The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released a slew of important new Obamacare rules and regulations today, continuing a widely expected post-election effort to successfully implement President Obama’s landmark health care reform law by 2014.

In a call with reporters, CMS and HHS outlined the new proposed rules, which instruct insurers, providers, and governmental institutions on how they must proceed in implementing Obamacare measures — ranging from a ban on discriminating against Americans with pre-existing medical conditions to public wellness initiatives such as coverage for employees’ gym use. Here are the three most important things you need to know about the new rules:

1) Insurers will be prohibited from discriminating against Americans with pre-existing conditions. Long considered one of the health insurance industry’s most odious practices, refusing to extend coverage to Americans suffering from a pre-existing medical condition will soon be a thing of the past. The first of CMS’s proposed rules mandates that insurance companies will need to base their premium rates solely on an individual’s age, family size, geography, and history of tobacco use — preventing discrimination against Americans for any other reason, such as their gender or their chronic illnesses. The rule will also set strict limits on how much insurers can vary the premiums they charge Americans based on these factors, marking an end to gender rating practices that charged women more than men for the same medical services. This will be a boon to the over 120 million Americans who suffer from a pre-existing condition in one form or another.

2) State exchanges will establish a standard of “essential health benefits” that every plan will be required to cover. Obamacare will require the plans offered under state-wide health insurance exchanges in 2014 to clear federal benchmarks across ten “essential health benefit” categories, including access to maternal care, mental health services, preventative health care, and prescription drug coverage. These assured benefits — which are supposed to reflect the level of coverage offered by a typical employer-sponsored plan — will help correct for spotty coverage that does not actually meet Americans’ medical needs. CMS’s proposed rule requires state exchanges to offer to the same level of coverage as a statewide benchmark health plan of the state’s choosing. If a state’s chosen benchmark plan does not cover all of Obamacare’s required benefit categories — for instance, by not offering mental health services — then the federal government will intervene and supplement that plan so that it does meet the health law’s coverage requirements. The rule also creates standards for prescription drug coverage so that such coverage actually meets Americans’ health care needs and prohibits health plans from designing their benefits in a way that discriminates against certain groups of Americans.

3) Wellness programs will help promote public health and curb health care costs. The last of the three proposed rules is joint guidance from HHS, the Treasury, and the Department of Labor regarding sponsorship of workplace wellness programs. Obamacare encourages preventative health initiatives and a transition from “sick care” to actual “health care” in an effort to both improve Americans’ quality of life and lower national health spending. Under the proposed rule, employers are encouraged to continue both participatory and health-contingent wellness programs — such as subsidizing the cost of employees’ fitness center memberships or enrolling employees in tobacco-cessation programs — in exchange for federal rewards.

These rules will give states more clarity as they move forward in implementing the Affordable Care Act. Although many Obamacare details must still be worked out — particularly regarding the statewide insurance exchanges — the reform law has made enormous strides in the last year that will result in a fairer, more accessible, and more affordable American health care system that is a marked improvement over the pre-Obamacare era. “It’s important to remember what this market looked like back in 2009… We were definitely headed in the wrong direction,” HHS Secretary Kathleen Sebelius said on the conference call.

A little more than a week after Mitt Romney lost his bid for the presidency, the prominent Republican tapped to head his transition is encouraging states to implement the Affordable Care Act, a law which Romney had pledged to eliminate on “day one” during the 2012 campaign.

Former Utah Gov. Mike Leavitt — who also served as Health and Human Services Secretary under President George W. Bush — had been helping states establish the law’s exchanges through his firm Leavitt Partners before being tapped for the high-profile transition job. And now, as Republican governors decide how to move forward with the law in the face of a second Obama term, Leavitt is “working to get states to create their own exchanges” — the new marketplaces that will connect consumers with insurance coverage by 2014. States have the option of establishing and administrating their own systems or outsourcing the task to the federal government.

The former Utah governor’s outfit, Leavitt Partners, argues that it will be a “bureaucratic nightmare” for states to deal with the federal government if they don’t have their own exchanges, that states would be giving up the power to design their own uniquely tailored systems if they default to the feds, and that they risk losing regulatory authority over insurers that operate in their states under the auspices of the federally designed exchange.

