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Health Care Reform Timeline

The Affordable Care Act (ACA) affects everyone — healthcare providers and facilities, employers, individuals, and insurance health plans such as Optima Health. The information in this timeline on key ACA regulations and programs will help you gain a better understanding of all the changes taking place over several years.

Provisions by Year

  • 2010

    • The Affordable Care Act Becomes LawEmployersIndividualsHealth PlansHospitals

      Implementation: March 23, 2010

      President Obama signs the Patient Protection and Affordable Care Act (also known as Health Reform). It is a law with many changes that happen over several years. The goal is to make quality healthcare available and affordable for all.

    • Small Business Health Insurance Tax Credit PhaseEmployers

      Implementation: 2010

      Small for-profit and not-for-profit organizations can receive a tax credit to help them provide health benefits to their employees. The total credit can be as high as 35 percent of for-profit employer’s contribution toward the annual premium and 25 percent for small non-profit organizations.

    • More People Covered Under MedicaidIndividuals

      Implementation: April 1, 2010

      The federal government gives states matching money so they can cover “some additional low-income individuals and families under Medicaid for whom federal funds were not previously available.”

    • Early Retiree Reinsurance Program (ERRP) Employers

      Implementation: June 1, 2010

      The government provides $5 billion in financial help. The money allows some early retirees to keep their employee-based health plans until Medicare or exchange plans are available.

    • Pre-Existing Condition Insurance PlanIndividuals

      Implementation: July 1, 2010

      States or the Department of Health and Human Services offers the plan. People without a health plan for at least six months because of pre-existing conditions qualify for the plan until 2014. In 2014, the government prohibits all discrimination against pre-existing conditions.

    • Consumer Information Available at Healthcare.govEmployersIndividuals

      Implementation: July 1, 2010

      HealthCare.gov gives people information on health plans and helps them pick a plan that works for them.

    • Extension of Adult Child Coverage Until Age 26EmployersIndividuals

      Implementation: September 23, 2010

      In many cases, young adults can stay on their parent’s health plan until age 26. Employees should check with their employers for details.

    • Preventive Care Services with No Cost SharingEmployersIndividuals

      Implementation: September 23, 2010

      New health plans must cover some preventive services, such as mammograms and colonoscopies, without charging a Deductible, Copayment, or Coinsurance.

    • Prohibiting Rescission of CoverageHealth PlansIndividuals

      Implementation: September 23, 2010

      Health plans cannot search enrollees’ applications for errors and use mistakes to deny payments.

    • Introducing Initial Appeal Review StandardsHealth PlansIndividuals

      Implementation: September 23, 2010

      Consumers have a way to appeal health plan decisions. The government also provides an external process they can use to have decisions reviewed.

    • Elimination of Lifetime LimitsEmployersIndividuals

      Implementation: September 23, 2010

      Health plans cannot set lifetime dollar limits on essential benefits.

    • Regulation of Annual Insurance Coverage LimitsEmployersIndividuals

      Implementation: September 23, 2010

      New health plans in the individual market and all group health plans cannot set yearly dollar limits on a person’s coverage. In 2014, they cannot set yearly limits on essential benefits.

    • Prohibiting The Denial of Coverage for Children with Pre-Existing ConditionsEmployersIndividuals

      Implementation: September 23, 2010

      New plans and existing group plans must cover children under age 19 with pre-existing conditions.

    • Holding Insurers Accountable For Premium IncreasesHealth Plans

      Implementation: 2010

      States that require health plans to justify premium increases can apply for grants. Plans with excessive or unjustified premium increases could be excluded from exchanges in 2014.

    • Primary Care Workforce RebuildIndividuals

      Implementation: 2010

      Scholarships and favorable loan repayment plans are available for primary care doctors, nurses, and physician assistants working in underserved areas. Some repayment programs make loan payment amounts tax free.

    • Consumer Assistance ProgramsIndividuals

      Implementation: 2010

      With federal funding, states provide ombudsmen to help people understand health plans and related legal concerns.

    • Prevention and Public Health FundIndividuals

      Implementation: March 23, 2010

      The fund is dedicated to improving people’s health. It provides money for public prevention and health programs.

    • Community Health Center FundingIndividuals

      Implementation: 2010

      The federal government provides funding to expand health centers and care for nearly 20 million new patients.

  • 2011

    • Medicare Part D “Donut Hole” Drug CoverageIndividuals

      Implementation: January 1, 2011

      People reaching the coverage gap with Medicare Part D receive a 50 percent discount on covered brand-name drugs and a 7 percent discount on generic drugs while in the Donut Hole. The discounts increase until 2020 when the gap is closed.

