WASHINGTON (Reuters) - The Obama administration on Monday released broad new operating rules for state-run health insurance exchanges, which form a key part of the 2010 federal healthcare reform law that will face landmark Supreme Court hearings in just two weeks.

The long-awaited regulations, released by the Department of Health and Human Services, are intended to provide state lawmakers and officials flexibility on federal deadlines as they meet the complex task of building state and regional insurance markets before a January 1, 2014, deadline.

In a 642-page final rule, the government provides guidance on how states should establish exchanges, qualify health plans for participation and determine the eligibility of both individuals and small business that want to use exchanges to provide health coverage to their employees.

Industry and consumer groups welcomed the regulations, saying they provided states with the flexibility necessary to meet consumer needs for choice and quality protections. They also said the regulations shift policy focus to the state level, where the new rules must be implemented.

State exchanges are part of a two-pronged effort to provide health coverage for about 30 million uninsured Americans under the Patient Protection and Affordable Care Act, which also calls for a dramatic expansion of the joint federal-state Medicaid program for the poor.

The exchanges amount to federally subsidized state-run insurance markets designed to operate like Amazon.com by providing consumers Web-based access to affordable health plans that meet minimum quality standards.

But how state exchanges perform could be determined by a high profile Supreme Court case in which 26 states and a business group claim healthcare reform should be overturned as unconstitutional because it requires most adults to buy private health insurance or pay a penalty.

That requirement, known as the individual mandate, is intended to limit insurance risk in the exchanges by ensuring that younger, healthier adults participate. Otherwise, analysts say, the exchanges could become dominated by older, sicker adults, which would mean higher costs and fewer participating plans.

The Supreme Court will hear oral arguments March 26-28 and is expected to issue a ruling by July 1.

Many states have delayed participation until the ruling is out. About 33 states have received federal grant money to help set up exchanges.

The new rule retains a January 1, 2013, deadline for state exchanges to meet federal standards but also would allow states to qualify after January 1 if they can prove their exchanges will be ready to offer open enrollment by October 1, 2013.

The federal government will establish its own exchanges in states that fail to meet standards in time.

The administration is still working on a national regulation to establish essential health benefits that insurance plans must provide to participate in the exchanges.

Mike Russo, policy analyst at the public interest group US PIRG, said the new rules give states substantial leeway in establishing exchanges. But he called on state governments to exceed minimum requirements to negotiate on rates and coverage on behalf of consumers.

The insurance group America's Health Insurance Plans said it would be important to avoid duplicating existing state laws as exchanges develop, warning that duplication would add to complexity and increase costs for consumers.

(Reporting by David Morgan; Editing by Gary Hill)

http://news.yahoo.com/healthcare-exchange-rules-states-191121699.html

I will not buy health insurance. I will openly defy it if they mandate it. I will not pay the fines either. If the government wants me to have health insurence so bad then they can pay for it!

LOL

It is a good deal to see they are helping them to institute it effectively.

Some people are content to put lipstick on their favorite pig.... but it's still a pig, and that ain't gonna change!

Tell me, when is getting the government involved in anything a good idea? Now, they'll have your health records and don't think for a second they won't misuse this information. People can't be stupid enough to think the government actually cares about them?

Four hard truths of health care reform
By: David Nather
March 16, 2012 05:41 PM EDT

President Barack Obama promised over and over during the health care debate that “if you like your health care plan, you can keep your health care plan.”

It turns out that, for a lot of people, that isn’t true.

A Congressional Budget Office report issued this week says that 3 to 5 million people could move from employer-based health care plans to government-based programs as the Affordable Care Act takes effect. And in the worst-case scenario, it could be as many as 20 million.

For Obama, it’s an inconvenient truth at a really inconvenient time — coming less than two weeks before the Supreme Court begins oral arguments on the law and just as the administration touts the law’s early benefits on its second anniversary.

And it’s not the only hard truth Obama and the law’s supporters are facing. No matter what they said about rising health care costs, those costs aren’t actually going to go down under health care reform. The talk about the law paying for itself is just educated guesswork. And people aren’t actually liking the law more as they learn more about it — and some polls show they are just getting more confused.

But it’s Obama’s signature promise — “If you like it, you can keep it” — that’s most likely to get thrown back in his face. Here are the four hard truths of health care reform as the law approaches its March 23 anniversary:

1) Some people won’t get to keep the coverage they like.

For Republicans, the CBO report is a giant “I told you so” moment — and they’re lining up to tell you so.

“President Obama repeatedly promised during the health care debate, ‘if you like your current plan, you will be able to keep it,’” House Energy and Commerce Committee Republicans said in a statement Friday. “Even under CBO’s ‘best estimate,’ President Obama will have broken his promise to 3 million to 5 million Americans each year, but unfortunately, that number could be much higher.”

Sen. Orrin Hatch (R-Utah) cited the 20 million figure, saying: “This law keeps getting worse and worse; it needs to be repealed.”

Supporters of the law say it’s not as bad as all that. The 20 million figure is the extreme scenario, they point out — CBO says that 3 million to 5 million is more likely. And that’s out of the 161 million Americans who would have had workplace health insurance before the law was passed.

Even there, the number is misleading, according to Topher Spiro of the Center for American Progress, because CBO says about 3 million wouldn’t be forced out. They would leave their workplace coverage voluntarily — possibly for better coverage, with subsidies, through the law’s new health insurance exchanges.