As of Friday, 19 states had indicated they would let the feds run their exchanges, 11 are still undecided, while 20 states and the District of Columbia “had announced they would set up exchanges partially or fully run by their states.”

Leavitt Partners is heavily invested in the law’s state-based exchanges and “has been advising companies and state legislatures on how to create exchanges.” The group hired former government officials who helped build the Utah exchange soon after the federal health law passed and its websites brags about its abilities to help clients implement the measure.

Health and Human Services (HHS) Secretary Kathleen Sebelius has given recalcitrant Republican governors extra time to decide whether or not to implement Obamacare in their states, extending the deadline for submitting their plans for health insurance exchanges until December 14. But some lawmakers are already prepared to announce their intentions. This week, Republicans governors in Maine, Wisconsin, and Ohio officially turned down the opportunity to design their own state-wide health exchanges.

And The Hill reports that House Speaker John Boehner (R-OH) is pleased with his home state’s decision to avoid setting up a health exchange, releasing a statement that praises Gov. John Kasich (R) for “resisting the federal takeover” of Ohio’s health care system:

BOEHNER: I’m proud of my governor, John Kasich, for taking a stand and resisting the federal takeover of healthcare in Ohio. By declining to implement a government-run ‘exchange’ and preserving Ohio’s ability to regulate health insurance on its own, Gov. Kasich is protecting Ohio families and small businesses from some of the steep costs and red tape created by ObamaCare.

In fact, states that choose not to set up a health exchange simply cede their control to the federal government, which will then step in and set up one for them. As The Hill points out, Kasich’s decision not to pursue his own exchange ensures that “the federal government will now have total control over all the functions of Ohio’s exchange, such as the number of plans that can participate and whether to impose requirements above and beyond those spelled out in the law.”

And regardless of the role the federal government will play in implementing state-wide exchanges, Obamacare is not a strain on families and small businesses. In reality, the health reform law represents a massive tax cut for the middle class. Studies have confirmed that Obamacare’s implementation is not causing business owners to drop their employees’ coverage, and the law may actually help reduce costs for small businesses.

During the Republican Governors Association conference last night, Maine’s Gov. Paul LePage (R) told reporters he’s “not lifting a finger” to institute a health insurance exchange for his state. In his official letter to the federal government, LePage explains that’s because he doesn’t want Maine to be “complicit in the degradation of our nation’s premier health care system.”

Maine was well on its way to implementing Obamacare before the 2010 election cycle gave the GOP control over the state legislature and governor’s office. But LePage has now confirmed that Maine will join the other Republican-controlled states that continue to resist Obamacare — even in the wake of the Supreme Court upholding the law and President Obama’s recent reelection:

On Wednesday, Gov. LePage signed the letter along with 20 other Republican governors that was sent to the Obama administration requesting more time and guidance.

On Thursday, however, LePage sent a letter to Health and Human Services Secretary Kathleen Sebelius saying the state would not create a state-run exchange and saying the health reform law “is a stepping stone to a single-payer system. Maine will not be complicit in the degradation of our nation’s premier health care system.”

Yesterday, Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline for states to inform HHS whether they intend to establish their own statewide exchange, in an attempt to offer the 20 Republican governors the time they requested. If states like Maine choose not to set up an exchange, the federal government will step in and do it for them. And the Portland Press Herald reports that Maine lawmakers from both sides of the aisle are now bemoaning the wasted opportunity to build an insurance marketplace that specifically fits Maine’s needs, since LePage’s refusal to implement an exchange ensures that those decisions will now simply be turned over to the federal government.

As opposed to LePage’s assertion that health care reform would “degrade” what is already a “premier health care system,” six out seven doctors agree that the United States’ current health system isn’t working, largely because of the country’s high rates of uninsurance. Setting up state exchanges and expanding state-run Medicaid programs under Obamacare would help work toward expanding health insurance to the Americans who are currently uninsured.

Even though House Speaker John Boehner (R-OH) has acknowledged that Obamacare is the “law of the land,” nine state lawmakers in Wisconsin are hoping to ensure that President Obama’s health reform law won’t ever be implemented in their state. The group of Tea Party-affiliated Republicans is backing a bill that would arrest any federal officials who attempt to implement Obamacare in Wisconsin.

