Health Care Reform Implementation Timeline

January 2010

Providing Small Business Health Insurance Tax Credits.

• Up to 4 million businesses nationally are eligible for tax credits through the Affordable Care Act to help them provide health insurance to their workers.
• The credit is worth up to 35 percent of a small business' premium costs in 2010 (25% for tax-exempt employers). On Jan. 1, 2014, this rate increases to 50 percent (35% for tax-exempt employers).
• The tax credit is available on a sliding scale to businesses with fewer than 25 full time equivalent employees, average annual wages below $50,000 per FTE, and that contribute at least 50% of each employees premium. Reduced credits are available for businesses with wages above those limits.
• Small businesses can calculate their tax credits here. And more information is available here.

March 2010

Passage of the Patient Protection and Affordable Care Act March 23, 2010

 

• On March 23, 2010, President Obama signed the historic Affordable Care Act into law, marking the passage of the first comprehensive health care law in our nation’s history. This law puts control of health care back into the hands of consumers.
• The nonpartisan Congressional Budget Office says the law will reduce the federal deficit by $143 billion in the first 10 years and $1.3 trillion in the second 10 years of its passage.

June 2010

Relief for Seniors Who Hit the Medicare Part-D “Donut Hole”

 

• The Affordable Care Act works to eliminate the Medicare Part D “donut hole” coverage gap over ten years.
• Beginning in June 2010, seniors in Illinois who hit the Medicare donut hole received a one-time $250 rebate to help pay for prescription drugs.
• In 2010, more than 109,000 Illinois seniors have received this extra help.
• In addition to the $250 rebate, the law will offer a 50% discount on brand name drugs for Part D beneficiaries who fall into the donut hole in 2011.
• The donut hole will be fully closed by 2020, saving more than 133,000 Illinois seniors $1.2 billion dollars over ten years. A breakdown of savings for each Illinois county is available here.

 

Help for Early Retirees

 

• The Early Retiree Reinsurance Program provides $5 billion in financial relief to employers who provide coverage to early retirees.
• Employers are eligible to receive reinsurance reimbursement for the medical claims of retirees age 55 and older, their spouses, surviving spouses, and dependents, who are not eligible for Medicare.
• This program gives businesses, schools, unions, State and local governments, and non-profits the needed financial relief to help early retirees and their families continue to have quality, affordable coverage.
• To date, 279 employers in Illinois and 4,748 nationally have received help from the early retiree reinsurance program.
• More information is available here.

July 2010

Creation of Healthcare.gov

 

• The law creates an easy to use website, www.healthcare.gov, where consumers can learn about the insurance options available to them, compare plans, and pick the best option for them and their families.

 

Creation of a Pre-Existing Condition Insurance Plan

 

• A Pre-Existing Condition Insurance Plan provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition.
• The Illinois Pre-Existing Condition Plan (IPXP) opened for enrollment in August and as of today has covered nearly 1,500 Illinoisans who previously had no other insurance options due to their pre-existing condition.
• For enrollment information, click here.

September 2010

Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions.

 

• Insurance companies are prevented from denying coverage to children under the age of 19 due to a pre-existing condition in all new and existing group plans.
• Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans
• More info available here. 

 

Prohibiting Insurance Companies from Rescinding Coverage.

 

• All insurance companies are prohibited from rescinding your health insurance immediately, except in instances of fraud or misrepresentation. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick.
• Due to this provision, 612,000 people in Illinois are no longer at risk of losing their insurance coverage.
• Effective for health plan years beginning on or after September 23, 2010
• More info available here.

 

Eliminating Lifetime Limits on Insurance Coverage.

 

• All insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits like hospital stays.
• This affects nearly 7.5 million people in Illinois.
• Effective for health plan years beginning on or after September 23, 2010
• More info available here. 

 

Regulating Annual Limits on Insurance Coverage.

 

• Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans.
• In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.
• Effective for health plan years beginning on or after September 23, 2010
• More info available here. 

 

Expanding Young Adult Coverage

 

• Young adults under the age of 26, with no access to employer-sponsored health insurance are able to enroll under their parents’ insurance plan.
• 47,200 college students and young adults between jobs in Illinois will have the assurance of coverage.
• Effective for health plan years beginning on or after September 23, 2010
• More info available here. 

