Health care reform status update: a timeline

Marcus Pickett

When health care reform was first debated and passed, many saw it as a huge, one-time overhaul. In actuality, the law’s various provisions will be phased in over several years. Although this list is by no means exhaustive (more than 20 provisions went into effect during the law’s first year alone), here are some changes that could already be affecting your health care — and some that soon will be.

Already in effect

According to timelines from the Kaiser Family Foundation and HealthCare.gov (a website operated by the U.S. Department of Health and Human Services), here are some of the reforms that already have taken effect:

• 2010 — Consumer protections: Lifetime benefit caps have been outlawed, meaning your insurance company can’t stop covering you if you require a lot of expensive care. Insurance companies also limited in their ability to deny coverage. In the past, they could deny care for a current condition by digging up errors in a patient’s original application. Now, they can do so only if that patient deliberately committed fraud.

• 2010 — Expanded dependent coverage: One of the most popular and well-publicized provisions lets adult children age 26 and younger remain covered under their parents’ or guardians’ health plans.

• 2010 — Coverage for preexisting conditions: Health insurance companies can no longer deny coverage to children with pre-existing conditions. However, open enrollment periods (the time during which children can enroll in new plans without restrictions) still apply.

When it comes to adults with pre-existing conditions who have been denied coverage, the health care reform law has created funding for state-run high-risk health insurance pools. The pools are designed to bridge the gap until the 2014 insurance mandate.

• 2010 — Coverage for early retirees: Employers who have enrolled in the Early Retiree Reinsurance Program can get reimbursed for some of the costs of continuing to provide insurance to employees who have retired early. However, the program is no longer taking applications, and it’s designed to last only until 2014 (if funding doesn’t run out sooner).

• 2010- 2011 — Preventative health care: New health plans established as of Sept. 23, 2010, must cover certain preventative services without charging co-pays, deductibles or co-insurance. As of Jan. 1, 2011, Medicare enrollees get one yearly wellness exam for free, as well as certain preventative procedures (like screenings and vaccinations).

Coming soon

The following reform provisions are in the works, according to Kaiser and HealthCare.gov. Some have taken effect but have not been fully rolled out as federal agencies decide on final regulations:

• 2012 — Long-term care insurance: A program known as the Community Living Assistance Services and Support (CLASS) Act sets up a national long-term care insurance program. It was established Jan. 1, 2011, but participants won’t be able to take part until final regulations and policies are determined by the Department of Health and Human Services (no later than Oct. 1, 2012).
• 2014 — Health insurance mandate: Effective Jan. 1, 2014, insurance companies will no longer be able to deny coverage based on pre-existing conditions. In exchange, most Americans will be required to get insurance. Health insurance exchanges will be established to help consumers shop for coverage — and premium assistance subsidies will kick in to help low-income families pay for it.
• 2016 — Health care choice compacts: Buying a health insurance plan based in one state while living in another is currently not possible. The health care reform law will allow insurance to be sold across state lines in a limited way beginning in 2016. States would be able to form compacts, letting insurers sell plans developed in one state to consumers in another state if those states are in the same compact.
• 2020 — Elimination of the Medicare “donut hole”: In 2010, Medicare enrollees received a $250 check to help pay for drugs while in the donut hole, a coverage gap that occurs after a Medicare recipient has exhausted basic benefits but before catastrophic coverage kicks in. In 2011, Medicare enrollees in the donut hole will see a 50 percent discount on brand-name drugs and a 7 percent discount on generic drugs. These discounts will increase over the next decade until the donut hole is closed.