The Affordable Care Act was a massive piece of legislation, but it only went so far in defining the details of policy implementation. For example, the text of the bill mandates that Americans’ preventive care be provided without a copay, but it doesn’t specify what, exactly, counts as preventive care.
And that’s where the regulatory process kicks in. It’s up to the Obama administration to make choices defining the limits and the benefits under the legal framework. With this in mind, “Obamacare” implementation took another important step forward yesterday.
The Obama administration took a big step on Tuesday to carry out the new health care law by defining “essential health benefits” that must be offered to most Americans and by allowing employers to offer much bigger financial rewards to employees who quit smoking or adopt other healthy behaviors. […]
The rules translate the broad promises of the 2010 law into detailed standards that can be enforced by state and federal officials. Under the rules, insurers cannot deny coverage or charge higher premiums to people because they are sick or have been ill. They also cannot charge women more than men, as many now do.
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“Thanks to the health care law, no one will be discriminated against because of a pre-existing condition,” said Kathleen Sebelius, the secretary of health and human services, who issued the rules with Phyllis C. Borzi, an assistant secretary of labor, and Steven T. Miller, the acting commissioner of the Internal Revenue Service.
When it comes to “essential” benefits, states will have some leeway, but under the regulations unveiled yesterday, all insurers will be required to provide “dental care and vision services for children, treatment of mental health and drug abuse problems, and ‘habilitative services’ for people with conditions like autism or cerebral palsy.”
There’s also some worthwhile provisions related to wellness: “The less-familiar wellness rules will increase the maximum permissible reward for workers who participate in programs that encourage certain health outcomes, such as smoking cessation or weight loss. Under the proposed rules, these ‘health-contingent wellness programs’ will now yield a reward of up to 30 percent of the cost of health coverage rather than 20 percent.”
In light of the election results, the opportunities for the law’s opponents have faded away. All of this, in other words, really is going to happen.
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