A Timeline of Health Care Reforms 2010 – 2022
Here is an easy to understand Health Care Reform Timeline 2010 – 2022. The healthcare reform timeline lays out health insurance reforms and health care milestones contained within the Affordable Care Act (ObamaCare). Find out how the new health care law affects healthcare in the United States and you each year.
What is Health Care Reform?
Obama’s Health Care Reform, commonly called ObamaCare but officially called the Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA) for short, was signed into law on March 23, 2010. The ACA is meant to “provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes”.
ObamaCare’s reform of the health care system under the ACA has been an ongoing effort to reform the national health care system. Although reform has taken great strides under President Barack Obama, efforts to reform healthcare have been in motion for decades.
Why Does the Health Insurance Industry Need ObamaCare’s Reforms?
Why reform the healthcare system? Before we get to the health care reform timeline, here are some reasons ObamaCare health care reform was signed into law.
• PBS reports that 44 million Americans are currently Without Health Insurance. Part of this is due to the extraordinary costs of quality health insurance in the US. HealthCare reform ensures these Americans have access to health care.
• The Medicaid part D prescription drug “donut hole” coverage gap was leaving seniors unable to afford their medication or paying out of pocket. The ACA closes the donut hole.
• Government funding for private Medicare Advantage plans is costing the taxpayer money, it was supposed to save the taxpayer money when going on the private market. Obama’s Health Care Reform reigns in the wasteful spending.
• Insurance companies could deny you for pre-existing conditions or drop you when you get sick. In 2014 you can no longer be denied coverage or treatment based on health status.
• Insurance companies could drop you for being sick or stop treating you when you reached annual or life-time limits. Over 60% of bankruptcies were related to medical costs, many of these people had insurance. The issue was that lifetime and annual dollar limits didn’t cover expensive treatments. The only reason you can be dropped on new ACA protected health plans for fraud and life-time and annual dollar limits are on their way out.
• Insurance companies had no limits on raising your premiums. The rate review provision protects you against unjustified rate hikes. So far the program has curbed the rising cost of employer based premiums and reduced premiums for many Americans due to the new State-based health insurance marketplaces.
• Millions of people are too poor to afford health insurance, yet make too much to qualify for Medicaid. The ACA expands Medicaid and CHIP to over 15 million men, women and children who fell through the cracks. Many State’s chose to opt-out of expanding Medicaid coverage.
• Before the ACA preventative measures and wellness visits were not covered adequately. All New Plans require essential health benefits and preventive services be covered with no out-of-pocket costs.
• Small businesses have historically had an increasingly difficult time offering health benefits due to cost. The SHOP marketplaces offer tax breaks of up to 50% of employers share of employee premium costs.
• Some of America’s largest firms don’t offer health benefits. The 2015 employer mandate ensures that full-time workers at large firms have access to health benefits. Small firms are exempted.
ObamaCare timeline infographic by Clarity Way.
The Complete Timeline of Obama’s Health Care Reform 2010 – 2022
Many of the protections, reforms and taxes are already enacted. Some of the biggest changes roll out in 2014. Our timeline of health care reform breaks down what has already happened and what will happen each year until ObamaCare is fully implemented.
ObamaCare Health Care Reform Timeline 2010-2012
First, let’s start with the facts on what ObamaCare has done to reform the healthcare industry so far:
• ObamaCare allows the FDA to approve more generic drugs in order to drive competition up and prices down.
• ObamaCare increases rebates on drugs through Medicare for Seniors.
• ObamaCare closes the Part D Medicare Coverage Gap or “Donut Hole” that was forcing Seniors to pay out of pocket for drug costs. There is also a 50% discount on brand name drugs. Seniors currently get a rebate to cover the costs and ObamaCare closes the Medicare coverage gap for good in 2020.
• The PCORI, an independent non-profit advisory board, studies different types of treatments in order to ensure quality affordable health care under ObamaCare.
• Chain restaurants must now display calories in order to promote wellness and healthy living (this helps to keep the cost of health care down, since less people will need it).
• Health Insurance companies can’t drop your coverage when you are sick.
• Individuals Can't Be Denied Coverage for pre-existing conditions.
• Children under the age of 19 can’t be classified as having a pre-existing conditions
• Children under the age of 26 can stay on their parents insurance.
• Income exclusion for Indian Tribe health benefits that were provided after March 23rd, 2010
• ObamaCare cuts Medicare funding to hospitals and other health care facilities and then reinvests the money back into Medicare reform.
