Health Reform Timeline - Year-by-Year Implementation
Updated March 08, 2014.
Virtually all Americans will be affected in some way with the enactment of the Patient Protection and Affordable Care Act, which President Obama signed into law on March 23, 2010.
How you are impacted personally depends on how the fine details of the legislation are implemented. Your age, employment status, income, current insurance coverage, and health status can all influence how the health reform legislation may have an effect on you and your family.
The actual bill signed into law fills more than 1,000 pages and details a set of immediate health insurance benefits along with a plan for rolling out additional benefits over a four-year period and beyond.
The following timeline highlights some of the legislation’s specific provisions and an outline of when these requirements are scheduled to be implemented.
2010 – Immediate Impact of Health Reform
Updated March 08, 2014.
State Based High Risk Pools: Establish a state-based, high-risk pool program to offer health insurance to people with pre-existing medical conditions who have been denied coverage. This temporary program will be funded from July 1, 2010 through January 1, 2014 when state-based and regional health insurance exchanges will be available.
Extension of Coverage for Young Adults: Your health plan is required to allow your children to stay on your family policy until age 26 – unless your young adult is eligible for employer health coverage.
(Starting October 2010)
No Lifetime Limits on Coverage: Your health plan cannot impose any lifetime limits on your benefits. (Starting October 2010)
Protection from Cancellation of Your Existing Coverage: Your health plan cannot cancel your insurance when you file a claim, except if you have committed fraud or misrepresent facts about your health. (Starting October 2010)
No Pre-existing Coverage Exclusions for Your Children: Children with pre-existing conditions may not be denied access to your health plan and your health insurer will not be allowed to insure your child, but exclude treatments for your child's pre-existing condition. (Starting September 2010)
Free Prevention Benefits: All new health plans must offer prevention and wellness benefits. Additionally, your health plan cannot charge any out-of-pocket expenses – such as deductibles and copayments – for these services. (Starting October 2010)
Small Business Tax Credits: This provision offers tax credits to small businesses to make health coverage for employees more affordable.
Initially, a tax credit of up to 35% of the cost of health insurance premiums will be available to eligible employers that choose to offer coverage. (Starts with passage of the bill)
Medicare Drug Benefit Rebate: If you are enrolled in a Medicare Part D plan and hit the donut hole in 2010, you may receive a $250 rebate check. (Starts with passage of the bill)
Increasing the Number of Primary Care Providers: Funds will be made available for training programs to increase the number of available primary care doctors, nurses, and public health professionals. (Effective during 2010)
Expand Community Health Centers: The federal government will invest $11 billion over five years to expand Community Health Centers. This should improve access to primary care services in communities where it is needed most. (Starting in 2010)
2011
Updated March 08, 2014.
2012
Updated March 08, 2014.
Medicare will start to reduce payments to hospitals by a certain percentage if those hospitals have too many preventable hospital readmissions. This may help to improve quality of care for seniors as hospitals would be more likely to find ways to help individuals stay well after a hospital discharge.
The federal government will create the Medicare Independence at Home demonstration program, which will allow healthcare professionals to provide primary care services in the homes of Medicare beneficiaries who are at high need.
The professionals will be able to share in the savings by preventing hospitalizations and other expensive services.
Medicare will establish a hospital "value-based" program to pay hospitals according to how well they perform on quality measures established by Medicare.
Medicare will start to provide bonus payments to high–quality Medicare Advantage plans.
The government will create new demonstration projects in Medicaid to find more cost-effective ways to provide high-quality health care, including:
2013
Updated March 08, 2014.
In addition to the 50% discount on brand-name drugs started in 2011, Medicare will begin phasing-in an additional federal subsidy for brand-name prescription drugs filled in the Part D coverage gap (by 2020 this discount will be an additional 25%).
Similar to the project for Medicaid started in 2012, Medicare will establish a national Medicare pilot program to develop and evaluate paying a bundled payment for a Medicare beneficiary’s episode of care, including inpatient hospital services, physician services, outpatient hospital services, and care after a hospitalization.
The federal government will provide funds to the states to increase payments to primary care doctors, including family physicians, internal medicine physicians, and pediatricians. This may make it easier for you and other people enrolled in Medicaid to find a primary care physician. These additional funds will be available in 2013 and 2014.
To help make sure that all health providers are making decisions in the best interest of their patients, the government will require the disclosure of financial relationships between physicians, hospitals, pharmacists, other providers, and companies that produce and distribute medications, medical devices, and medical supplies.
If you itemize income tax deductions on Schedule A, effective January 1, 2013 the threshold for the itemized deduction for your medical expenses will be increased from 7.5% of adjusted gross income to 10% of adjusted gross income. This increase will be waived if you are 65 or older for tax years 2013 through 2016.
