Health Reform - Timeline

Health Care Reform: A Quick Timeline

On March 23, 2010, President Barack 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.

Here are some key dates and provisions in the health-reform timeline:

Year 2010:

Starts immediately with the Medicare rebate checks. Those on Medicare’s prescription drug plan whose initial benefits run out will receive a one-time $250 rebate designed to help cover the so-called "donut hole" gap in coverage. More discounts and subsidies will be phased in until the doughnut hole is eliminated by 2020.

• Pre-existing Condition Insurance Plans will last until 2014. The plans will provide immediate access to coverage for people who have no insurance now due to health problems. The out-of-pocket premium will be capped at $5,950 for individuals and $11,900 for families.

Other Year 2010 Provisions:

• The Early Retiree Reinsurance Program provides funds to help employers extend group health insurance to workers who retire between age 55 to 65. The program is scheduled to stop in 2014, when early retirees can take advantage of insurance exchanges.
• Community health centers will be funded. Health centers are community-based and patient-directed organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farmworkers, individuals and families experiencing homelessness, and those living in public housing. More details at http://www.nachc.org/
• Healthcare.gov was created to give consumers a place to find health insurance comparison options and tools to pick appropriate coverage.
  Free mammograms and colonoscopies: Health plans years beginning on or after Sept. 23 have to cover a number of preventive services like mammograms and colonoscopies for free. No deductible, co-pay or coinsurance. 
• No health insurance rescissions: Health insurance companies can’t drop you from your individual health insurance plan if you get sick.
• Children’s coverage: New individual plans and existing group plans cannot deny coverage to children with pre-existing conditions.
• No lifetime caps: Insurers cannot place lifetime caps on coverage. Annual limits must be approved by the government.
• Children will stay on parent’s plan until age 26: Adult children will be eligible for coverage as dependents on their parents' policies until they are 26, unless they have access to health insurance through a job.
• Appeal denials: New plans must include a way to appeal coverage determinations or claims. An external review process must also be established.
• No lifetime dollar limits:  Lifetime dollar limits on essential benefits such as hospital stays, are no longer allowed.

Year 2011:

• Medical loss ratio: Individual health insurance plans and small-group insurance plans must spend 80 percent of premiums on medical services, while large group plans have to spend at least 85 percent. If health insurance companies don’t meet these levels, they will have to give rebates to policyholders. This law goes into effect Jan. 1, 2011.
• Discount on prescriptions for Seniors: On Jan. 1, 2011, seniors who fall into that "donut hole" gap will receive a 50 percent discount on Medicare Part D covered brand-name prescription drugs.
• Free preventive care from Medicare i.e. annual wellness visits with no co-payments, begins Jan. 1.
• The Community First Choice Option will give states the option of treating disabled persons using Medicaid at home or through community-based services, instead of just at nursing homes. This begins Oct. 1, 2011.  Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, or intermediate care facility will have a new option offered by States for community-based attendant services and supports. The Federal government will offer increased assistance for States who offer these community-based services.
• The Community Care Transitions Program will coordinate care for Medicare beneficiaries who have been released from the hospital, in order to reduce the number of re-admissions. Eligible entities include hospitals with high readmission rates and community-based organizations that partner with such hospitals to provide care transitions services. If selected for participation by the Secretary, these entities will receive funding to provide improved transition services to qualifying, high-risk Medicare beneficiaries. Qualifying beneficiaries are those with an elevated risk for hospital readmissions due to either a diagnosis of multiple chronic conditions, or a diagnosis of other risk factors that make the individual particularly vulnerable throughout the transitions process. On January 1, 2011, the program will be official and will be conducted for five years.
• The Independent Payment Advisory Board will begin operating on Oct. 1, 2011, and will look for ways to cut wasteful spending out of the Medicare system.  Independent Payment Advisory Board –IPAB is a an 15 member independent panel, to be appointed by the president and confirmed by the Senate is charged with enforcing an upper limit on annual Medicare spending growth. This action effectively caps Medicare beginning in 2015.

