Healthcare Reform Resources

What should you know about healthcare reform? How can changes in the law impact you? This page offers links to resources that provide information on healthcare reform.

The Affordable Care Act

The Patient Protection and Affordable Care Act, known as the Affordable Care Act (ACA) was signed into law on March 23, 2010. The ACA contains provisions that will be implemented over the next several years. At the bottom of this page is a table to help you better understand the ACA and its impact on healthcare practices in the United States.

View ACA Timeline

HealthCare.gov

On this government Web site, you’ll find consumer-friendly information on provisions of healthcare reform law, an implementation timeline for the Affordable Care Act, and health insurance options in your state.

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Affordable Care Act (ACA) Timeline

2010

Provision Impacts Details
Creation of Consumer Website Patients In July 2010, the Department of Health and Human Services created a consumer website (healthcare.gov). The website can help you identify your healthcare coverage options.
Pre-Existing Condition Plan Patients This is a temporary program that provides health coverage to people with pre-existing conditions. You must be uninsured for at least 6 months to be eligible. The program ends in 2014, when insurance companies can no longer deny coverage due to pre-existing conditions.
Extended Dependent Coverage Patients Starting in September 2010, individual and group policies began allowing adult children, up to age 26, to stay on their parents’ policies as dependent children.
Medicare Beneficiary Drug Rebate Patients In January 2010, individuals with Medicare Part D who reached the Part D coverage gap (aka, the “Donut Hole”) were eligible for a one-time $250 rebate. Additional financial help and discounts began in 2011.
Prohibition of Lifetime Limits Patients Starting on or after September 2010, health plans cannot place lifetime limits on coverage.
Coverage of Preventive Benefits Patients Starting on or after September 2010, health plans must cover certain benefits such as immunizations or wellness visits for children without cost-sharing.
Establish CER Entity Physicians The Patient-Centered Outcomes Research Institute (PCORI) is established.

2011

Provision Impacts Details
Changes to Tax-Free Accounts Patients Over-the-counter drugs will no longer be reimbursed through a Health Reimbursement Account or health Flexible Spending Account. Also, they will not be reimbursed on a tax-free basis through a Health Savings Account or Archer Medical Savings Account.
Closing the Part D Coverage GAP Patients For individuals with Medicare Part D, their cost-share for prescriptions filled in the Medicare Part D “donut hole” decreases. In 2011, the cost-sharing responsibility while in the donut hoe is:
  • 50% for brand name, prescription drugs
  • 93% for generic prescription drugs.
By 2020, cost-sharing for all drugs in the donut-hole will decrease to 25%.
Medicare Advantage Payment Changes Providers 2011 Medicare Advantage rates are frozen at 2010 levels. Plans are prohibited from mandating higher cost-sharing levels for some Medicare benefits that are required under the traditional program.

2012

Provision Impacts Details
Elimination of Cost Sharing for Full-Benefit Dual Eligibles Patients People enrolled in both Medicare and Medicaid ( “dual eligibles”) will no longer have copayments or coinsurance for their covered Part D drugs or for covered Part B services with visits to physicians.
Hospital-Based Value Purchasing Providers The law establishes a plan for Medicare to pay hospitals based on their performance. There will be pre-defined quality standards.
Accountable Care Organizations (ACOs) Providers Providers, organized as ACOs, may arrange inpatient and outpatient care for Medicare patients. They may share in the cost-savings this achieves.

2013

Provision Impacts Details
Flex Spending Account Changes Patients The new provisions limit contributions to a flexible spending account to $2,500 per year.
Bundled Payment Initiative Providers This provision establishes a national Medicare program to develop and evaluate bundled payments for: inpatient hospital services; physician services; outpatient hospital services; and post-acute care services.
Physician Payment Disclosure Mandate ("Sunshine Act") Providers ACA requires manufacturers to disclose payments (for example, consulting fees, royalties, etc) or transfers of value given to healthcare providers. The disclosures will be reported on a public website.

2014

Provision Impacts Details
Prohibitions of Annual Limits Patients Health plans will not be able to put annual limits on the dollar value of coverage.
Medicaid Expansion Patients
Providers
The provision expands Medicaid eligibility to all individuals with incomes up to 133% of the federal poverty level. States have the option to expand their Medicaid programs.
State Insurance Exchanges Patients ACA creates a health insurance marketplace that allows patients to shop for a health plan. Plans will be offered at the state level.
Essential Health Benefits Patients
Providers
The law creates a set of healthcare services that must be covered by most insurance plans. Also, almost all plans must phase out annual spending limits for these services.

2015

Provision Impacts Details
Physician Quality Reporting System (PQRS) Penalties Providers Starting in 2015, penalties are sent to providers for not successfully participating in PQRS.
Independent Payment Advisory Board (IPAB) Providers 2015 marks the first year that the IPAB can recommend Medicare payment cuts to Congress. Recommendations would be made any year the Medicare growth rate exceeds a pre-determined target. The recommendations are automatically effective unless Congress intervenes.

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