HHS details health care rules

November 21, 2012 - Updated: 8:38 a.m.

WASHINGTON – The Obama administration reaffirmed key requirements of the new health care law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits.

Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law’s requirements as the federal government races to implement the legislation by the end of next year.

But the proposed rules issued Tuesday hew closely to the Affordable Care Act the president signed in 2010. At the same time, administration officials restated their commitment to move rapidly ahead, despite continued resistance from some Republican governors.

“What this means is that beginning in October next year, families and small-business owners everywhere will be able to shop for affordable, quality health coverage,” Secretary of Health and Human Services Kathleen Sebelius said. “Entrepreneurs won’t have to give up their chance at affordable health coverage to start a new business.”

Under the law, Americans who are not covered through work will be able to comparison shop for health insurance in online markets, also known as exchanges, designed to mimic the shopping experience of popular travel sites.

These exchanges will be run by state governments, except in states that elect to leave the job to the federal government or to partner with Washington.

More than 15 states, mostly with Republican governors, have said they will not operate an exchange. Some governors have complained the federal government has put too many requirements on the exchanges.

In state- and federally-run exchanges, insurance companies will be prohibited from denying coverage to sick Americans. Insurers will no longer be able to charge more to women or customers with medical conditions.

And for the first time, insurers will have to cover 10 basic benefits, including hospitalizations, emergency care, newborn and maternity care, and prescription drugs.

The Obama administration has allowed each state to detail this set of benefits, allowing for some variations of drugs that might be covered, for example.

That worries many consumer advocates who would like to see a national standard for health insurance. “By leaving the decision up to the states of which drugs insurance plans must cover, we fear many patients, particularly those with complex medical conditions, may not have the coverage they need,” said Carl Schmid, deputy executive director of the AIDS Institute.

But several leading consumer groups, including the AARP, which represents retirees, and the American Cancer Society’s Cancer Action Network, applauded the administration for retaining key protections in the law, including a requirement that insurers charge elderly customers no more than three times as much as they charge young customers.

Insurers had pushed for more leeway to vary rates based on age, arguing that this is necessary to keep premiums affordable for younger, healthier customers.

Gary Cohen, who oversees insurance regulations at the Department of Health and Human Services, said the administration does not believe this is necessary to attract younger customers, who will have access to a lower-priced health plan to cover catastrophic illness and also may qualify for new subsidies to offset their premiums.


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