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Published: Wednesday, 6/23/2010

New rules offer protection from health-insurance industry

BLADE STAFF AND NEWS SERVICES

WASHINGTON - The Obama Administration on Tuesday issued new regulations to protect Americans from the insurance industry as the President met at the White House with Americans who had been denied care and challenged Republicans who are trying to repeal his health-care overhaul.

"They want to go back to the system we had before," Mr. Obama said from the East Room of the White House, where he signed the health-care law 90 days ago. "I refuse to go back."

The insurance rules, all of which are set out in the new law, were put in the bill by the Obama Administration and its Democratic allies to provide consumers with early protections until the insurance market is more fully overhauled in 2014.

The regulations include the following:

• With some exceptions, insurance plans starting after September will no longer be able to deny coverage to children under 19 with pre-existing medical conditions.

• Insurers will not be able to rescind coverage except in clear cases of fraud.

• Insurers will be prohibited from imposing lifetime limits on what they will pay for care.

• Insurers will not be able to impose annual limits of less than $750,000 on coverage of essential benefits including maternity care, emergency services, and pharmaceuticals; the minimum annual limit would rise to $2 million by 2014.

• And insurers will be prohibited from requiring their customers to get prior approval before they get emergency care outside the provider network.

Employer-provided plans that do not make major changes to their benefits or dramatically increase cost-sharing with employees will be exempt from some of these new mandates as "grandfathered" plans.

With health-insurance premiums continuing to rise, the Obama Administration has been working to highlight the immediate benefits of the new health-care law to Americans who remain skeptical of the planned overhaul.

Administration officials estimated that as many as 200,000 children and adults could benefit from the new protections, not counting several million who could gain easier access to emergency care, according to an analysis accompanying the proposed new rules.

Among those at the White House yesterday were Taylor Wilhite and her mother, Amy Wilhite, of Marblehead, Ohio.

According to a news release, Taylor Wilhite was diagnosed with a type of leukemia in 2007. She received three rounds of chemotherapy and a bone-marrow transplant. The cancer treatment produced multiple side effects: problems with her heart and hip, short-term memory loss, steroid-induced diabetes, and a compromised immune system.

Taylor's father's insurance plan has a $1 million lifetime limit. As Taylor approached the limit, her parents requested a $500,000 extension and it was granted. Although Taylor is in remission, she will need follow-up visits with her oncologist, check-ups with her endocrinologist, and multiple major surgeries on her hip. Amy Wilhite said the family has been picking and choosing which tests and follow-ups to go through with, because they don't want to exceed the cap.

Republicans quickly condemned the rules Mr. Obama announced yesterday as a sales job. "This shouldn't be called a health-care bill of rights, but a bill of goods," Utah Sen. Orrin Hatch said in a statement. He has sponsored legislation to repeal parts of the health-care law.

Mr. Obama may face a bigger challenge as millions of Americans get double-digit premium increases in the mail.

Yesterday, the President explicitly warned insurance companies to restrain their rates.

"We've got to make sure that this law is not being used as an excuse to simply drive up costs," Mr. Obama said after emerging from a closed-door meeting with insurance executives and state insurance regulators.



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