• “Comparative Effectiveness Research” (CER) studies the effectiveness of drugs by comparing drug to drug and seeing which one works best. They will continue to research and publish studies until 2019.
• ObamaCare establishes a “Patient-Centered Outcomes Research Institute” (PCORI) — a public-private entity that oversees ObamaCare’s funding, goals, and outside partnerships.
• ObamaCare creates a high-risk pool for individuals with pre-existing conditions. These individuals can still get treatment, but at higher rates. The high-risk pool disappears come 2017, at which point high-risk individuals will buy the same insurance as everyone else. In general there are no pre-existing conditions on new plans starting 2014.
• Insurance companies can no longer discriminate for disabilities or domestic abuse.
• The law imposes a 10% tax on tanning booths. The concept is to tax and regulate products and services that are likely to cause people to need to use their health coverage in order offset what it costs to treat these individuals.
• Rate Hike Review is implemented. Insurers can no longer increase your premiums for profit (also known as “price gouging”). They must justify rate hikes over 10% to the state and then display them on their website (and .gov website) the same day. As of Sept 2012 this measure saved Americans $1 billion. However not all States are using this rule, causing large Premium increases in their respective States.
• The 80/20 rule is implemented. Insurance companies now have to tell their customers how their money is being spent. If they don’t spend at least 80% of the money on health care they have to give customers a rebate for the difference. The 80/20 rule has saved Americans $1.1 billion dollars via rebates.
• Health Insurance companies can no longer turn down a claim without an appeal process. This allows customers to have legal standing to fight the appeal.
• Anti-fraud funding is increased and new ways to stop fraud are created.
• Increases rebates for brand name pharmaceuticals purchased through Medicaid.
• New Annual taxes on pharmaceutical companies.
• ObamaCare payment increases to physicians, mostly in rural areas.
• Some Small Employers are eligible for tax credits to help with health care related costs.
• ObamaCare improves treatment for patents with chronic illnesses.
• The law prohibits non-group plans from canceling coverage.
• A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. This does not include insulin, asthma medication or other vital drugs.
• Employers must list employee benefits on their tax form. This helps to determine whether the company will get tax breaks or credits for insuring employees.
• Hospitals in “Frontier States” (ND, MT, WY, SD, UT ) receive higher Medicare Payments.
• Hospitals in “low cost” areas receive higher Medicare payments for 2 years.
• All new plans must provide preventive care free of charge.
• ObamaCare does away with annual spending caps.
• ObamaCare greatly eliminates lifetime limits and reduces annual limits of health insurance plans.
• New tools to fight fraud have been established, this returned more than $2.5 billion in 2009 alone.
• Cuts $716 Billion from Medicare and Medicare advantage and reinvests it back into Medicare and ObamaCare (this obviously covers a lot of ground. Read more on ObamaCare and Medicare.)
• ObamaCare places a $2500 limit on tax free spending under FSAs (flexible spending accounts).
• ObamaCare establishes state consumer assistance programs to help consumers file complaints, appeals, enroll in health care and other consumer related assistance to better understand trouble spots that need oversight.
• Your FSA cost of an over-the-counter medicine or drug cannot be reimbursed from Flexible Spending Arrangements (FSAs) or health reimbursement arrangements unless a prescription is obtained. The change does not affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eye glasses, contact lenses, co-pays and deductibles. A similar rule went into effect on Jan. 1, 2011, for Health Savings Accounts (HSAs), and Archer Medical Savings Accounts (Archer MSAs).
• FSA and HRA participants can continue using debit cards to buy prescribed over-the-counter medicines, if requirements are met.
• The hospital “pay-for-quality” program begins. This is part of an overall effort to promote quality not quantity in the health care industry.
• There is a 3.8% tax increase on capital gains over, unearned income, interest, dividends, annuities, rent, royalties, and inactive businesses. Exemptions include income from tax-exempt bonds, veterans benefits and qualified plan distributions such as those from an IRA or 401k.
• The 3.8% tax does not apply to selling your primary residence in most cases.
• The Affordable Care Act has a 5 year plan that works to simplify administrative tasks associated with health insurance such as reducing paperwork.
• Starting in 2012 there is a new tax on private health insurance plans.
ObamaCare Health Care Reform Timeline 2013
• Health Insurance Exchanges open for low to middle income Americans to make it easier for them to shop for health insurance. Those making over 400% of the poverty level can shop on the exchange but will not receive tax credits or discounts. The insurance purchased on the exchange doesn’t go into effect until Jan 1st, 2014.