And for the rest, Spiro said, employers will have to take the responsibility for what happens — because they’ll still have plenty of incentives to offer coverage to their workers, especially once the individual mandate requires everyone to have it. “If they decide to drop coverage, that will be their decision, and they should not blame the health care law,” Spiro said.

But try explaining all that over the 30-second Republican campaign ads that are sure to come. And it’s not what Obama promised as he pushed for the new law two years ago.

“If you like your plan and you like your doctor, you won’t have to do a thing,” Obama promised at a press briefing in June 2009. “You keep your plan; you keep your doctor. If your employer’s providing you good health insurance, terrific. We’re not going to mess with it.”

The 3 to 5 million estimate is also a net figure, so it masks some bigger changes in both directions.

For one thing, CBO says 11 million Americans won’t get employment-based health insurance they would have had before the law — so they will be forced out (technically by their employer, not by the president, but the context will be the changes brought about by the health law). Another 9 million would gain coverage — but everyone who loses it will see their lives disrupted, and it will be used as more evidence of broken Obama promises.

But all of that assumes CBO is right. For the law’s supporters, the dream scenario is that employment-based coverage will go up — which is what happened in Massachusetts under Mitt Romney’s health care reform law, which (as his Republican rivals have been known to point out) also has an individual mandate. According to the state’s figures, the percentage of employers that offer health coverage has increased from 70 percent to 77 percent since 2005.

2) Costs aren’t going to go down.

The video released by the Obama campaign Thursday has a graph that shows health insurance premiums climbing and climbing — way above general inflation. Giving families and businesses relief was a big part of Obama’s sales pitch for health care reform.

“Health care costs had been rising three times the rate of inflation, crushing family budgets and choking businesses. And he knew that he couldn’t fix the economy if he didn’t fix health care,” narrator Tom Hanks says in the video.

But no matter what happens with the law, the line on that graph isn’t going to go down. If the law works as the administration hopes, premiums may not rise as fast. But they’re not going to plummet.

That’s because the main drivers of rising costs — including technology, expensive new drugs, an aging population, a surge in chronic diseases, and Americans’ propensity to use a lot more health care than many other countries even if it doesn’t make them any healthier — have nothing to do with the law.


It’s not clear whether a lot of people actually expected premiums to go down — but there’s already a perception that the law has increased the cost of insurance, which is feeding the negative attitudes. A Kaiser Family Foundation poll released this week found that 49 percent believe the law has “significantly increased the price of health insurance.”

That’s not true. An Aon Hewitt survey of health plans found that health insurance premiums on average rose 12.3 percent in 2011 — but only an average of 1.5 percent can be attributed to the health law. And health premiums had been rising for years before the law was passed.

But what is true is that what most people pay for their insurance — either through higher premiums or bigger co-pays and deductibles — aren’t rising more slowly. The law creates lots of experiments for delivering health care more efficiently, but those are just getting underway. If those don’t work, and costs keep rising, the law will get blamed for it.

3) It’s just a guess that the law can pay for itself.

The Obama administration insists that the health care law will actually reduce the deficit — which sounds like a fantasy to many people, since the law will clearly increase spending through insurance subsidies and an expansion of Medicaid.

But that’s what CBO says. And it’s because the budget office believes the law will pay for itself through cuts in Medicare payments and various new taxes, including fees that health insurers and medical device makers will pay.

Like everything else CBO does, though, those estimates are mostly educated guesses — and they assume Congress is actually going to let the Medicare cuts happen. For example, the law is supposed to save $157 billion over 10 years by increasing Medicare payments more slowly for inpatient hospital, home health and skilled nursing facility services. The law expects those providers to become more productive and more efficient. But watch for plenty of lobbying pressure on Congress to cancel those cuts.

4) “The more they know, the more they'll like it” isn’t happening.

When the bill passed, Democrats were convinced that Americans would like the health care reform law more once they were able to see its benefits. When then-House Speaker Nancy Pelosi said Congress had to “pass the bill so you can find out what is in it” — an inartful phrase that Republicans have happily quoted ever since — her aides insisted that’s what she meant: People would find out about its benefits once the controversy died down.

Except the controversy has never died down, and people don’t like the law any more now than they did then.

The latest Kaiser Family Foundation poll found that 41 percent had favorable views of the law, while 40 percent had unfavorable views. That’s down from the 46 percent who favored the law in April 2010, right after Obama signed it.

And people actually seem to know less about what’s in the law than they did then. Only 56 percent now know that people will get subsidies to pay for health insurance, compared to the 75 percent who knew in April 2010. Just over half of Americans knew that people with pre-existing conditions will be guaranteed coverage, compared to the 64 percent who knew it in 2010.

The part the most people knew about is the individual mandate — the least popular part of the law. And once the Supreme Court starts hearing the health care reform case on March 26, they’ll hear about that part even more.


I really hope the Supreme Court does the right thing and finds this law unconstitutional!!!

The CBO just came out with a new total cost for the healthcare scam.
Instead of the 900 billion it is now over 1.7 TRILLION.

Do you mean you don't want health insurance at all? Do you work for a company that provides it? If you did, would you buy it through them?

I'm just curious why you would not want it at all. I understand (I think) your objection to having it mandated by law.

i've never had it and never needed it...the human body can take care of itself... i don't believe in taking pills, getting shots or any of that stuff. just about every medication they give has side effects.

I dont know. I think civil rights laws were a good idea.
I think medicare was a good idea.
I think welfare is a good idea.

Huh, well okay. But have you never known anybody who got seriously ill? Anybody?