The state officials responded to a survey from the right-wing advocacy group Campaign for Liberty to confirm they would support “legislation to nullify ObamaCare and authorize state and local law enforcement to arrest federal officials attempting to implement the unconstitutional health care scheme known as ObamaCare.” As the Journal Sentinel reports, the nine lawmakers who say they would back such a bill remain unconvinced of the health law’s constitutionality:

Rep. Chris Kapenga (R-Delafield) is one of the nine from Wisconsin who told the Campaign for Liberty he would back legislation to declare Obamacare illegal and allow police to arrest federal officials who take steps to implement it in Wisconsin. He said he believes the health care law is unconstitutional, despite the U.S. Supreme Court’s ruling that it passes constitutional muster.

“Just because Obama was re-elected does not mean he’s above the constitution,” Kapenga said.

Another one of the state lawmakers who responded to Campaign for Liberty’s survey, Rep. Don Pridemore (R-Hartford), said he would also support legislation preventing his governor from setting up a health exchange in the state without first getting approval from the state legislature — similar to a ballot initiative that passed last week in Missouri. “That seems reasonable,” Pridemore told the Journal Sentinel. “It was making a statement to the federal government that we don’t want Obamacare.”

Under the health reform law, states that refuse to set up their own health insurance exchanges simply cede their control to the federal government, which will step in and set up an exchange for them.

The Campaign for Liberty promotes a “tenther” vision of the Constitution that would allow conservative states to reject federal laws they disagree with, though Wisconsin is still required to follow federal laws like Obamacare.

Now that the election is over and Obamacare is here to stay, states are facing rapidly approaching deadlines for some of the health law’s provisions. But since many Republican governors resisted working toward Obamacare’s key state-level reforms in the hopes that Mitt Romney would win the presidency and repeal the health law, they are now caught in a position where they haven’t done their homework — and many of them don’t have enough time to catch up before the November 16th deadline for submitting their health exchange plans.

In the interest of encouraging states to work out the best plans for their residents, however, the Obama Administration will give those recalcitrant governors a little more time. The Department of Health and Human Services has announced that states will have until December 14th to submit their detailed plans for state-level health exchanges, although they will still have to declare their intentions to form an exchange by this Friday.

“This administration is committed to providing significant flexibility for building a marketplace that best meets your state’s needs,” HHS Secretary Kathleen Sebelius wrote. “We have heard from many states that additional time would allow you to submit a more comprehensive, complete blueprint application for your exchange.”

Nevertheless, at least five Republican governors have already stated their intention to block Obamacare’s implementation in their states, and continue to refuse to set up their health exchanges or expand their Medicaid programs. Lawmakers like Florida Gov. Rick Scott (R) are being pressured to reconsider their positions and cooperate with Obamacare to extend coverage to their state’s low-income residents — but if intransigent governors continue to resist the health reform law, Obamacare won’t be able to operate as it was intended, potentially falling short of its goal to extend coverage to roughly 30 million previously uninsured Americans.

The Obama administration may be facing an uphill battle, since last week’s election results ensure that Republican governors will control 30 states by next year.

President Obama’s re-election confirms his landmark health care reform isn’t going anywhere, but Republican lawmakers will likely continue their attempts to undermine Obamacare even if they no longer push for an full repeal of the law. In fact, uncompromising Republican governors will likely keep preventing Obamacare from taking effect in their states by standing firm in their resistance to setting up health exchanges and expanding Medicaid.

As Politico points out, whether or not the health reform law is able to operate as it was intended — and expand coverage to about 30 million previously uninsured Americans — largely depends on the extent that governors agree to cooperate in their states. But some Republican governors have already made it clear that they don’t plan on playing nice during Obama’s second term:

Bob McDonnell (R-VA)

McDonnell acknowledged that federal health reform is inevitable now that Obama has been re-elected — but that doesn’t mean he’s ready to cooperate. McDonnell confirmed that Virginia will not be setting up its own health exchange and will continue to refuse to participate in the expansion of the Medicaid program. “I don’t want to buy a pig in a poke for the taxpayers of Virginia,” he said on Wednesday.

