March 23, 2010The Affordable Care Act Becomes Law
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. Others have already begun. Use this timeline to learn about what’s changing and when.
Effective Jan. 1, 2010
Providing Small Business Health Insurance Tax Credits
Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit.
Effective April 1, 2010Allowing States to Cover More People on Medicaid
States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.
Program applied only on 2010: Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole”
An estimated 4 million seniors reached the gap in Medicare prescription drug coverage known as the “donut hole” in 2010. Each eligible senior received a one-time, tax free $250 rebate check.
Many provisions effective now
Cracking Down on Health Care Fraud...
Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in FY 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP.
Applications for employers available June 1, 2010
An estimated 4 million seniors reached the gap in Medicare prescription drug coverage known as the “donut hole” in 2010. Each eligible senior received a one-time, tax free $250 rebate check.
Many provisions effective now
Cracking Down on Health Care Fraud...
Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in FY 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP.
Applications for employers available June 1, 2010
Expanding Coverage for Early RetireesToo often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents.
National program established July 1, 2010
Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions
A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to
individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state has chosen not to do so, a plan has been established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited. Effective July 1, 2010
Putting Information Online
The law provides for an easy-to-use website, HealthCare.gov, where consumers can compare health insurance coverage options and pick the coverage that works for them.
Effective for health plan years beginning on or after September 23, 2010
Extending Coverage for Young Adults
Under the new law, young adults are allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23, 2010
Providing Free Preventive Care
All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.The law provides for an easy-to-use website, HealthCare.gov, where consumers can compare health insurance coverage options and pick the coverage that works for them.
Effective for health plan years beginning on or after September 23, 2010
Prohibiting Insurance Companies from Rescinding Coverage
In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately.
Effective for new plans beginning on or after September 23, 2010
Appealing Insurance Company Decisions
The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
Effective for health plan years beginning on or after September 23, 2010
Eliminating Lifetime Limits on Insurance Coverage
Under the new law, insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
Effective for health plan years beginning on or after September 23, 2010
Regulating Annual Limits on Insurance Coverage
Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive is restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.
Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans: Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions
The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition.
Grants will be awarded beginning in 2010
Holding Insurance Companies Accountable for Unreasonable Rate Hikes
The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new Affordable Insurance Exchanges in 2014.
Effective 2010
Rebuilding the Primary Care Workforce
To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants, including funding for scholarships and loan repayments for primary care doctors and nurses working in
underserved areas. Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Grants Awarded October 2010 Establishing Consumer Assistance Programs in the States
Under the new law, states that apply receive federal grants to help set up or expand independent offices to help consumers navigate the private health insurance system. These programs help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. The programs also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that need further oversight.
Funding begins in 2010
Preventing Disease and Illness
A new $15 billion Prevention and Public Health Fund invests in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity.
Effective 2010
Strengthening Community Health Centers
The law includes new funding to support the construction of and expansion of services at community health centers, allowing these centers to serve some 20 million new patients across the country.
Effective 2010Payments for Rural Health Care Providers
Today, 68% of medically underserved communities across the nation are in rural areas, and these communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities.
Effective January 1, 2011
Prescription Drug Discounts
In 2011, seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.
Prescription Drug Discounts
In 2011, seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.
Effective January 1, 2011
Free Preventive Care for Seniors
The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare.
Effective January 1, 2011
Bringing Down Health Care Premiums
To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.
Effective January 1, 2011
Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage
Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.
Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage
Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.
Effective no later than January 1, 2011
Improving Health Care Quality and Efficiency
The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Effective January 1, 2011
Improving Care for Seniors after They Leave the Hospital
The Community Care Transitions Program helps high-risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities.
Improving Care for Seniors after They Leave the Hospital
The Community Care Transitions Program helps high-risk Medicare beneficiaries who are hospitalized avoid unnecessary re-admissions by coordinating care and connecting patients to services in their communities.
Administrative funding becomes available October 1, 2011
New Innovations to Bring Down Costs
The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care.
New Innovations to Bring Down Costs
The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care.
Effective beginning October 1, 2011
Increasing Access to Services at Home and in the Community
The new Community First Choice Option allows states to offer home and community based services to disabled people through Medicaid rather than institutional care in nursing homes.
Increasing Access to Services at Home and in the Community
The new Community First Choice Option allows states to offer home and community based services to disabled people through Medicaid rather than institutional care in nursing homes.
Effective January 1, 2012
Encouraging Integrated Health Systems
The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” In these groups, doctors can better coordinate patient care and improve the quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
Encouraging Integrated Health Systems
The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” In these groups, doctors can better coordinate patient care and improve the quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save.
Effective March, 2012
Understanding and Fighting Health Disparities
To help understand and reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic, and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities.
Understanding and Fighting Health Disparities
To help understand and reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic, and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities.
(Republican) Resistance...
111th Congress
Republican Representatives Steve King of Iowa and Michele Bachmann of Minnesota introduced bills in the House to repeal the Act shortly after it was passed. Senator Jim DeMint did the same in the Senate. None of the three bills were considered by either body.
112th Congress
In 2011, the Republican-controlled House of Representatives voted 245–189 to approve a bill entitled "Repealing the Job-Killing Health Care Law Act" (H.R.2), which, if enacted, would repeal the Patient Protection and Affordable Care Act and the health care-related text of the Health Care and Education Reconciliation Act of 2010. All Republicans and three Democrats voted for repeal. In the Senate, the bill was offered as an amendment to an unrelated bill, and was subsequently voted down. Before votes in both houses of the Congress took place, President Obama stated that he would veto the bill should it pass both chambers.
Democrats in the House proposed that repeal not take effect until a majority of the Senators and Representatives had opted out of the Federal Employees Health Benefits Program. The Republicans voted down this measure.
Job “Consequences” of Repeal
A spokesman for Republican Majority Leader Eric Cantor stated:
"This is a job-killing law, period. Anyone who argues otherwise is ignoring the construct of the health care law and the widely accepted facts."
The House Republican leadership justified its use of the term "job killing" by contending that the PPACA would lead to a loss of 650,000 jobs, and attributing that figure to a report by the Congressional Budget Office. However, the CBO report specifically stated that the negative effect on jobs was because people would voluntarily choose to work less once they have health insurance outside of their jobs. FactCheck noted that the 650,000 figure was not in the CBO report, and said that the Republican statement "badly misrepresents what the Congressional Budget Office has said about the law. In fact, CBO is among those saying the effect 'will probably be small.'"
Effect of repeal proposals on federal budget projections
The CBO estimated that repealing the entire PPACA (including both its taxing and spending provisions) would increase the net 2011-2021 federal deficit projections by $210 billion. Others disagree, arguing that estimate was based on unrealistic assumptions; House Speaker John Boehner said:
"I don't think anyone in this town believes that repealing Obamacare is going to increase the deficit."
In May 2011, CBO analyzed proposals to prevent the use of appropriated funds to implement the legislation, and wrote that "a temporary prohibition, extending through the remainder of fiscal year 2011, would reduce the budget deficit by about $1.4 billion in 2011 but would increase deficits by almost $6 billion over the 2011-2021 period... CBO cannot determine whether changes in spending under a permanent prohibition would produce net costs or net savings relative to its baseline projection, which assumes full implementation."
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