Democratic Club of Worcester County

Health Care Reform Implementation Timeline

I have cobbled this timeline together from a variety of sources including the section-by-section analysis, data from CNN, a timeline developed by PHRMA, and data from the Kaiser Family Foundation. I'm sure there will be changes and I'll post them as I become aware of them. I'll be doing this in pieces, adding more from time to time.

2010 or Immediately Upon Enactment

Medicare Part D Donut Hole begins to close. $250 tax rebate for 2010.

Patient-Centered Outcomes Research. Effective upon enactment but members of the Board have to be appointed.

Limits on Pre-Existing Conditions Exclusions. 90 days after enactment there will be immediate access to insurance for those with pre-existing conditions through a temporary high-risk pool. This will expire in 2013 when insurers will be required to accept anyone with pre-existing conditions (except October 2010 for children)

End to Health Insurance Rescissions. Effective for plan years beginning on or after six months from the date of enactment, insurers will not be able to revoke coverage after the fact.

Elimination of Lifetime Limits on Benefits and Annual Limits on Essential Benefits. Effective for plan years beginning six months or more after the date of enactment.

Require Insurers to Extend Coverage of Parents' Policies to Adult Unmarried Children until age 26. Effective six months after the date of enactment.

New Plans Must Provide Coverage of Preventive Services without Co-Pay. Beginning six months after enactment. All plans by 2014.

Prohibit Discrimination by Employer Plans Based on Salary. Beginning six months after enactment, employer plans may not establish eligibility criteria that discriminate against lower wage employees.

Health Insurance Premium Review. Effective immediately, premium increases will be reviewed and compared to the loss ratio of the plan.

Tan Tax A 10% tax will be imposed on indoor tanning facilities beginning on July 1.

Tax Credit for Small Businesses. Businesses with fewer than 50 employees will get tax credits for 35% of their health care premiums (increases to 50% in 2014)

Appeal Process. Effective in September, requires any new group or individual plan to implement an effective appeals process for coverage determination and claims.

Ensuring Reconstructive Surgery for Children. Requires plans to pay for reconstructive surgery for children with deformities.

COBRA Extension. Allows individuals to keep their COBFA coverage until the Exchange is up and running. (note: this is separate from premium assistance in the Recovery Act)

Limitation on Post-Retirement Reductions of Retiree Health Benefits. Prohibits employers from reducing retirees' health benefits unless the reduction is also made to benefits for active participants.

Reinsurance for Early Retirees. Creates a new, temporary, reinsurance program to help employers offset the cost of coverage for retiree health benefits for those ages 55-64

Adoption Tax Credit. Increases the adoption tax credit and adoption assistance tax exclusion by $1,000, makes the credit refundable, and extends the credit through 2011

Improved Consumer Information through the Web. Requires the Secretary of HHS to establish an internet website through which residents of any state may identify affordable health insurance coverage options in that State. The website will also include information for small businesses about available coverage options, reinsurance for early retirees, small business tax credits and other information of interest to small businesses.

Improved Consumer Assistance. Provides for grants to States to establish health insurance consumer assistance or ombudsman programs.

2011

50% Discount for Brand Name Drugs in the ‘Donut Hole'. Effective Jan. 1, 2011

Improved Preventive Health Coverage. Provides a free, annual wellness visit and personalized preventive plan service for Medicare beneficiaries and eliminates cost sharing for preventive services. Effective Jan. 1, 2011

Increased Reimbursement for Primary Care. Provides a 10% Medicare bonus payment for primary care physicians and general surgeons.

Improving Health Care Quality and Efficiency. Establishes a new Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models to reduce health care costs and enhance the quality of care. Effective Jan. 1 2011

Long-Term Care Insurance. Creates a long-term care insurance program to be financed through voluntary payroll deductions. Effective Jan. 1 2011

Pharmaceutical Manufacturers Fee. Impose an annual, non-deductible fee on the pharmaceutical manufacturing industry allocated according to market share. Effective for tax years beginning after December 31, 2010

Reformed Payments to Medicare Advantage. Freezes 2011 Medicare Advantage payments at 2010 levels. Continues to reduce Medicare Advantage payments in subsequent years relative to current levels over a 3 to 7 year period depending on the size of the reductions.

Increased Training for Primary Care. Establishes a Graduate Medical Education Policy allowing unused training slots to be re-distributed for purposes of increasing primary care training. Also expands training programs to increase the size of the primary care and nursing workforce. Both effective July 1, 2011.

Increased Access to Home and Community-Based Services. Allows States to offer home and community-based services to disable individuals through Medicaid rather than institutional care. Effective October 1, 2011

Reporting Health Care Costs on Form W-2. Requires employers to disclose the value of benefit provided by the employer for each employee's health insurance coverage on the annual W-2 form. Note: this does not mean the benefit is taxable, it is simply a disclosure. Effective for tax years beginning after December 31, 2010

Increase the Tax Penalty for Non-Qualified HSA Withdrawals. The additional tax for withdrawal from Health Savings Accounts for non-medical expenses will be increased by 10% for those under age 65. Effective for tax years beginning after December 31, 2010

2012

Reducing Avoidable Hospital Readmissions. Directs Center for Medicare Services to track hospital readmission rates for certain high-cost conditions and implement a payment penalty for hospitals with the highest readmission rates.