 

Access to Free Preventive Care

 

• Private insurance plans must offer their customers free preventive services—such as mammograms, colonoscopies and vaccinations—with no co-payments or cost sharing.
• Effective for health plan years beginning on or after September 23, 2010
• More info available here. 

 

Appealing Insurance Company Decisions.

 

• The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process for claims they feel are wrongfully denied.
• Effective for new plans beginning on or after September 23, 2010
• More info available here. 

January 2011

Access to Free Preventive Care for Seniors

 

• Seniors and other Medicare enrollees will now receive free preventive services such as annual wellness visits and personalized prevention plans.
• This will help 1.8 million seniors in Illinois, many of whom live on fixed incomes.
• More info available here. 

 

Prescription Drug Discounts for Seniors in the Donut Hole.

 

• Seniors in Medicare Part D prescription drug plans who reach the so called “donut hole” coverage gap in 2011 will receive a 50 percent discount when buying brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. This will save more than 133,000 Illinois seniors $1.2 billion dollars over ten years
• More info available here and here.

 

Bringing Down Health Care Premiums.

 

• To ensure premium dollars are spent primarily on health care, the new law requires that starting in 2011, at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement—not overhead, CEO salaries and profit.
• For plans sold to individuals and small employers, at least 80% of the premium must be spent on health services and quality improvement.
• If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers.
• More info available here. 

 

Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage.

 

• Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan.
• The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.

October 2011

Increasing Access to Services at Home and in the Community.

 

• The new Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes. The CFCO remedies the lack of options available to seniors and individuals with disabilities when they face long-term care needs.

2012

Providing New, Voluntary Options for Long-Term Care Insurance.

 

• The law creates a voluntary long-term care insurance program – called CLASS—to provide cash benefits to adults who become disabled.
• This is an affordable, voluntary insurance program to help people with disabilities continue to live in their homes and communities.
• This approach complements Medicare, Medicaid and private long-term care insurance by allowing people to pay modest premiums to protect themselves against the need for future long-term care.

2013

Improving Preventive Health Coverage.

 

• To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.

 

Providing Additional Funding for the Children’s Health Insurance Program.

 

• Under the new law, states will receive two more years of funding for the Children’s Health Insurance Program to continue providing health insurance coverage for children not eligible for Medicaid.

2014

Prohibiting Discrimination Due to Pre-Existing Conditions or Gender for Adults

 

• The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status.

 

Eliminating Annual Limits on Insurance Coverage.

 

• The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.

 

Ensuring Coverage for Individuals Participating in Clinical Trials.

 

• Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies to all clinical trials that treat cancer or other life-threatening diseases.

 

Making Care More Affordable.

 

• Tax credits will make it easier for the middle class to afford insurance.
• People with incomes above 133 percent of poverty ($14,404 for an individual and $29,327 for a family of four in 2010) and below 400 percent of poverty ($43,000 for an individual or $88,000 for a family of four) who are not eligible for or offered other affordable coverage will be offered these tax credits on a sliding scale.
• These individuals may also qualify for reduced cost-sharing (e.g. copayments, coinsurance, and deductibles) to reduce the cost associated with care.

 

Establishing Health Insurance Exchanges.

 

• Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy insurance directly in an Exchange – an online, competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans.
• Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Members of Congress and federal employees will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too.

 

Increasing the Small Business Tax Credit.

 

• The second phase of the small business tax credit will be implemented for qualified small businesses and small non-profit organizations, increasing the available credit up to 50 percent of the employer’s contribution to provide health insurance for employees. There is also acredit for small non-profit organizations worth up to 35 percent of the employer’s contribution.

 

Increasing Access to Medicaid.

 

• Americans who earn less than 133 percent of the poverty level ($14,404 for an individual and $29,327 for a family of four in 2010) will be eligible to enroll in Medicaid.
• States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90 percent federal funding in subsequent years.

 

Promoting Individual Responsibility.

 

• Under the new law, most individuals who can afford basic health insurance will be required to obtain coverage or pay a fee to help offset the costs of caring for uninsured Americans.
• If affordable coverage is not available to an individual, he or she will be eligible for an exemption. For example, if your income is below the poverty level, you will not be penalized for not having insurance and if insurance would cost you more than 8% of your income, you will not be penalized for not having insurance.

2015

Paying Physicians Based on Value Not Volume.

 

• A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care.