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A year after passage, the government is just gearing up for the arduous task of writing the rules for Obamacare.

By  Scott Sinder and Rhonda Bolton

March 23 marks the one-year anniversary of the enactment of the Patient Protection and Affordable Care Act, and the focus since then has been on the monumental task facing the Department of Health & Human Services, the Department of Labor and the Internal Revenue Service, which must write the regulations for the new law. The job has only begun, but it’s worth considering what’s been accomplished and what still remains.

What’s Been Done?

Many of the Act’s core provisions went into effect September 23, a timetable that gave regulators six months to resolve a host of complex plan-design matters. To meet this schedule, regulators issued several “Interim Final Rules.” Although they are in effect, these regulations are subject to tweaking before the government publishes them in final form. So far, interim rules have been issued on:

· Grandfathering plans

· Coverage of adult children to age 26

· A “Patients’ Bill of Rights,” the moniker regulators gave to a rule covering annual and lifetime limits (and the former’s effect on mini-med plans), pre-existing condition exclusions, rescissions and access to certain providers

· Free preventive services

· Internal claims review and external appeals processes

· Small business tax credits for providing health insurance to employees

· Medical loss ratio compliance by carriers

· State/federal premium increase reviews for carriers.

These rules do not represent the end of the process. Thanks to their complexity and some unintended consequences that became apparent once they went into effect, additional clarifying regulatory guidance has been issued on several topics. For example, the rules on grandfathering health plans have generated considerable confusion, especially a provision requiring an insured plan to give up its grandfathered status even if the only change sought was to switch carriers. Criticism of the provision prompted regulators to allow for carrier changes.

Similarly, regulators decided to allow mini-med plans to seek waivers of the strict new rules on annual benefits limits due to mounting evidence that the rules would cause the immediate loss of this coverage for millions of low-wage workers. Such responses are encouraging because they demonstrate some willingness on the part of the regulators to take the concerns of the public and industry into account.

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