Encourage Integrated Health Systems. Implements physician payment reforms that enhance payments for primary care services and encourage physicians to join together to form ‘accountable care organizations'.

Linking Payments to Quality Outcomes. Establishes a hospital value-based purchasing system to improve quality outcomes for acute care hospitals. Also, requires the Secretary of HHS to submit a plan to Congress to move home health and nursing home providers into a value-based system.

2013

Improving Preventive Health Coverage. Creates incentives for State Medicaid programs to cover evidence-based preventive services with no cost-sharing.

Administrative Simplification. Health plans must adopt and implement uniform standards and business rules for electronic exchange of health information to reduce paperwork and administrative costs.

Increase Medicaid Payment for Primary Care. Requires States to pay primary care physicians the same rate Medicare pays, and fully fund any additional costs to the States.

Limit Health Flexible Savings Account Contributions. Limits the amount of contributions to health FSAs to $2,500 per year, indexed to inflation.

Eliminate the Deduction for Employer Part D Subsidies. Eliminates the tax deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D retirees.

Increased Threshold for Itemizing Medical Deductions. Increases the threshold for itemizing deductions for medical expenses from 7.5 to 10 percent of income except that persons over 65 would keep the 7.5 percent rate through 2016.

Additional Hospital Insurance Tax for High Income Persons. Increases the hospital insurance tax rate by 0.9 percent on wages over $200,000 for an individual ($250,000 for a couple). Expands the tax to include a 3.8% tax on ent investment income for those in the same income bracket.

Medical Device Excise Tax. Establishes a 2.3 percent excise tax on the first sale for use of a medical device. Excepted from the tax are eye glasses, contact lenses, hearing aids, and any device that is generally purchased by the public at retail.

2014

Reform Health Insurance Regulations. Implements strong health insurance reforms that prohibit insurance companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due to an individual's health status. Insurers can no longer exclude coverage for treatment based on pre-existing conditions. It also limits the ability of insurers to charge higher rates due to health status, gender, or other factors. Premiums can only vary on age (not more than 3:1), geography, family size and tobacco use.

Eliminates Annual Limits. Prohibits insurers from imposing annual limits on coverage.

Establishes Health Insurance Exchanges. Opens health insurance exchanges in each state to the individual and small group market. This will enable people to comparison shop for standardized health packages. It facilitates enrollment and administers tax credits so that people of all incomes can obtain affordable coverage.

Ensuring Choice through a Multi-State Option. Provides a choice of coverage through a multi-state plan, available, nationwide, and offered by private insurance carriers under the supervision of the Office Of Personnel Management

Provide Health Care Tax Credits. Makes premium tax credits available through the Exchange to ensure people can obtain affordable coverage. The credits apply to people with incomes below 400% of the poverty level and apply to both premiums and cost-sharing.

Free Choice Vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

Promoting Individual Responsibility. Requires most individuals to obtain acceptable health insurance or pay a penalty.

Promoting Employer Responsibility. Requires employers with 50 or more employees to offer health care coverage or pay a penalty.

Increased Access to Medicaid. Medicaid eligibility will increase to 133 percent of the poverty level for all non-elderly individuals. States will receive 100% Federal funding for the first three years of coverage expansion.

Small Business Tax Credit. Implements the second phase of the small business tax credit for qualified small employers.

Quality Reporting for Certain Providers. Requires the Secretary of HHS to implement quality-reporting programs for ambulatory surgical centers, long-term care hospitals, inpatient rehabilitation centers, inpatient psychiatric facilities and hospice providers.

Health Insurance Provider Fees. Imposes an annual, non-deductible fee on the health insurance sector allocated according to market share.

2015

Continuing Innovation and Lower Health Costs. Establishes an Independent Payment Advisory Board to develop and submit to Congress proposals aimed at extending the solvency of Medicare, lowering health care costs, improving outcomes promoting quality and efficiency and expanding access to evidence-based care.

Paying Physicians Based on Value not Volume. Creates a physician value-based payment program to promote increased quality of care for Medicare beneficiaries.

2018

High-Cost Plan Excise Tax. Imposes an excise tax on insurance companies and plan administrators that is above the threshold of $10,200 for self only coverage and $27,500 for family plans. The tax would only apply to premiums above the threshold. The thresholds are indexed to the DPI.

Hear What the Opponents Have to Say

Opponents of the Health Care Reform Bill, some 200 of them, rallied at the Capitol the other day to protest against passage of the bill.  Here's a chance to listen to some of their cogent arguments against the bill and against health care reform.  Since we like to hear all sides of the argument, here's what they have to say.  The best parts begin about a minute and a half into the clip.