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.
This article appears in July 27 • 2012.
