President Obama signs into law the Affordable Care Act, the health plan he'd unveiled shortly after his election in 2008 and spent a year pushing through Congress. Some of its provisions were delayed until future years. Some took effect right away, including:
>> Children can be kept on their parents' health plans until age 26.
>> New consumer rules, including: Insurers can't set lifetime limits on coverage, can't deny coverage of children for pre-existing conditions, can't drop policyholders when they get sick, must fully cover certain preventive care for women and children.
>> Federal-state review process to ban insurers from making “unreasonable” premium hikes.
>> Research institute to gauge which treatments are best for patients.
>> New tax credit for small businesses that provide health insurance.
>> New council to design national preventive health strategy, led by surgeon general.
>> New tax on indoor tanning services.
January: House votes to repeal the law, the first of dozens of such votes since, all in vain.
Several provisions of the act take effect this year, including:
>> Health plans required to spend 85 percent of premium dollars (80 percent for individual or small-group plans) on actual health care, as opposed to profits and administration. Violators must pay rebates to consumers.
>> Medicare's “doughnut hole,” a coverage gap in which patients must pay for drugs out of pocket, begins phasing out. It's to be gone in 2020.
>> A center for Medicare/Medicaid innovation starts testing new methods of reducing costs without sacrificing quality.
>> Insurers must tell the government when they want to raise premiums on individual or small-group policies by more than 10 percent.
More provisions go into effect, including:
>> Insurers must provide a uniform summary of coverage to applicants, in hopes of helping consumers do apples-to-apples comparison shopping.
>> The “contraceptive mandate” takes effect, requiring most employers to cover birth control for female employees at no extra cost. Houses of worship are exempt. Other religiously affiliated organizations, such as schools and hospitals, may let the insurer foot the extra cost. The rule is still under court challenge.
June: The U.S. Supreme Court upholds the Affordable Care Act as constitutional.
November: After a campaign that dwells on the new law, Obama is re-elected.
The provisions keep rolling out, including:
>> Tax changes kick in. Deductibility of medical expenses is limited, and Medicare taxes are increased on upper incomes. A tax is imposed on medical devices.
>> States are required to say whether they'll run an online insurance marketplace (or “exchange”), let the federal government do so, or jointly run one. Nebraska is letting the feds do it; Iowa chose a joint operation.
>> Health entities — doctors, hospitals, pharmacists, drug makers, medical suppliers and others — must disclose when they have financial relationships with each other.
Oct. 1: Individuals may start buying health coverage through the online marketplaces.
Jan. 1: “Individual mandate” takes effect: Everyone, with a few exceptions, must have health insurance or pay a penalty. A tax credit will defray the cost for those of modest income.
These provisions will take effect:
>> Health plans must be sold regardless of an individual applicant's health status (such as a pre-existing condition) and higher premiums can now be assessed only for age, geographic area, family composition and tobacco use. The plans can't set an annual limit on coverage.
>> In states that participate — Iowa is moving to do so, Nebraska is not — Medicaid will be expanded to all low-income individuals who aren't eligible for Medicare.
>> The marketplaces must start adding two “multi-state health plans” to their lineups, one run by a nonprofit, one including no abortion coverage. By 2017 all marketplaces are to offer two such plans.
>> A new tax starts phasing in on health insurance companies.
Companies of 50-plus full-timers that don't offer a health plan will be penalized $2,000 per employee. Companies that do will get a 50 percent tax credit.
A new tax is imposed on companies offering “Cadillac” health plans.
Sources: World-Herald news wires, archive