Health Care Changes in Progress
What's already in effect and what's still to come
Since its passage in 2010, the Patient Protection and Affordable Care Act has been steadily overhauling the cumbersome American health care market. Here's a sampling of what has already taken effect under the law. See more detail at www.healthcare.gov/law/timeline.
• The 80/20 rule: Insurers must spend 80% of income on health care provision for large employer plans, and 85% for individuals and small employers. Customers who have been overcharged for administration should receive reimbursement checks.
• Children with pre-existing conditions cannot be denied coverage. Adults can use the new federal Pre-existing Condition Insurance Plan, a $5 billion program providing coverage until 2014.
• Young adults are allowed to stay on their parents' plan until the age of 26.
• Free preventative care like mammograms and colonoscopies on new policies.
• No lifetime limits on coverage and new regulations on annual limits.
• New appeal process against insurance company decisions and new restrictions on premium hikes, plus insurers cannot deny coverage for a technical mistake on applications.
• Additional funds to train primary health care providers, plus more money for rural health care and community health care centers
• Bringing payments to Medicare Advantage insurers in line with the less costly Medicare Original.
• Closing the prescription "donut hole" between what Medicare covers and maximum client payments. The gap will be completely closed by 2020.
• Big changes for retirees: prescription discounts, improved post-hospital care, as well as free preventative care for seniors.
• Emphasis on home and community services for people with disabilities, rather than nursing homes
• Emphasis on efficiency, with a new Independent Payment Advisory Board looking into Medicare waste, and physician-run Accountable Care Organizations developing new best practices.
What's To Come
Oct. 1, 2012
• Introduction of value-based purchasing in Medicare, linking provider payments to performance.
• Beginning of shift to electronic records, expected to cut administrative costs.
Jan. 1, 2014
• Introduction of the individual mandate, requiring individuals who can afford it to buy basic health insurance.
• Affordable Insurance Exchanges for people who do not receive coverage through their employers.
• End of annual limits on coverage.
• No more denial of coverage for pre-existing conditions.
• No more discriminatory pricing for gender or health status.
• Tax credits for anyone earning up to 400% of federal poverty line and increased small-business tax credits.
• Insurers will no longer be able to drop people participating in clinical trials.
Jan. 1, 2015
• Physician payments linked to quality of care, not volume.