Also effective in 2013, if you earn more than $200,000 a year as an individual or $250,000 as a couple, you will see an increase in your income-related taxes, including:
2014 - Health Coverage Mandates and Health Insurance Exchanges
Updated March 08, 2014.
All U.S. citizens and legal residents will be required to have “qualifying” health insurance, which includes coverage through your job, a government plan (such as Medicaid, Medicare, Veterans Administration, and the Armed Services), or a health plan you have purchased on your own.
If you don’t have health insurance, you will pay a tax penalty that will be phased-in starting in 2014 with a fine of $95.
In 2015, the penalty will increase to $325, and in 2016 to $695 or a percentage of your taxable income. After 2016, your penalty will be increased every year according to the changes in the cost of living.
Companies with more than 200 employees will be required to routinely enroll their employees into health plans offered by the employer. Any employee may opt out of coverage.
A company with more than 50 employees that does not offer health coverage will be fined $2,000 per full-time employee. The first 30 employees are excluded from this assessment.
Update: Implementation of the employer insurance mandate has been delayed until January 1, 2015.
Beginning on January 1, 2014 health insurance exchanges will be created where an individual or small business (up to 100 employees) can compare the costs of various health plans and different types of health coverage benefits. The purpose of the health insurance exchanges is to make health insurance more affordable and easier to purchase for small business and individuals.
Health plans will be required to both issue and renew your policy regardless of any pre-existing health conditions. What you pay for your monthly premium can vary based only on your age, where you live, your family’s composition, and tobacco use.
Your out-of-pocket limit, or yearly maximum, will be decreased based on your income as a percentage of the Federal Poverty Level.
If you purchase insurance through an exchange, you will be able to choose health coverage that is best for you and your family. Each of the health plans to be offered will include an essential set of benefits that provide comprehensive health care services with different levels of cost sharing.
The federal government will contract with health insurers to offer at least two multi-state health plans in each health insurance exchange.
If your family income is 133% to 400% of the Federal Poverty level, you may be eligible for a premium credit (or subsidy) to help you purchase insurance through your state’s health insurance exchange.
Updated March 08, 2014.
Medicare will continue to phase-in prescription medication discounts for people who are in the Part D coverage gap.
Require Medicare Advantage plans to operate more efficiently and spend at least 85% of the premiums they receive on paying for health care services.
Medicare will establish a Payment Advisory Board that is independent of the federal government and other interest groups.
This board, comprised of 15 members, will submit recommendations to help reduce the growth in Medicare spending.
Medicaid eligibility will expand to include all Americans under age 65 with incomes up to 133% of the federal poverty level. This would include children, pregnant women, parents, and adults without dependent children. To pay for this expansion, the federal government will provide your state with additional Medicaid funds starting in 2014.
Your employer will be allowed to offer you and your fellow employees rewards of up to 30%, increasing to 50% if appropriate, of the cost of coverage for participating in a wellness program and meeting certain health-related standards.
The federal government will require a new annual fee from health insurance companies.
Updated March 08, 2014.
The health reform legislation is complicated and the sweeping changes will have far-reaching consequences for how health care is delivered and practiced in the U.S. Listed below are a set of resources to help you better understand what will happen and when.
Articles from Dr. Mike:
Information from the Kaiser Family Foundation:
Updated March 08, 2014.
Virtually all Americans will be affected in some way with the enactment of the Patient Protection and Affordable Care Act, which President Obama signed into law on March 23, 2010.
How you are impacted personally depends on how the fine details of the legislation are implemented. Your age, employment status, income, current insurance coverage, and health status can all influence how the health reform legislation may have an effect on you and your family.
The actual bill signed into law fills more than 1,000 pages and details a set of immediate health insurance benefits along with a plan for rolling out additional benefits over a four-year period and beyond.
The following timeline highlights some of the legislation’s specific provisions and an outline of when these requirements are scheduled to be implemented.
2010 – Immediate Impact of Health Reform
Updated March 08, 2014.
Health Insurance Reforms
State Based High Risk Pools: Establish a state-based, high-risk pool program to offer health insurance to people with pre-existing medical conditions who have been denied coverage. This temporary program will be funded from July 1, 2010 through January 1, 2014 when state-based and regional health insurance exchanges will be available.
Extension of Coverage for Young Adults: Your health plan is required to allow your children to stay on your family policy until age 26 – unless your young adult is eligible for employer health coverage.
(Starting October 2010)
No Lifetime Limits on Coverage: Your health plan cannot impose any lifetime limits on your benefits. (Starting October 2010)
Protection from Cancellation of Your Existing Coverage: Your health plan cannot cancel your insurance when you file a claim, except if you have committed fraud or misrepresent facts about your health. (Starting October 2010)
No Pre-existing Coverage Exclusions for Your Children: Children with pre-existing conditions may not be denied access to your health plan and your health insurer will not be allowed to insure your child, but exclude treatments for your child's pre-existing condition. (Starting September 2010)
Free Prevention Benefits: All new health plans must offer prevention and wellness benefits. Additionally, your health plan cannot charge any out-of-pocket expenses – such as deductibles and copayments – for these services. (Starting October 2010)
Small Business Tax Credits: This provision offers tax credits to small businesses to make health coverage for employees more affordable.
