Time line for Obama care

2012

• Medicare cuts to dialysis treatment begin.
• 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 psychiatric 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, non-active 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.  The result of this tax will be fewer innovative and life-saving medical devices, as this article demonstrates.
• 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).  The danger here is that people will wait until they are sick to obtain health insurance policies, which will ultimately cause private health insurance companies to be unable to offer new plans.  
• 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.  The result of this mandate will be fewer consumer choices and higher prices for these comprehensive plans. 
• 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).