Patient Protection and Affordable Care Act

What Takes Effect Immediately?

1) TAX CREDITS FOR SMALL BUSINESSES

Offers tax credits to small businesses to make employee coverage more affordable.  Tax credits of up to 35 percent of premiums will be available to firms that choose to offer coverage.  Effective beginning calendar year 2010.  (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)

2) NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS

Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions.  Effective 6 months after enactment.  (Beginning in 2014, this prohibition would apply to all persons.)

3) COVERAGE AVAILABLE FOR THOSE WITH PRE-EXISTING CONDITIONS

Provides access to affordable insurance for Americans who are uninsured because of a pre‐existing condition through a temporary subsidized high-risk pool.  Effective in 2010.

4) BANS INSURERS FROM DROPPING THE SICK

Bans insurance companies from dropping people from coverage when they get sick.  Effective 6 months after enactment.

5) BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE

Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.  Effective for calendar year 2010.  (Beginning in 2011, institutes a 50 percent discount on prescription drugs in the donut hole; also completely closes the donut hole by 2020.)

6) FREE PREVENTATIVE CARE FOR MEDICARE

Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.  Effective beginning January 1, 2011.

7) CHILDREN CAN BE COVERED UNTIL AGE 26

Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice.  Effective 6 months after enactment.

8) HELP FOR EARLY RETIREES

Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55-64.  Effective in 2010.

9) BANS LIFETIME LIMITS ON COVERAGE

Prohibits health insurance companies from placing lifetime caps on coverage.  Effective 6 months after enactment.

10) BANS ANNUAL LIMITS ON COVERAGE

Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans.  These tight restrictions will be defined by HHS.  Effective 6 months after enactment.  (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)

11) FREE PREVENTITIVE CARE FOR NEW PLANS

Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles.  Effective 6 months after enactment.

12) CREATES A NEW INDEPENDENT APPEALS PROCESS

Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan.  Effective 6 months after enactment.

13) ENSURES VALUE FOR PREMIUM PAYMENTS

Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent.  Insurers that do not meet these thresholds must provide rebates to policyholders.  Effective on January 1, 2011.

14) GROWS COMMUNITY HEALTH CENTERS

Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years.  Effective beginning in fiscal year 2011.

15) INCREASES NUMBER OF PRIMARY CARE DOCTORS

Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants.  Effective beginning in fiscal year 2011.

16) STOPS DISCRIMINATION BASED ON INCOME

Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.  Effective 6 months after enactment.

17) MORE HELP FOR HEALTH INSURANCE CONSUMERS

Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.  Effective beginning in fiscal year 2010.

18) PROTECTS AGAINST UNREASONABLE RATE HIKES

Creates a grant program to support States in requiring health insurance companies to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges.  Starting in plan year 2011.