Administration Unveils Obamacare Rules

 
on November 20 2012 2:03 PM
US Health Care Policy
The Supreme Court's approval of the Patient Protection and Affordable Care Act is "unambiguously good" for American business, a George Mason University analyst said Thursday, a view also expressed by Standard & Poor's Ratings Services. REUTERS

The Department of Health and Human Services has released some much-awaited proposals for the new rules the Affordable Care Act will impose on insurance companies.

President Barack Obama's re-election has ensured that the implementation of the sweeping new health care law can roll out as planned, with the law scheduled to take full effect by 2014. Part of that process is writing regulations about the kind of coverage insurers will be required to offer as part of the law's goal of extending health insurance to all Americans.

One of the new rules would bar insurers from discriminating against people with pre-existing conditions, a provision that Obama has touted heavily in defending the still-controversial law. In a press release, the Department of Health and Human Services estimated that up to 129 million Americans suffer from conditions, from heart disease to asthma, that insurers have until now been able to invoke in denying insurance benefits.

“In most states, these consumers can be denied individual health insurance coverage or have benefits for medical conditions excluded by insurance companies," the press release reads. "In addition, individuals and small employers often find that they have few protections against exorbitant premiums increases.”

Insurance companies have pursued that strategy because customers with health conditions are more costly to insure. The Affordable Care Act attempts to offset the cost of covering those Americans by requiring that everyone obtain health insurance, providing insurance companies with a deluge of new customers.

One of the ways Obamacare does that is by having states construct insurance marketplaces called "exchanges," where consumers can comparison shop and -- if they qualify -- use government subsidies to purchase insurance. The Affordable Care Act imposes limited standards of coverage for the plans offered on those exchanges, and another proposed rule released on Tuesday specifies what "essential health benefits" would need to be provided.

Many Republican-controlled states have resisted creating insurance exchanges. Critics of the Affordable Care Act had held back, first hoping that the Supreme Court would strike down the law and then waiting to see if Mitt Romney would win the presidency and attempt to repeal the law. Since Obama's re-election, some Republican governors have said they will allow the federal government to set up the exchanges, citing a belief that states do not have enough flexibility in crafting the rules governing the marketplaces.

Another rule proposed by HHS would limit the extent to which insurance companies can change their prices based on factors like age, family size and tobacco use. Yet another urges states to create "wellness plans" focused on preventitive medicine.

“Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening," the HHS release said. “Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.”

Share this article