The Washington Times-Herald

Community News Network

November 20, 2012

With health-care law set, now come the new rules

(Continued)

"The big one that everyone's watching is more definition around the exchanges," said Chas Roades, chief research officer at the Advisory Board, a Washington consultancy.

The government also has to specify how cost-sharing rules for consumers will work and what types of medical services must be covered in health plans sold in the exchanges. Twenty-six states have already chosen an existing health plan as a benchmark identifying what "essential benefits" their state's insurers must provide. In those states that don't establish a benchmark, the administration is empowered to choose one. Until the government does, insurers say they are hampered in devising what kind of insurance policies to offer.

"Unless such guidance is forthcoming, it will be difficult for health plans to complete product development, fulfill network adequacy requirements, obtain necessary state approvals and reviews, and ensure that their operations, materials, training and customer service teams are fully prepared," Daniel Durham, a vice president for America's Health Insurance Plans, testified before a House subcommittee in September.

Debra Ness, president of the National Partnership for Women and Families, said consumer advocates are concerned that the rules may give insurers too much leeway in deciding how skimpy or rich benefits are within the 10 broad categories of coverage the health law requires. "You can end up with places that have fine prescription drug treatment and really lousy maternity care," she said.

Other insurance regulations are also expected. The government has to clarify new standards for companies that insure their own workers, including what level of coverage is sufficient, how a new tax on premiums included in the health law will be assessed and how wellness programs designed to encourage employees to adopt health behaviors will operate.

Several of these insurance rules appear to be far along in the pipeline and are pending before the White House Office of Management and Budget, the final stage before issuance. The office's Web site shows that three rules — on exchanges, the health insurance market and wellness programs_ were submitted by HHS to the OMB days after the election.

Text Only
Community News Network
  • Screen Shot 2014-07-28 at 2.21.22 PM.png VIDEO: Dog 'faints' from excitement of seeing owner

    A reunion between a Pennsylvania woman who had been living overseas for two years and her pet schnauzer has gone viral, garnering nearly 20 million views on YouTube.

    August 1, 2014 1 Photo

  • Comiskey.jpg Sterling not the only bad owner

    As the Donald Sterling era in with the Los Angeles Clippers looks to be winding down, many are calling him the worst owner in sports history. From being cheap with the players to his most recent racist comments, it's hard to argue against.
    Yet, there are a few owners of athletic teams who can give Sterling a run for title of worst in history.

    August 1, 2014 1 Photo

  • 20140727-AMX-GUNS271.jpg Beretta, other gun makers heading to friendlier states

    In moving south and taking 160 jobs with it, Beretta joins several other prominent gunmakers abandoning liberal states that passed tough gun laws after the Newtown shooting.

    August 1, 2014 1 Photo

  • Church's denied request for National Guard visit draws national attention

    A Missouri church finds itself in the middle of a media storm after the Missouri National Guard, citing short notice and time constraints, was not able to fulfill a request last week to appear at the church’s vacation Bible school.

    August 1, 2014

  • Lindley, Tom.jpg Grandstands feel a little empty at NASCAR races

    Two decades after NASCAR started running at Indianapolis Motor Speedway, the crowds have thinned considerably. It's probably no reflection on the sport's massive following, which stretches from coast to coast, but it surely doesn't NASCAR's image help when the cameras pan across all of those empty seats.

    July 31, 2014 1 Photo

  • The virtues of lying

    Two computational scientists set out recently to simulate the effects of lying in a virtual human population. Their results, published in the Proceedings of the Royal Society B, show that lying is essential for the growth of a cohesive social network.

    July 31, 2014

  • lockport-police.jpg Police department turns to Facebook for guidance on use of 'negro'

    What seems to be a data entry mistake by a small town police department in western New York has turned into a social media firestorm centered around the word "negro" and whether it's acceptable to use in modern society.

    July 31, 2014 3 Photos

  • Screen Shot 2014-07-31 at 2.12.55 PM.png VIDEO: Five-year-old doesn't want her brother to grow up

    Sadie, an adorable 5-year-old from Phoenix, wants her brother to stay young forever, so much so that her emotional reaction to the thought of him getting older has drawn more than 10 million views on YouTube.

    July 31, 2014 1 Photo

  • Why a see-through mouse is a big deal for scientists

    A group of Caltech researchers announced in Cell Thursday their success in making an entire organism transparent. Unfortunately, this isn't any kind of "Invisible Man" scenario: The organism in question is a mouse, and the mouse in question is quite dead.

    July 31, 2014

  • Sunburn isn't the only sign of summer that can leave you itchy and blistered

    You've got a rash. You quickly rule out the usual suspects: You haven't been gardening or hiking or even picnicking, so it's probably not a plant irritant such as poison ivy or wild parsnip; likewise, it's probably not chiggers or ticks carrying Lyme disease; and you haven't been swimming in a pond, which can harbor the parasite that causes swimmer's itch.

    July 30, 2014