Nathan Deal (R-GA)

On Thursday, Deal said his state still doesn’t want any part of Obamacare during the president’s second term and likely won’t work toward setting up its own health exchange. “We’ve pretty well indicated that we don’t like the way that the program has evolved,” he said. Unfortunately for his state’s low-income residents, Deal doesn’t plan to expand the Medicaid program in Georgia either.

Sam Brownback (R-KS)

Brownback chose to put off the decision about setting up a health exchange until after the election, in hopes that a Romney win would eliminate the need to implement Obamacare in his state. But now that the future of the health reform law is secure, Brownback noted on Thursday that he still won’t cooperate with the federal government. “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could costs Kansas taxpayers millions of dollars,” Brownback said in a statement.

Rick Scott (R-FL)

Even before the election, Scott made it clear that he wouldn’t set up a health exchange or expand Medicaid in his state. And now that Obama has won a second term, he is holding firm in his opposition to heath care reform, even though Florida has some of the highest rates of uninsurance in the nation. On Wednesday, Scott confirmed that Obama’s re-election doesn’t change anything for him.

Nikki Haley (R-SC)

Like Scott, Haley announced her intention to opt out of both a state-run health exchange and the expansion of the Medicaid program during Obama’s first term. And her administration is showing no signs of changing course now that the election is over. On Thursday, South Carolina’s Department of Health and Human Services director Tony Keck reiterated that the state will not be pursuing its own exchange. “We’ve let them know we’re not going to set up a state-based exchange. It’s a federal program and it’s their responsibility to make it work,” Keck said.

President Obama’s re-election this week solidified the fact that his landmark health care reform law will be sticking around. Even conservative health policy analysts are beginning to admit defeat, acknowledging that their long fight to repeal Obamacare is certainly a losing battle. But when it comes to effectively implementing Obamacare across states to ensure that 30 million previously uninsured Americans have access to health care by 2014, intransigent Republican governors could still stall the process by continuing to resist key pieces of the health care law.

Over the past year, GOP lawmakers have continually resisted two of Obamacare’s important state-level provisions: setting up state-run health insurance exchanges and expanding the eligibility threshold for the Medicaid program. At least eight governors insisted on putting off their decisions about implementing Obamacare after the presidential election, just in case a Romney win would have eliminated the need for them to cooperate with the health law. But as Wonkblog’s Sarah Kliff notes, that excuse has run out and those lawmakers now need to take a different approach:

In the wake of President Obama’s reelection, and with the Affordable Care Act’s future secured, Republican-led states are scrambling to figure out what comes next for the law they squarely oppose.

“The folks who need to restrategize at this point are going to be the Republican governors, for the most part,” says Cheryl Smith, a director at Leavitt Partners, the health consulting firm founded by former Health and Human Services Secretary Michael Leavitt.

“They can’t just say no anymore. They have to accept that the Supreme Court ruling was what it was, and that the status quo is not sustainable.”

Nonetheless, some Republican governors are already digging in their heels. Gov. Rick Scott (R-FL) — one of Obamacare’s most vocal critics, despite the fact that his state has some of the highest rates of uninsurance in the nation — has already said that Obama’s re-election doesn’t change anything for him. Scott will not change his decision to reject the Medicaid expansion, denying health coverage to 1 million low-income Floridians who could have otherwise accessed the program, and he plans to continue avoiding setting up a federal exchange.

On Tuesday, voters in Florida actually rejected a meaningless anti-Obamacare ballot initiative that would have attempted to prohibit individuals and employers from participating in a health exchange under the law. And when it comes to Medicaid, nearly two-thirds of white Southerners in states like Florida actually support expanding the program. But for stubborn GOP lawmakers like Scott, resisting Obamacare is a matter of partisan principle rather than following through with the policies that voters support. In the upcoming weeks, Scott’s fellow Republican governors will need to decide where they fall.

One of the biggest victories in last night’s election went to President Obama’s landmark health reform law. Now that the Supreme Court has upheld the vast majority of the law and the president has been reelected, Obamacare is here to stay — and the upcoming months and years will see a flurry of major changes to the U.S. health care system aimed at protecting American consumers.