Initially, a tax credit of up to 35% of the cost of health insurance premiums will be available to eligible employers that choose to offer coverage. (Starts with passage of the bill)
Medicare Reforms
Medicare Drug Benefit Rebate: If you are enrolled in a Medicare Part D plan and hit the donut hole in 2010, you may receive a $250 rebate check. (Starts with passage of the bill)
Improving Access to Care
Increasing the Number of Primary Care Providers: Funds will be made available for training programs to increase the number of available primary care doctors, nurses, and public health professionals. (Effective during 2010)
Expand Community Health Centers: The federal government will invest $11 billion over five years to expand Community Health Centers. This should improve access to primary care services in communities where it is needed most. (Starting in 2010)
2011
Updated March 08, 2014.
Prevention and Wellness Programs
- The federal government will provide grants to small employers to establish wellness programs for their employees.
- Chain restaurants and vending machine companies will be required to disclose the nutritional content of each food item.
Medicare Reforms
- If you are enrolled in Medicare, your cost-sharing expenses (deductibles, copayments, and coinsurance) for preventive services such as glaucoma tests, mammograms, and prostate cancer screening will be eliminated.
- Medicare will pay for an annual checkup, including a physical examination and access to a comprehensive health risk assessment and creation of a personalized prevention plan.
- If you reach the donut hole, you will be given a 50% discount on the total cost of brand name drugs while in the gap. This has been agreed to by pharmaceutical companies.
- To help improve access to care, Medicare will provide a payment bonus of 10% to primary care physicians and to general surgeons practicing in areas with a significant shortage of physicians. This will be in effect from 2011 through 2015.
Improving the Quality of health Services
- The federal government will establish a new program to help support community-based emergency departments and trauma centers.
- Along with funds for community health centers, new programs to support school-based health centers and nurse-managed health clinics will start to be developed.
Tax Changes
- Starting January 1, 2011, you can no longer be reimbursed on a tax-free basis for the costs of over-the-counter medications. And, the tax on distributions from your HSA that is not used for qualified medical expenses will increase from 10% to 20%.
- The federal government will require a new annual fee from pharmaceutical manufacturing companies.
2012
Updated March 08, 2014.
Medicare Reforms
Medicare will start to reduce payments to hospitals by a certain percentage if those hospitals have too many preventable hospital readmissions. This may help to improve quality of care for seniors as hospitals would be more likely to find ways to help individuals stay well after a hospital discharge.
The federal government will create the Medicare Independence at Home demonstration program, which will allow healthcare professionals to provide primary care services in the homes of Medicare beneficiaries who are at high need.
The professionals will be able to share in the savings by preventing hospitalizations and other expensive services.
Medicare will establish a hospital "value-based" program to pay hospitals according to how well they perform on quality measures established by Medicare.
Medicare will start to provide bonus payments to high–quality Medicare Advantage plans.
Medicaid Reforms
The government will create new demonstration projects in Medicaid to find more cost-effective ways to provide high-quality health care, including:
- Bundled payments for episodes of care that include hospitalizations. For example, instead of paying a doctor, a lab, and a hospital separately for services, Medicaid would “bundle” these services together into one payment. (Effective January 1, 2012 through December 31, 2016)
- Allow pediatricians who are organized as “accountable care organizations” to share in the cost-savings from the health care they provide. (Effective January 1, 2012 through December 31, 2016)
2013
Updated March 08, 2014.
Health Insurance Reforms
The federal government will create the Consumer Operated and Oriented Plan (CO-OP) program that will provide loans and grants to create non-profit, member-run health insurance companies known as Consumer Operated and Oriented Plans (CO-OPs). All profits must be used to lower premiums, improve benefits, or improve the quality of health care delivered to its members.Medicare Reforms
In addition to the 50% discount on brand-name drugs started in 2011, Medicare will begin phasing-in an additional federal subsidy for brand-name prescription drugs filled in the Part D coverage gap (by 2020 this discount will be an additional 25%).
Similar to the project for Medicaid started in 2012, Medicare will establish a national Medicare pilot program to develop and evaluate paying a bundled payment for a Medicare beneficiary’s episode of care, including inpatient hospital services, physician services, outpatient hospital services, and care after a hospitalization.
Medicaid Reforms
The federal government will provide funds to the states to increase payments to primary care doctors, including family physicians, internal medicine physicians, and pediatricians. This may make it easier for you and other people enrolled in Medicaid to find a primary care physician. These additional funds will be available in 2013 and 2014.
