Rep. Dave Camp, ranking Republican of the House Ways and Means Committee, has compiled this list of when different aspects of the recently passed healthcare legislation will go into effect.
2009
• 2 ]year tax credit (total cap of $1 billion) for new chronic disease therapy investments
• Medicare cuts to hospitals begin (long ]term care (7/1/09) and inpatient and rehabilitation facilities (fiscal 2010)) 2009
2010
• States and federal officials review premium increases
• FDA authorized to approve "follow ]on" biologics
• Increase brand name pharmaceutical Medicaid rebate (from 15.1% to 23.1%)
• Medicare payments to physicians in primarily rural areas increase (2 years)
• Deny "black liquor" eligibility for cellulosic biofuel producers credit
• Tax credits provided to certain small employers for health care ]related expenses
• Increase adoption tax incentives for 2 years
• Codify economic substance doctrine and impose penalties for underpayments (transactions on/after 3/23/10)
• Provide income exclusion for specified Indian tribe health benefits provided after 3/23/10
• Temporary high ]risk pool and high ]cost union retiree reinsurance ($5 billion each for 3.5 years) (6/23/10)
• Impose 10% tax on indoor UV tanning (7/1/10)
• Medicare cuts to inpatient psych hospitals (7/1/10)
• Prohibits lifetime and annual benefit spending limits (plan years beginning 9/23/10)
• Prohibits non ]group plans from canceling coverage (rescissions) (plan years beginning 9/23/10)
• Requires plans to cover, at no charge, most preventive care (plan years beginning 9/23/10)
• Allows dependents to stay on parents’ policies through age 26 (plan years beginning 9/23/10)
• Provides limited protections to children with pre ]existing conditions (plan years beginning 9/23/10)
• Hospitals in "Frontier States" (N.D., Mont., Wyo., S.D., Utah) receive higher Medicare payments (fiscal 2011)
• Hospitals in “low ]cost” areas receive higher Medicare payments for 2 years ($400 million, fiscal 2011)
22011010
2011
• Medicare Advantage cuts begin
• No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over ]the counter medicines
• Medicare cuts to home health begin
• Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed for inflation in Parts B/D)
• Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc.
• Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable medical equipment
• Impose new annual tax on brand name pharmaceutical companies
• Americans begin paying premiums for federal long ]term care insurance (CLASS Act)
• Health plans required to spend a minimum of 80% of premiums on medical claims
• Physicians in "Frontier States" (N.D., Mont., Wyo., S.D., Utah) receive higher Medicare payments
• Prohibition on Medicare payments to new physician ]owned hospitals
• Penalties for non ]qualified HSA and Archer MSA distributions double (to 20%)
• Seniors prohibited from purchasing power wheelchairs unless they first rent for 13 months
• Brand name drug companies begin providing 50% discount in the Part D “donut hole”
• 10% Medicare bonus payment for primary care and general surgery (5 years)
• Employers required to report value of health benefits on W ]2
• Steps towards health insurance administrative simplification (reduced paperwork, etc) begins (five year process)
• Additional funding for community health centers (five years)
• Seniors who hit Part D “donut hole "in 2010 receive $250 check (3/15/11)
• New Medicare cuts to long ]term care hospitals begin (7/1/11)
• Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient rehab facilities begin (fiscal 2012)
• New tax on all private health insurance policies to pay for comp. eff. research (plan years beginning fiscal 2012)
2012
• Medicare cuts to dialysis treatment begins
• Require information reporting on payments to corporations
• Medicare to reduce spending by using an HMO ]like coordinated care model (Accountable Care Organizations)
• Medicare Advantage plans with a 4 or 5 star rating receive a quality bonus payment
• New Medicare cuts to inpatient psych hospitals (7/1/12)
• Hospital pay ]for ]quality program begins (fiscal 2013)
• Medicare cuts to hospitals with high readmission rates begin (fiscal 2013)
• Medicare cuts to hospice begin (fiscal 2013)
2013
• Impose $2,500 annual cap on FSA contributions (indexed to CPI)
• Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned, nonactive business income for those earning over $200,000 or $250,000 for families (not indexed to inflation)
• Generally increases (7.5% to 10%) threshold at which medical expenses, as a percentage of income, can be deductible
• Eliminate deduction for Part D retiree drug subsidy employers receive
• Impose 2.3% excise tax on medical devices
• Medicare cuts to hospitals which treat low ]income seniors begin
• Post ]acute pay for quality reporting begins
• CO ]OP Program: Secretary of Health and Human Services awards loans and grants for establishing nonprofit health insurers
• $500,000 deduction cap on compensation paid to insurance company employees and officers
• Part D “donut hole” reduction begins, reaching a 25% reduction by 2020
2014
• Individuals without government ]approved coverage are subject to a tax of the greater of $695 or 2.5% of income
• Employers who fail to offer "affordable" coverage would pay a $3,000 penalty for every employee that receives a subsidy through the Exchange
• Employers who do not offer insurance must pay a tax penalty of $2,000 for every full-time employee
• More Medicare cuts to home health begin
• States must have established Exchanges
• Employers with more than 200 employees can auto ]enroll employees in health coverage, with opt ]out
• All non ]grandfathered and Exchange health plans required to meet federally mandated levels of coverage
• States must cover parents /childless adults up to 138% of poverty on Medicaid, receive increased FMAP
• Tax credits available for Exchange ]based coverage, amount varies by income up to 400% of poverty
• Insurers cannot impose any coverage restrictions on pre ]existing conditions (guaranteed issue/renewability)
• Modified community rating: individual or family coverage; geography; 3:1 ratio for age; 1.5:1 for smoking
• Insurers must offer coverage to anyone wanting a policy and every policy has to be renewed
• Limits out ]of ]pocket cost ]sharing (tied to limits in HSAs, currently $5,950/$11,900 indexed to COLA)
• Insurance plans must include government ]defined "essential benefits " and coverage levels
• OPM must offer at least two multi ]state plans in every state
• Employers can offer some employees free choice vouchers for health insurance in the Exchange
• Government board (IPAB) begins submitting proposals to cut Medicare
• Impose tax on nearly all private health insurance plans
• Medicare payment cuts for hospital ]acquired infections begin (fiscal 2015)
2015
• More Medicare cuts to home health begin
2016
• States can form interstate insurance compacts if the coverage with HHS approval (2016)
2017
• Physician pay ]for ]quality program begins for all physicians
• States may allow large employers and multi ]employer health plans to purchase coverage in the Exchange.
• States may apply to the HHS secretary for a limited waiver from certain federal requirements
2018
• Impose "Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain threshold: ($10,200 individual coverage, $27,500 family or self ]only union multi-employer coverage)
