| The federal health care reform legislation, known as | | | | disabled individuals to stay in their homes or cover |
| the Patient Protection and Affordable Care Act, signed | | | | nursing home costs. Benefits would start five years |
| by the President on March 23, 2010, and the Health | | | | after people begin paying a fee for coverage. |
| Care and Education Reconciliation Act approved by | | | | * Funding for community health centers would be |
| Congress, signed by the President today, will expand | | | | increased to provide care for many low income and |
| the availability of health care coverage to millions of | | | | uninsured people. |
| Americans. While some of the measures will be | | | | 2012 |
| implemented this year, many do not take effect until | | | | * Hospitals, physicians, and payers would be |
| 2014 and some extend out to 2020. | | | | encouraged to band together in "accountable care |
| Below is a high-level overview of the timeline. It is | | | | organizations." |
| important to note that many of these reforms and | | | | * Hospitals with high rates of preventable readmissions |
| their effective dates are subject to the rules and | | | | would face reduced Medicare payments. |
| regulations process both at the state and federal | | | | 2013 |
| levels – which could alter the intended timing of | | | | * Individuals making $200,000 a year or couples making |
| implementation. | | | | $250,000 would have a higher Medicare payroll tax of |
| 2010 | | | | 2.35% on earned income —up from the current |
| New Programs:* Temporary retiree reinsurance | | | | 1.45%. A new tax of 3.8% on unearned income, such |
| program is established | | | | as dividends and interest, is also added. |
| * National risk pool is created, small business tax credit | | | | * Medical expense contributions to flexible spending |
| is established | | | | accounts (FSAs) limited to $2,500 a year—indexed |
| * $250 rebate for Medicare members who reach the | | | | for inflation. In addition, the thresholds for claiming |
| "doughnut hole" | | | | itemized tax deduction for medical expenses rise from |
| Insurance Reforms:* Prohibits lifetime benefit limits – | | | | 7.5% to 10% of income. |
| based on dollar amounts | | | | * Medical device manufacturers would have a 2.9% |
| * Allows restricted annual limits on the dollar value of | | | | sales tax on medical devices; devices such as |
| certain benefits | | | | eyeglasses, contact lenses, and hearing aids would be |
| * Coverage rescissions/cancellations are prohibited | | | | exempt. |
| (except for fraud or intentional misrepresentation) | | | | * Eliminates deduction for expenses allocable to |
| * Cost-sharing obligations for preventive services are | | | | Medicare Part D subsidy for employers who maintain |
| prohibited | | | | prescription drug plans for their Medicare Part D eligible |
| * Dependent coverage up to age 26 is mandated | | | | retirees. |
| * Internal and external appeal processes must be | | | | 2014 |
| established | | | | Coverage Mandates & Subsidies: |
| * Pre-existing condition exclusions for dependent | | | | * Individual and employer coverage responsibilities are |
| children (under 19 years of age) are prohibited | | | | effective. |
| * New health plan disclosure and transparency | | | | * Individual affordability tax credits are created and |
| requirements are created | | | | small business tax credits are expanded. |
| 2011 | | | | Health Insurance Exchange & Insurance Reforms: |
| Insurance Reforms: | | | | * State individual and small group health insurance |
| * Uniform coverage documents and standard | | | | exchanges operational. |
| definitions are developed | | | | * Guaranteed issue, guaranteed renewability, modified |
| * Minimum medical loss ratios are mandated | | | | community rating and minimum benefit standards |
| Medicare Reforms:* Medicare Advantage cost sharing | | | | ("essential benefits" plan) effective. |
| limits effective | | | | * Lifetime and annual dollar limits are prohibited for |
| * Medicare beneficiaries who reach the doughnut hole | | | | essential benefits. |
| will receive a 50% discount on brand name drugs | | | | * Pre-existing condition exclusions are prohibited. |
| * A 10% Medicare bonus will be provided to primary | | | | Taxes & Fees:* Addition of new taxes on health |
| care physicians and general surgeons practicing in | | | | insurers |
| underserved areas, such as inner cities and rural | | | | Medicaid and Medicare Reform:* Medicaid expanded |
| communities. | | | | to cover low income individuals under age 65 up to |
| * Medicare Advantage plans would begin to have their | | | | 133% of the federal poverty level—about $28,300 |
| payments frozen. | | | | for a family of four. |
| Other:* Employers are required to report the value of | | | | * Minimum medical loss ratio of 85% required for |
| health care benefits on employees' W2 tax | | | | Medicare Advantage plans |
| statements. | | | | 2018 |
| * Annual industry fee for pharmaceutical | | | | Taxes & Fees:* Tax ("Cadillac tax") imposed on |
| manufacturers of brand name drugs. | | | | employer sponsored health insurance plans that offer |
| * Voluntary long term care insurance program would | | | | policies with generous levels of coverage. |
| be made available to provide cash benefit for assisting | | | | |