, and without any politcal leader even reading it. How sad that the people of our country would re-elect politicians who don't even read the bills they pass, nor do not offer a budget or make any attempt to stop excessive spending. I truly feel sorry for our children and grandchildren who will be stuck paying for this and receiving poor healthcare as well.

December 02, 2012 at 1:13 pm

People keep stating that "it's about time that these freeloaders will have to get insurance". While I do like that concept to keep uninsuredfrom swarming emergency rooms, the policy only applies to LEGAL residents! We will still be on the hook for the illegals swarming our emergency rooms!

Enjoy paying!

December 02, 2012 at 1:12 pm

Big insurance and drug companies is the problem with healthcare!

December 02, 2012 at 12:44 pm

Unlike other countries, around the world who allow their governments to create revenue from business, the US government derives its revenue solely through taxation. As the population grows older and health care costs continue to rise - taxes will continue to rise to cover the cost. Health care premiums are now approaching the average mortgage payment, and that’s absurd. Those who drive are required to have auto insurance – shouldn’t we also have health insurance. I just don’t see what all of fuss is about. Thank God someone in our government is trying to get a handle on the rising cost of heath care.

P. Smee
December 02, 2012 at 11:28 am

I think it sounds like we are moving in the right direction..maybe we should take some of it out of what we are currently paying for our legistlators health insurance premiums.. in fact let's quit paying for their health insurance all together so that they can understand how difficult it is to buy your health insurance without a group behind you. Plus, I feel that we should not be responsible for their health insurance as it is since they are making enough to purchase their own plans privately.

Miker Riley
December 02, 2012 at 11:07 am

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"

This pro-Obama writer HOPES that more states foolishly sign on to the Medicaid Exchanges.
Then they will just Pay, and Pay, and PAY.

There is NO MONEY for Obamacare.
EXCEPT by taking money AWAY from Medicare for Seniors. And taking money away from your doctor so he will not trear you.

December 02, 2012 at 10:55 am

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. "

That's exacrly WHY states should OPT OUT of the Medicaid Exchanges. This law gives the Secretary ofd the HHS WAY too much power.

In fact the bill says "The Secretary of the HHS SHALL or Will SEEK TO" 1000 TIMES!

It's a BAD law,

Erica Dennis
December 02, 2012 at 10:45 am

Barbara has made some very harsh comments without realizing that not everyone is able to work forever. I worked 45 years but am now below federal poverty level and without health insurance. I am not and have never been a deadbeat. People should not judge other's circumstances in life. I wish no ill upon anyone, but people like Barbara should count their blessings and realize that her place in life's hierarchy could change very suddenly and perhaps not even be her own fault and then she might see that she might not be so arrogant and judgemental.

December 02, 2012 at 10:42 am

I am so sick of the GOP, they do not care if seniors drop dead! The truth seniors need all the help we can get, Yes we need Dental! In my state if your are young, you get help, but seniors NO help for Dental, and yes there is not enough money to pay for Drs. and medicines as well as all the other things to pay, utilities, food ( heaven fobid we as SENIORS should eat) Big TIME HELP IS NEEDED. Doctors will not cut us a break, my husband and I have diabetes and cannot afford to go even with MEDICARE like we should. WE pray everyday that we will be alright, and nothing will come along we can't handle!!!!!!!