The Clinton Herald, Clinton, Iowa

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November 20, 2012

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

With the national health law's political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law's complex components.

Most of the anticipation has been focused on rules that determine how the new state-based insurance marketplaces, or "exchanges," will operate. Also closely awaited are decisions about how the government will tax medical devices, allot the shrinking pool of money for hospitals that treat the uninsured, and determine how birth-control insurance coverage can be guaranteed for employees of religious institutions.

"We knew right after the election, this is all coming out," said Blair Childs, an executive at the Premier health alliance, which advises hospitals.

Some of the rules have been in the works for nearly a year.

Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.

Here are summaries of some of the significant decisions on the health law that the administration is expected to announce shortly:

Medical device excise tax

In February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.

Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures, such as dental instruments and latex gloves? Does the tax apply to kits — two or more medical tools packaged and sold together — even if the manufacturer of each component had already collected the tax when it was sold to the kit maker?

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