Obama Takes Next Steps to Implement Health Care Reform ~ Discrimination Based on Pre-existing Conditions Prohibited

The Obama Administration took its next steps to implement health care reform law last week. It proposed rules for 3 main provisions in the Affordable Care Act, including barring insurance companies from discriminating against people with pre-existing conditions, making standards and policies for consumer health plans and their core “essential health benefits,” and promoting and implementing employment-based wellness programs.

Below is a summary of these provisions from the Department of Health and Human Services recent press release with links to relevant fact sheets.

The California HealthCare Foundation (CHCF) also recently issued a guide to track California’s preparation and progress for the January 2014 launch date of health care reforms’ core provisions. The guide is focused on 4 main areas: expansion of Medi-Cal coverage from 1.2 million Californians to 1.6 million; simplification in the eligibility and enrollment process for Medi-Cal; protection of consumers by banning coverage denials due to pre-existing conditions and standardizing the essential health benefits offered in each plan; and the creation of a new marketplace for health insurance through the state’s Health Benefit Exchange. See the guide, Tracking ACA Implementation in California, for more info.

Here’s the summary of the Obama administration’s provisions issued last week:

  • A proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition.  Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.  Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable, and young adults, have access to a catastrophic coverage plan in the individual market.  For more information regarding this rule, visit:http://www.healthcare.gov/news/factsheets/2012/11/market-reforms11202012a.html.
  • A proposed rule outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.  For more information regarding this rule, visit http://www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html.
  • A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.  For more information regarding this rule, visit:http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

See the HHS press release for more details. You can also see HHS Secretary, Kathleen Sebelius’ blog on these proposed rules.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.