Unless otherwise noted, all the information and quotations below were taken from the US Department of Health and Human Services' (HHS) publication "Key Features of the Affordable Care Act By Year,” available at http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html (accessed Aug. 12, 2013). Entries do not represent a comprehensive listing of all the changes under Obamacare.
Jan. 1, 2015
Employer Mandate to Provide Health Insurance Begins - Starting Jan. 1, 2015, a large employer "may have to pay an assessment if it does not offer affordable insurance and one of its employees gets tax credits to purchase insurance in the Exchange. These assessments do not apply to businesses with less than 50 employees.
Large employers that do not offer health benefits coverage at all may be required to pay an assessment of $2,000 per year for each fulltime employee, excluding the first 30 full-time employees. Larger employers that do offer health benefits coverage that is unaffordable or lacks minimum value may be assessed a payment of $3,000 per year for each full-time employee receiving federal financial assistance." [source]
[Editor's Note: The Obamacare mandate requiring employers with 50 or more employees to provide coverage for their workers or pay penalties was originally set to be implemented on Jan. 1, 2014, but on July 2, 2013, the Obama administration postponed the mandate until Jan. 1, 2015.]
Paying Physicians Based on Quality of Care - "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."
Health Insurance Exchanges Begin- "Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too."
Individual Insurance Mandate Begins- "Under the law, most individuals who can afford it will be required to obtain basic health insurance 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."
Medicaid Expansion - "Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years."
Tax Credits for Purchasing Insurance - "Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles)."
Prohibition on Refusing Coverage Due to Pre-Existing Conditions or Gender- "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."
Small Business and Non-Profit Tax Credit for Insurance Coverage - "The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations."
Open Enrollment in the Health Insurance Marketplace Begins- "Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace [health insurance exchange]."
Increased Medicaid Payments for Primary Care Doctors- "As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government."
Home and Community Health Care Services - "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."
Medicare Prescription Drug Discounts- "Seniors who reach the coverage gap will receive a 50% discount when buying Medicare Part D covered 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."
Insurance Premium Rebates - "To ensure premium dollars are spent primarily on health care, the new law generally requires that 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. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits 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."
Independent Payment Advisory Board Begins Operating - "The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care."
Coverage for Young Adults until Age 26 - "Under the law, young adults will be allowed to stay on their parents' plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work)."
Insurance Companies Can No Longer Rescind Coverage - "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. The health care law makes this illegal."
Regulating Annual Limits on Insurance Coverage - "Under the aw, 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."
Children with Pre-Existing Conditions Cannot Be Denied Coverage - "The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition."
Establishment of Pre-Existing Condition Insurance Pools - "The 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. States have the option of running this program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state."