    • Medical Loss RatioEmployersHealth PlansIndividuals

      Implementation: January 1, 2011

      Health plans report the percentage of premiums paid for medical claims and efforts to improve the quality of care. The percentage must be at least 80 percent for individual and small group plans and at least 85 percent for others. Health plans pay rebates if they do not meet the requirements.

    • Center for Medicare and Medicaid InnovationIndividuals

      Implementation: January 1, 2011

      The center looks for new ideas to lower costs and improve the quality of care.

    • Community Care Transitions ProgramIndividuals

      Implementation: January 1, 2011

      The program tests ways to improve transitions from hospitals to other medical care centers. It also tests ways to reduce hospital readmissions for high-risk Medicare recipients.

    • FSA/HSA/HRA ChangesIndividuals

      Implementation: January 1, 2011

      Unless they have a prescription, buyers cannot be reimbursed through a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA) for over-the-counter medications. Also, people making non-qualified HSA withdrawals will be taxed at 20 percent.

    • Community First Choice OptionIndividuals

      Implementation: October 1, 2011

      States can give Medicaid recipients with disabilities care at home, and use community-based attendant services instead of in an institution.

    • Non-Discrimination Rules for Insured Plans Section 105 (h)Health PlansIndividuals

      Implementation: 2011

      Employers cannot offer certain employees, such as those earning high salaries, extra health plan benefits or lower health plan costs.

  • 2012

    • Accountable Care Organizations (ACO)Health PlansIndividuals

      Implementation: January 1, 2012

      Healthcare providers and health plans work together to improve health, affordability, and patients’ experiences. The groups focus on primary care and are accountable for results. The government can reward the groups for lowering costs and improving quality.

    • Women’s Preventive Services at No Cost SharingEmployersIndividuals

      Implementation: August 1, 2012

      Health plans offer more women’s preventive services, such as well-women visits and contraception, with no cost to the patient.

    • Uniform Summary of Benefits and Coverage and GlossaryHealth PlansIndividuals

      Implementation: September 23, 2012

      All health plans share details of their benefits on a standard Summary of Benefits and Coverage (SBC) form. The form includes a glossary of terms. The information makes it easy to compare health plans.

    • Value-Based Purchasing ProgramHospitals

      Implementation: October 1, 2012

      The Center for Medicare and Medicaid Services rewards hospitals for the quality of care they provide to Medicare recipients. Successful hospitals follow best clinical practices and improve patients’ experiences.

    • Patient-Centered Outcomes Research FeeEmployersHealth Plans

      Implementation: October 1, 2012

      Health plans pay a fee for research to determine best care practices.

  • 2013

    • Open Enrollment in the Health Insurance MarketplaceEmployersIndividuals

      Implementation: October 1, 2013

      Small businesses and individuals may buy affordable health insurance that meets new government standards. The benefits start as early as January 1, 2014.

    • Administrative SimplificationEmployersIndividualsHealth PlansHospitals

      Implementation: 2013

      Health plans and certain health providers complete paperwork and electronic transactions the same way. With everyone working alike, the process is easier and costs less.

  • 2014

    • Health Insurance MarketplaceEmployersIndividuals

      Implementation: January 1, 2014

      Health insurers offer affordable plans for small businesses and individuals. The health plans meet new requirements set by the government. Small businesses and individuals choose their plans.

    • Medicaid ExpansionIndividuals

      Implementation: January 1, 2014

      People making less than 133 percent of the Federal Poverty Level would be eligible for Medicaid. The limits are approximately $14,000 for an individual and $29,000 for a family of four annually. States receive money from the federal government to support the expanded coverage.

    • Health Insurance Subsidies for Qualified IndividualsIndividuals

      Implementation: January 1, 2014

      People with incomes between 100 and 400 percent of the poverty level may receive tax credits. These credits help lower the cost of health insurance premiums. People might also qualify for lower Copayments, Deductibles, and Coinsurance.

    • Elimination of Annual Limits on Health Insurance CoverageEmployersIndividuals

      Implementation: January 1, 2014

      New health plans and existing group plans cannot limit how much they pay for a person’s health bills each year.

    • Guaranteed IssueHealth PlansIndividuals

      Implementation: January 1, 2014

      Health insurers allow everyone to buy insurance — regardless of their health or past medical conditions.

    • Small Business Health Insurance Tax Credit Phase IIEmployers

      Implementation: January 1, 2014

      Employers who qualify can receive tax credits when they pay for at least half of the cost of employees’ health insurance premiums. The credit may be as high as 50 percent of the premium costs and up to 35 percent for small non-profit organizations.

