The rules that consumers should benefit expand significantly federal authority to use bonuses to head collected from companies such as UnitedHealth, Etna, Humana and Wellpoint. While some States have had such requirements,'s Monday announcement is the first such mandate by the Federal Government and grows out of the new national health care law.
"Millions of Americans better value will receive for your health insurance premium dollars," said Kathleen Sebelius, the Secretary of health and human services, when drawing up the rules.
Mrs Sebelius said the rules would protect nearly 75 million people: large employers 10.6 million with policies, 24.2 million with small group coverage and 40 million covered by.
From next year, she insurers in the market said individual and small groups have to spend at least 80 percent of their premium revenue to healthcare and activities to improve the quality of care.Insurer on the market of large group must spend at least 85 percent of premium dollars for these purposes.
Insurers who meet the standards not next year, discounts to consumers, starting in 2012 to zahlen.Frau Sebelius estimated that up to nine million people could receive discounts worth up to $ 1.4 billion.Are about 45 percent of people with individually acquired insurance in health plans that meet the new standards known as medical claims, federal officials said.
At a press conference on Monday attacks administration officials repeatedly rejected on Republican law to respond to public health.Still would discuss Republican calls for the abolition of the law, a centerpiece of President Obama's domestic agenda.
"We just try to implement this regulation", said Jay Angoff Director is the chief Autor.Er rules of Department of health and human services' consumer information and insurance oversight.
He said that most insurers should be able to meet the standards because "your profitability and reserves at an all-time high."
However, said State officials could destabilize the standard insurance markets in some countries.Specifically, you said you were afraid that some airlines withdraw from the market in some countries, would result in less individual choice and less competition.
According to the rules, federal officials can reduce sleeps up to three years in States, where "it's a fair chance that destabilization, market and thus harm to the consumer."
Mr Angoff said that Georgia, Iowa, Maine, South Carolina had asked for such adjustments.
Joshua R. Raskin, senior analyst at Barclays Capital, an investment bank, said: "With these rules, the Federal Government for the first time, health insurance companies for the placing on the market a minimum amount of premiums in the direction of medical expenses is accountable."
The rules allow special handling for health plans that provide limited benefits at an affordable price.At least 1.4 million people are in such 'Mini-med' plans, the cover for one or more services at $5,000 or $10,000 a year Cap $25,000 enrolled - or maybe.
Employer provides those cover had said it could at the end, because you could meet not the 80 percent standard next year.
Premiums are generally lower for mini-med plans as for regular insurance and administrative costs can be high because these plans often abdecken.Infolgedessen accounts for employees with high turnover rates administrative costs a higher share of premiums.
In addition, some consumer groups of mini-med plans said had higher profit margins than traditional insurance.
"Managing a smart accommodation made, which will temporarily save this covering industry is very important for many employees in the retail and restaurant" said E. Neil Trautwein, a Vice President of National Retail Federation.
"Is the dispensation for mini-med plans for a Jahr.Die Government will collect data on these plans next year and decide how you continued in 2012 and 2013.""In the year 2014, we expect these mini-med policies will disappear and be replaced by more comprehensive health plans", said Steven B. Larsen, a federal insurance regulator.
In general recommendations of the National Association of Insurance Commissioners, representing government regulators follow the rules.
However, "We have a disagreement on a point," Jane said L. Cline, Insurance Commissioner of West Virginia and President of the Association.
State officials Mr Obama said on States that allow requests over several years to avoid disruption of the individual or small group insurance market phase soll.Das White House, said "The law enables the adjustments of the medical loss ratio for the single market in a State and does not apply to small groups market."
Consumers Union, the American Heart Association and democratic members of Congress praised the rules.
Representative George Miller, Democrat of California, said the folly of efforts for the abolition of the health care showed the rules Act.
"If", Republican, Mr. Miller said, "take money directly from the pockets of millions of average Americans."
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Companies like Philip Morris International and British American Tobacco are contesting limits on ads in Britain, bigger health warnings in South America and higher cigarette taxes in the Philippines and Mexico. They are also spending billions on lobbying and marketing campaigns in Africa and Asia, and in one case provided undisclosed financing for TV commercials in Australia.
The industry has ramped up its efforts in advance of a gathering in Uruguay this week of public health officials from 171 nations, who plan to shape guidelines to enforce a global anti-smoking treaty.
This year, Philip Morris International sued the government of Uruguay, saying its tobacco regulations were excessive. World Health Organization officials say the suit represents an effort by the industry to intimidate the country, as well as other nations attending the conference, that are considering strict marketing requirements for tobacco.
Uruguay’s groundbreaking law mandates that health warnings cover 80 percent of cigarette packages. It also limits each brand, like Marlboro, to one package design, so that alternate designs don’t mislead smokers into believing the products inside are less harmful.
The lawsuit against Uruguay, filed at a World Bank affiliate in Washington, seeks unspecified damages for lost profits.
“They’re using litigation to threaten low- and middle-income countries,” says Dr. Douglas Bettcher, head of the W.H.O.’s Tobacco Free Initiative. Uruguay’s gross domestic product is half the size of the company’s $66 billion in annual sales.
Peter Nixon, a vice president and spokesman for Philip Morris International, said the company was complying with every nation’s marketing laws while selling a lawful product for adult consumers.