• A health insurance exchange is set up by state or the federal government if the state decides not to run their own exchange.
• Tax credits, discounts on out-of-pocket costs, tax breaks and other subsides are available on the exchange. The help you get on the exchange is directly related to your gross adjusted income.
• There is a .9% ObamaCare Medicare tax on those making over $200k as an individual or $250k as a business or family. This accounts for somewhere between 1.5% and 4.2% of tax payers (these numbers are from recent IRS and census reports, 2% is often used as a rough and not inaccurate estimate. Most sources agree the number is under 3%. 3% is also the number of businesses making over this amount in taxable income).
• 3.8% Medicare tax on unearned income over $200K for individuals and $250K for families and businesses.
• $500,00 deduction cap on compensation paid to insurance company workers
• ObamaCare lays out new rules about the amount that can be contributed to an FSA. A cap of $2,500 is applied to reform FSA’s and prevent individuals from overpaying and then needing to rush to use the money before it disappears.
• Part D Coverage Gap or “Donut Hole” reduction goes into effect
• Eliminates deduction for Part D retiree drug subsidies for employers
• ObamaCare increases (7.5% to 10%) threshold at which medical expenses, as a % of income, can be deductible)
ObamaCare Health Care Reform Timeline 2014
• The Individual Mandate: There is a tax starting at 1% of your income or $95 and raising to 2.5% of your income or $685 by 2016 for individuals. For a family, it’s capped at $285 in 2014 and rises to $2,085 by 2016. It cannot exceed these amounts. This helps pay for emergency and future coverage you may need. The tax penalty is paid on your tax returns. This is a “tax” not a “mandate”.
• You can no longer be denied for pre-existing conditions.
• The ACA takes measures to prevent all types of discrimination in regards to your right to health care. Factors such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry can no longer be used by insurance companies to increase health insurance premiums.
• The only factors that can affect premiums of new insurance plans starting in 2014 are your income, age, tobacco use, family size, geography and the type of plan you buy. This applies to all plans sold through your State’s health insurance marketplace.
• All new plans sold must include Ten Essential Health Benefits.
• No Annual dollar limits on coverage.
• Congress must shop on the health insurance exchanges.
• Pharmaceutical companies are subject to a new tax.
• ObamaCare Medicaid Expansion expands coverage to 15.9 million low-income individuals (The supreme court ruling has given states the opportunity to opt-out of Medicaid expansion).
• Insurance purchased on the health insurance exchange / marketplace goes into effect.
• Employers will be able to shop on the health insurance exchanges for employee insurance.
• Tax credits, tax breaks and help with up-front costs are available to those struggling to pay for insurance.
• There is a new tax on medical devices.
• Insurance companies are taxed based on their market share.
• ObamaCare raises the bar on medical expenses before you deduct them from your taxes.
• Small Business Employers can shop for employee coverage on the health insurance exchange.
ObamaCare Health Care Reform Timeline 2015
• Employers with over 50 full-time equivalent employees must offer health insurance.
• Doctors’ income is based on quality of care not quantity of care. This is a vast simplification of the actual documentation in the bill. It is a protection from the current fee-for-service payment model.
ObamaCare Health Care Reform Timeline 2017
• States can implement their own plans which meet the standards of ObamaCare such as single-payer. (similar to ObamaCare, but instead of buying private insurance everyone pays a tax and everyone has coverage)
• Provides states flexibility to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange
• No more preexisting conditions for anyone including high-risk customers.
ObamaCare Health Care Reform 2018
• All healthcare plans (including plans held since before preventive care was required) must now offer preventive coverage.
• The “Cadillac” tax for higher quality coverage for individuals and employers purchasing insurance for employees is put in place.
ObamaCare Health Care Reform 2020
• ObamaCare fully eliminates the Medicare Gap (instead of just offering rebates to seniors).
For more information on health care reform check out our extensive coverage of Obama Care Facts.
Health Care Reform Timeline Summary
Obama’s Health Care Reform Bill is 1990 pages long. The wording is confusing, but the details of every benefit, tax, protection and reform is listed clearly. This health care reform Timeline gives you a good idea of everything that in contained in the bill and how its provisions unfold over the next decade. We will continue to update our health care reform timeline to keep it accurate and up to date in order to help provide all information on ObamaCare health care reform in one easy to use place.
Health Care Reform: ObamaCare Reform Timeline