Improving the Quality of Health Services
To help make sure that all health providers are making decisions in the best interest of their patients, the government will require the disclosure of financial relationships between physicians, hospitals, pharmacists, other providers, and companies that produce and distribute medications, medical devices, and medical supplies.
Tax Changes
If you itemize income tax deductions on Schedule A, effective January 1, 2013 the threshold for the itemized deduction for your medical expenses will be increased from 7.5% of adjusted gross income to 10% of adjusted gross income. This increase will be waived if you are 65 or older for tax years 2013 through 2016.
Also effective in 2013, if you earn more than $200,000 a year as an individual or $250,000 as a couple, you will see an increase in your income-related taxes, including:
- An extra charge of 0.9% for Medicare Part A hospital insurance, an increase from 1.45% to 2.35% – for example, if you are an affluent family with an annual income of $350,000, you will pay an additional $900 a year in Medicare taxes.
- A 3.8% Medicare tax on unearned income such as dividends and royalties. Currently, you pay Medicare taxes only on earned income, such as salary from your job or revenue from self-employment.
2014 - Health Coverage Mandates and Health Insurance Exchanges
Updated March 08, 2014.
Individual Insurance Coverage Mandate
All U.S. citizens and legal residents will be required to have “qualifying” health insurance, which includes coverage through your job, a government plan (such as Medicaid, Medicare, Veterans Administration, and the Armed Services), or a health plan you have purchased on your own.
If you don’t have health insurance, you will pay a tax penalty that will be phased-in starting in 2014 with a fine of $95.
In 2015, the penalty will increase to $325, and in 2016 to $695 or a percentage of your taxable income. After 2016, your penalty will be increased every year according to the changes in the cost of living.
Employer Insurance Mandate
Companies with more than 200 employees will be required to routinely enroll their employees into health plans offered by the employer. Any employee may opt out of coverage.
A company with more than 50 employees that does not offer health coverage will be fined $2,000 per full-time employee. The first 30 employees are excluded from this assessment.
Update: Implementation of the employer insurance mandate has been delayed until January 1, 2015.
Health Insurance Exchanges
Beginning on January 1, 2014 health insurance exchanges will be created where an individual or small business (up to 100 employees) can compare the costs of various health plans and different types of health coverage benefits. The purpose of the health insurance exchanges is to make health insurance more affordable and easier to purchase for small business and individuals.
Health plans will be required to both issue and renew your policy regardless of any pre-existing health conditions. What you pay for your monthly premium can vary based only on your age, where you live, your family’s composition, and tobacco use.
Your out-of-pocket limit, or yearly maximum, will be decreased based on your income as a percentage of the Federal Poverty Level.
If you purchase insurance through an exchange, you will be able to choose health coverage that is best for you and your family. Each of the health plans to be offered will include an essential set of benefits that provide comprehensive health care services with different levels of cost sharing.
The federal government will contract with health insurers to offer at least two multi-state health plans in each health insurance exchange.
If your family income is 133% to 400% of the Federal Poverty level, you may be eligible for a premium credit (or subsidy) to help you purchase insurance through your state’s health insurance exchange.
Updated March 08, 2014.
Medicare Reforms
Medicare will continue to phase-in prescription medication discounts for people who are in the Part D coverage gap.
Require Medicare Advantage plans to operate more efficiently and spend at least 85% of the premiums they receive on paying for health care services.
Medicare will establish a Payment Advisory Board that is independent of the federal government and other interest groups.
This board, comprised of 15 members, will submit recommendations to help reduce the growth in Medicare spending.
Medicaid Reforms
Medicaid eligibility will expand to include all Americans under age 65 with incomes up to 133% of the federal poverty level. This would include children, pregnant women, parents, and adults without dependent children. To pay for this expansion, the federal government will provide your state with additional Medicaid funds starting in 2014.
Prevention and Wellness Programs
Your employer will be allowed to offer you and your fellow employees rewards of up to 30%, increasing to 50% if appropriate, of the cost of coverage for participating in a wellness program and meeting certain health-related standards.
Tax Changes
The federal government will require a new annual fee from health insurance companies.
Updated March 08, 2014.
The health reform legislation is complicated and the sweeping changes will have far-reaching consequences for how health care is delivered and practiced in the U.S. Listed below are a set of resources to help you better understand what will happen and when.
Articles from Dr. Mike:
- Immediate Effects of Health Reform
- The Mandate for Health Coverage
- What Is a Health Exchange?
- Pre-Existing Conditions
- Medicare Changes and Health Reform
Information from the Kaiser Family Foundation:
- Health Reform Implementation Timeline - a more detailed overview
- Patient Protection and Affordable Care Act - a detailed summary of the health reform legislation
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