He said the company’s lawsuits were intended to combat what it felt were “excessive” regulations, and to protect its trademark and commercial property rights.
Cigarette companies are aggressively recruiting new customers in developing nations, Dr. Bettcher said, to replace those who are quitting or dying in the United States and Europe, where smoking rates have fallen precipitously. Worldwide cigarette sales are rising 2 percent a year.
But the number of countries adopting tougher rules, as well as the global treaty, underscore the breadth of the battleground between tobacco and public health interests in legal and political arenas from Latin America to Africa to Asia.
The cigarette companies work together to fight some strict policies and go their separate ways on others. For instance, Philip Morris USA, a division of Altria Group, helped negotiate and supported the anti-smoking legislation passed by Congress last year and did not join a lawsuit filed by R. J. Reynolds, Lorillard and other tobacco companies against the Food and Drug Administration. So far, it is not protesting the agency’s new rules, proposed last week, requiring graphic images with health warnings on cigarette packs.
But Philip Morris International, the separate company spun out of Altria in 2008 to expand the company’s presence in foreign markets, has been especially aggressive in fighting new restrictions overseas.
It has not only sued Uruguay, but also Brazil, arguing that images the government wants to put on cigarette packages do not accurately depict the health effects of smoking and “vilify” tobacco companies. The pictures depict more grotesque health effects than the smaller labels recommended in the United States, including one showing a fetus with the warning that smoking can cause spontaneous abortion.
In Ireland and Norway, Philip Morris subsidiaries are suing over prohibitions on store displays.
In Australia, where the government announced a plan that would require cigarettes to be in plain brown or white packaging to make them less attractive to buyers, a Philip Morris official directed an opposition media campaign during the federal elections last summer, according to documents obtained by an Australian television program, and later obtained by The New York Times.
The $5 million campaign, purporting to come from small store owners, was also partly financed by British American and Imperial Tobacco. The Philip Morris official approved strategies, budgets, ad buys and media interviews, according to the documents.
Mr. Nixon, the spokesman, said Philip Morris made no secret of its financing of that effort. “We have helped them, not controlled them,” he said.
Mr. Nixon said Philip Morris agreed that smoking was harmful and supported “reasonable” regulations where none exist.
“The packages definitely need health warnings, but they’ve got to be a reasonable size,” he said. “We thought 50 percent was reasonable. Once you take it up to 80 percent, there’s no space for trademarks to be shown. We thought that was going too far.”
These days in courts around the world, the tobacco giants find themselves on the defensive far more than playing offense. The W.H.O. and its treaty encourage governments and individuals to take legal action against cigarette corporations, which have encountered growing numbers of lawsuits from smokers and health care systems in Brazil, Canada, Israel, Italy, Nigeria, Poland and Turkey.
But in other parts of the world, notably Indonesia, the fifth-largest cigarette market, which has little regulation, tobacco companies market their products in ways that are prohibited elsewhere. In Indonesia, cigarette ads run on TV and before movies; billboards dot the highways; companies appeal to children through concerts and sports events; cartoon characters adorn packages; and stores sell to children.
Officials in Indonesia say they depend on tobacco jobs, as well as revenue from excise taxes on cigarettes. Indonesia gets some $2.5 billion a year from Philip Morris International alone.
“In the U.S., they took down billboards, agreed not to sponsor music events, no longer use the Marlboro cowboy,” said Matthew L. Myers, president of the Washington-based Campaign for Tobacco-Free Kids. “They now do all of those things overseas.”
The world’s second-biggest private cigarette maker, British American Tobacco, with $4.4 billion profits on $23 billion sales in the year ending June 30, is spending millions of dollars lobbying against anti-smoking health measures, like smoke-free air policies in the European Union.
A video on the company’s Web site says some of the proven methods of reducing smoking — like taxes and display bans — encourage a black market in cigarettes and that, in turn, would finance drug, sex and weapons traffickers and terrorists.
The six-minute video, in which actors play gangsters, one with an Eastern European accent, concludes, “Only the criminals benefit.”
The conference beginning on Monday in Punta del Este, Uruguay, will try to add specific terms to a public health treaty known as the Framework Convention on Tobacco Control, which since 2003 has been ratified by 171 nations. It would eventually oblige its parties to impose tighter controls on tobacco ingredients, packaging and marketing, expand cessation programs and smoke-free spaces and raise taxes — proven tactics against smoking.
President George W. Bush signed the treaty in 2004 but did not send it to the Senate, where a two-thirds vote is needed for ratification. President Obama hopes to submit it to the Senate next year, a White House spokesman said on Thursday.
One recommendation drawing fire from tobacco farmers would either restrict or prohibit the use of popular additives, like licorice and chocolate, to blended tobacco products that account for more than half of worldwide sales.
The International Tobacco Growers’ Association says that could threaten the makers of burley tobacco, an air-cured leaf that has long been sweetened with additives, costing millions of farmers their jobs and devastating economies worldwide.
“We all know the real objective here is to eliminate tobacco consumption,” says Roger Quarles, a Kentucky grower and president of the association.
Aubrey Belford contributed reporting.
This article has been revised to reflect the following correction:
Correction: November 14, 2010
An earlier version of this article made an incorrect reference to Uruguay's gross domestic profit rather than its gross domestic product.
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