Although certain Obamacare measures — such as allowing young adults to remain on their parents’ insurance until the age of 26 and requiring insurance companies to use 80 percent of their premiums for actual health care rather than their own profits — have already been implemented, the bulk of the law will go into effect over the next two years. Here’s what Americans can expect to see from Obamacare in the near future, and what it means for their health and financial security:

1) Statewide health insurance exchanges. States will soon decide whether to institute their own insurance exchanges, an exchange operated jointly with the federal government, or one run entirely by the federal government. And in 2014, those exchanges will allow individual Americans, small businesses, and eventually large businesses to purchase insurance on large marketplaces where they can leverage their purchasing power to get more affordable coverage. Plans under these exchanges must meet federal benchmarks across ten essential benefit categories, including maternal care and mental health services, helping to provide Americans with affordable insurance options that actually meet their medical needs. Members of Congress must also purchase their insurance plans from these exchanges starting in 2014.

2) An end to insurance company discrimination against Americans with pre-existing conditions. While Obamacare has already barred insurance companies from denying insurance to children with pre-existing conditions, this highly popular consumer protection will be extended to all Americans by January 2014. This means that Americans suffering from a host of genetic and chronic ailments that are completely beyond their control will no longer be relegated to expensive and inefficient high-risk pools, or be forced to forego critically needed health coverage entirely.

3) Prohibitions on lifetime and annual benefit caps. Also beginning in 2014, insurers will be completely prohibited from imposing lifetime and annual benefit caps on Americans. The provision will give much-needed peace of mind to Americans who require constant or expensive medical care due to a critical or ongoing health condition. During this year’s Democratic National Convention in Charlotte, speaker Stacy Lihn spoke movingly about how her young daughter — who suffers from a congenital heart defect — would have gone through half her lifetime benefit cap by the time she was six-months-old if it were not for Obamacare protections. Soon, all Americans will share in that potentially life-saving security.

4) Increased access to affordable contraception. Obamacare’s contraception mandate requiring employer-based insurance plans to cover contraception without a co-pay — a provision that studies have shown to benefit low-income women and reduce abortion rates — went into effect this past August. But the health law granted religious institutions some extra time to prepare for the birth control mandate. That time runs out in August 2013, when religious organizations will start implementing this aspect of the law through a workaround that shifts the cost of birth control services onto insurance companies.

5) Employer incentives for offering workers health care benefits. A little more than a year from now, Obamacare will require all employers with 50 or more full-time employees to provide workers with health benefits or risk paying a $2,000 per employee fine. Although 70 percent of Americans receive employer-sponsored health insurance, companies have been steadily shifting the cost of care onto their employees. Studies have shown that Obamacare’s employer mandates will actually lower health spending for small businesses and only modestly increase large companies’ health care costs, all while substantially helping low-wage and working Americans receive the affordable health coverage they need.

These are only some of the provisions that will eventually be in place under Obamacare. In order to actually deliver on the promise of affordable, quality coverage for all Americans, lawmakers on both the state and federal level must quickly begin laying the groundwork for Obamacare’s implementation. With last night’s affirmation of President Obama’s reform policies, Americans will soon experience first-hand the numerous landmark protections and benefits of Obamacare that have only existed in abstract terms up until now.

While today’s elections include several landmark statewide initiatives ranging from marriage equality to marijuana legalization, five states have also tacked purely symbolic measures onto their ballots purely to oppose Obamacare.

The Washington Post’s Sarah Kliff notes that — despite federal law’s supremacy over state law, and despite the fact that the Supreme Court upheld Obamacare’s constitutionality this summer — five states’ ballots include measures to invalidate Obamacare provisions. Wyoming’s Amendment A, Florida’s Amendment 1, Alabama’s Amendment 6, and Montana’s Measure LR-122 would all prohibit state residents and employers from being forced to purchase insurance or participate in any externally-imposed health care system. In Missouri, Proposition E seeks to prevent the state from instituting its own health insurance exchange.

But even if any of the first four measures to amend those states’ constitutions passed, all Americans would still be subject to federal Obamacare provisions, including the individual and employer mandates. And Obamacare already accounts for states that choose not to create their own statewide exchanges by requiring the federal government to set up “federally-facilitated exchanges” for them in 2014.

All five initiatives are totally ineffective, amounting to little more than political posturing against President Obama’s health reform law.