 Year 2012:

• Accountable Care Organizations will use incentives to encourage doctors to better coordinate patient care and reduce illness and disease.
• CLASS, a long-term insurance program, (Community Living Assistance Services and Supports Act (CLASS Act) will be created on Oct. 1, 2012, to use voluntary payroll deductions to provide cash benefits for people who later require long-term care services. CLASS will not have such health qualification requirements. The plan will be available on a guaranteed-issue basis.
• Electronic medical records: Health plans must begin implementing ways to exchange confidential medical information.

Year 2013:

• More taxes: Families who make $250,000 or more ($200,000 or more for singles) will pay more in Medicare payroll taxes. Unearned income on this group will also be taxed.
  Flexible spending accounts: Those who utilize flexible spending accounts will be limited to $2,500 in contributions. This number will be adjusted yearly for the cost of living, and these plans will no longer allow reimbursement for over-the-counter medications. The threshold for deducting out-of-pocket medical expenses on your taxes will rise from 7.5 percent of income to 10 percent. (People over age 65 will remain at the 7.5 percent deduction threshold through 2016.)
  Medicaid programs will receive new funding to cover preventive services, meaning more access for more patients.
  The Children’s Health Insurance Program (CHIP) will receive funding for two more years on Oct. 1, 2013.

Year 2014

• Mandate: Most individuals will be required to buy health insurance, and most employers will have to provide coverage. Both groups will face penalties for non-compliance. American Indians, those with religious objections and those who would face a financial hardship are exempt. If you would end up paying more than 8 percent of your income for health insurance, you won't have to pay penalties for not buying coverage.
• Pre-existing conditions: As of Jan. 1, 2014, health  insurers may no longer deny coverage or refuse to renew coverage to people with pre-existing conditions. They also may not charge higher premiums based on gender or pre-existing conditions.
• No annual limits: Annual limits on coverage are no longer allowed for new plans and existing group plans.
• Health insurance exchanges: If your employer doesn’t offer health insurance, you will have the option to buy affordable health insurance through state-run insurance marketplaces called exchanges. If you have coverage through your employer but your policy covers less than 60 percent of costs, or you pay more than 9.5 percent of your income to get that coverage, you can buy subsidized coverage. If you still can’t afford the insurance coverage offered by your employer, you can take the funds they would have contributed to the group plan and use them to buy potentially cheap health insurance from the exchange.
• Health insurance subsidies: Families with income up to 400 percent of the federal poverty level (about $43,000 for an individual or $88,000 for a family of four) will earn subsidies to buy health insurance.
• Medicaid expansion: Families who earn less than 133 percent of the poverty level (about $14,000 for an individual and $29,000 for a family of four) can enroll in Medicaid.  
• Insurance companies will be banned from charging higher premiums because of a person's sex or health status.
• Small-group health plan deductibles will be limited to $2,000 for individuals and $4,000 for families. Contributions can be offered to offset any amounts above these amounts.
• Waiting periods for health insurance coverage will be capped at 90 days.
• The Medicare Part D out-of-pocket maximum that enrollees pay for catastrophic coverage will be lowered.
• Clinical trials: Health insurance companies many not drop or limit coverage for patients who choose to participate in a clinical trial for treatment for a life-threatening disease.

Year 2015:

• Doctors’ pay will be tied to quality of care rather than volume of patients. Paying Physicians Based on Value Not Volume.  A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care.  Effective January 1, 2015.

Year 2018:

• A 40 percent excise tax on high-end policies (that is, health insurance plans with annual premiums of $10,200 for individuals and $27,500 or more for families) will be imposed. It is unclear who will have to absorb this cost: consumers or employers.

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Jim Robinson posted on Saturday, November 13, 2010

Tags: Medicare, Health Reform, Health Care, Health Insurance

Posted in: Health Reform

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