Published 5/1/2010

A timeline for reform

The Patient Protection and Affordable Care Act, with its companion reconciliation bill, includes many provisions that do not become effective for several years. Other provisions, however, will take effect very quickly and have a significant impact on health insurance coverage for those Americans who are currently uninsured. The AAOS office of government relations has put together the following timeline indicating when various provisions become effective.

Within the first 90 days

Provides immediate access to high-risk pools for people who have no insurance because of pre-existing conditions

Within the first 6 months

  • Bars insurers from denying people coverage when they get sick
  • Bars insurers from denying coverage to children who have pre-existing conditions
  • Bars insurers from imposing lifetime caps on coverage
  • Requires that all group health plans and plans in the individual market must provide coverage for preventive services with no deductible
  • Requires insurers to allow young people to stay on their parents’ policies until age 26

Within a year

  • Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out
  • Provides a 2-year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. The credit would be available for qualifying investments made in 2009 and 2010

In 2011

Requires individual and small group market insurance plans to spend 80 percent of premium dollars on medical services. Large group plans would have to spend at least 85 percent of premium dollars on medical services

In 2012

  • Encourages physicians to join together to form “accountable care organizations” to gain efficiencies and improve quality
  • Establishes a hospital value-based purchasing program for acute-care hospitals
  • Directs the Centers for Medicare & Medicaid Services (CMS) to track hospital readmission rates for certain high-cost conditions and implements a payment penalty for hospitals with the highest re-admission rates

In 2013

  • Increases the Medicare payroll tax and expands it to dividend, interest, and other unearned income for individual filers earning more than $200,000 and joint filers earning more than $250,000
  • Alters the Medicare physician payment formula (sustainable growth rate formula) to include a new value-based payment modifier
  • Establishes a national pilot program on payment bundling for hospitals, doctors, and postacute care providers

In 2014

  • Provides subsidies for families earning up to 400 percent of the poverty level (under current guidelines, about $88,000 a year) to purchase health insurance
  • Requires most employers to provide coverage or face penalties
  • Requires most people to obtain coverage or face penalties
  • Institutes additional insurance market reforms, including limitations on pre-existing health conditions, and rating rules (only vary on age, geography, and family size)
  • Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals
  • Continues the second phase of the small business tax credit for qualified small business employers
  • Requires certain providers—including long-term care hospitals, inpatient rehabilitation facilities, PPS-exempt cancer hospitals and hospice providers—to implement quality measure reporting programs

In 2015

Establishes the Independent Payment Advisory Board (IPAB)

In 2018

Imposes a 40 percent excise tax on high-end insurance policies

In 2019

Expands health insurance coverage to 32 million people