    • Wellness Program RequirementsEmployersIndividuals

      Implementation: January 1, 2014

      The government encourages wellness programs. The programs are open to all employees, regardless of their health. They can be linked to health insurance discounts. Any rewards linked to specific health goals must also be linked to alternative goals to include as many people as possible.

    • Essential Health BenefitsEmployersHealth PlansIndividuals

      Implementation: January 1, 2014

      Non grandfathered health insurance plans in the individual and small group markets must offer the following 10 essential benefits:

      • ambulatory patient services;
      • emergency services;
      • hospitalization;
      • maternity and newborn care;
      • mental health and substance use disorder services, including behavioral health treatment;
      • prescription drugs;
      • rehabilitative and habilitative services and devices;
      • laboratory services;
      • preventive and wellness services and chronic disease management; and
      • pediatric services, including oral and vision care.
    • Health Insurer FeeEmployersHealth Plans

      Implementation: January 1, 2014

      Health insurers pay an annual fee to fund federal and state health exchanges. The government predicts total fees for 2014 at $8 billion.

    • Transitional Reinsurance ContributionEmployersHealth Plans

      Implementation: January 1, 2014

      Health insurers pay an annual fee for three years. The fees help cover high-risk individuals’ healthcare. The government predicts total fees for 2014 to 2016 at $25 billion.

    • Deductible Caps on Health Insurance PlansEmployersIndividuals

      Implementation: January 1, 2014

      Individual and small businesses (2-50 employees) health plans limit yearly costs, including Deductibles, Copayments, and Coinsurance. The limit equals the Health Savings Account Plan limit, about $6,350 for a single-person and $12,700 for a family in 2014. Individuals and families meeting income levels and purchasing certain health plans can limit their costs further.

    • Individual MandateIndividuals

      Implementation: January 1, 2014

      Most everyone will be required to have health insurance or pay a penalty. This includes employer-sponsored coverage, individual coverage, or a government program such as Medicare or Medicaid.

    • Mandatory Coverage for Clinical TrialsEmployersIndividuals

      Implementation: January 1, 2014

      Insurers cannot cancel or limit coverage because a person is part of a clinical trial treating a life-threatening disease.

    • Removal of Pre-Existing Conditions ExclusionsEmployersHealth PlansIndividuals

      Implementation: January 1, 2014

      Insurers must offer coverage to everyone, even people with health conditions.

    • Rating RestrictionsEmployersHealth PlansIndividuals

      Implementation: January 1, 2014

      Health insurers can only consider geographic area, age, and tobacco use when setting prices. Rating restrictions limit how much insurers are allowed to adjust rates based on these factors.

    • Waiting Period LimitsEmployersIndividuals

      Implementation: January 1, 2014

      An employer waiting period cannot exceed 90 days from date of hire.

  • 2015

    • Employer Mandate (100+ employees)Employers

      Implementation: January 1, 2015

      Employers with 100 or more full-time employees and equivalents must offer affordable health insurance coverage or pay a penalty.

    • Physician Payments Based on Quality of CareIndividuals

      Implementation: January 1, 2015

      Medicare providers are paid differently by the Centers for Medicare and Medicaid Services (CMS). CMS bases payments on the quality of care instead of the quantity.

    • Exchange Opens to CHIP Eligible IndividualsIndividuals

      Implementation: 2015

      Each state has an exchange, a group of insurers who offer affordable health insurance. People with the Children’s Health Insurance Program (CHIP) may use the exchange.

  • 2016

    • Employer Mandate (50-99 employees)Employers

      Implementation: 2016

      Employers with 50-99 or more full-time employees and equivalents must offer health insurance to its full-time employees or pay a penalty.

    • Exchange Opens to Employers with 51-100 EmployeesEmployers

      Implementation: 2016

      Employer groups with 100 or fewer employees may purchase health plans from the Small Business Health Options Program (SHOP). Previously, only employer groups with 2-50 employees were eligible.

  • 2017

    • Exchange Opens to all Fully Insured EmployersEmployersIndividuals

      All employers with fully insured health plans may now purchase group plans for their employees through the Exchange (pending state approval).

  • 2018

    • High-Value Plan Excise Tax (Cadillac Tax)EmployersIndividuals

      Employers pay a tax if their health insurance is high priced -- over $10,200 for an individual or $27,500 for a family annually. The plans include features, such as low or no Copayments and no Deductibles that promote over-using medical care.