On March 23, 2010, President Barack Obama signed into law the most comprehensive health reform legislation in decades. The Congressional Budget Office estimates that, once fully implemented, the Patient Protection and Affordable Care Act (H.R. 3590) and the Health Care and Education Reconciliation Act (H.R. 4872) will reduce the number of uninsured by 32 million, and reduce the deficit by $143 billion over 10 years. Here, in no particular order, are some of the main health-care provisions that have been signed into law, compiled from this guide from the Kaiser Family Foundation, a nonpartisan source of health policy and information on health-care issues, as well as from the links at the bottom:
With immediate effect
1) Insurance companies will be barred from denying coverage to children with pre-existing illnesses, and young adults will be permitted to stay on their parents' insurance policies up to age 26. Insurance companies' practice of levying annual caps and lifetime caps on health care coverage will be banned, as will rescissions (dropping coverage when patients get sick). Any increases in health plan premiums will be subject to review.
2) Adults with pre-existing conditions will be eligible for coverage in high risk health insurance pools until future health-care exchanges are established.
3) All new private plans will be required to provide free preventative care, with no co-payments or deductibles. Medicare will adopt this requirement beginning in 2011.
4) The so-called Medicare 'donut hole' will be addressed through a rebate to Medicare beneficiaries who find themselves in the prescription drug coverage gap. Beginning in 2011, a 50% discount will be applied to prescription drugs in the 'donut hole.'
5) Community health centers will receive increased funding in the next fiscal year to help treat the expected increase of patients over the next few years.
6) The legislation, coupled with the executive order signed by the president yesterday, reaffirms the Hyde Ruling that there will be no federal funding of abortion, except in cases of rape, incest, or risk to the life of the mother.
Gradual implementation
1) By 2014, most individuals will be required to have health insurance. The individual mandate, which is explained here, would be phased in from 2014-2016, and would be subject to various exceptions, including for financial hardship and religious objections.
2) States will be required to create American Health Benefit Exchanges to serve as marketplaces for individuals to purchase insurance. Separate Exchanges will be set up for small employers. Subsidies will be provided to families with incomes between 133-400% of the poverty level ($29,327 to $88,200 for a family of four in 2009) to help them purchase insurance through the Exchanges. With the establishment of these Exchanges, all pre-existing condition discrimination will be banned.
3) Medicaid will be expanded to include those with incomes up to 133% of the federal poverty level ($14,404 for an individual; $29,327 for a family of four). States will be required to expand Medicaid to include childless adults from 2014 onwards.
4) The Children's Health insurance Program (CHIP) will continue until it is determined that the new Exchanges are provide reliable and comprehensive coverage and protections for children.
5) Employers will not be required to buy insurance for their employees, but larger employers may be subject to penalties if they do not provide insurance.
Covering the costs
1) From 2012, the Medicare Payroll Tax will be expanded to include unearned income, that is, a 3.8% tax on investment income for families making more than $250,000 per year ($200,000 for individuals).
2) Beginning in 2018, insurance companies will pay a 40% excise tax on high-end insurance plans worth over $27,500 for families ($10,200 for individuals).
For further coverage:
- The New York Times: A look at the key provisions.
- PolitiFact: "Top 10 facts to know about health care reform."
- CBS News: "A Look At What's in the Bill."
- The Wall Street Journal: "What's in the Bill."
- Health Insurance Providers: A timeline of health care reform changes.
Justin Fung is the policy and organizing assistant for Sojourners. A graduate of Fuller Theological Seminary, he also blogs regularly at Gershom's Journal.
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