03/26/2010 – Timeline of Major Provisions in the Health Care Package
Timeline of Major Provisions in the Health Care Package
Ways & Means Committee:
Ranking Member Dave Camp
Friday, March 26, 2010
2009
·
2‐year tax credit (total cap of $1B) for new chronic disease therapy investments
·
Medicare cuts to hospitals begin (long‐term care (7/1/09) and inpatient and rehabilitation facilities (FY10))
2010
·
States and Federal officials review premium increases
·
FDA authorized to approve "follow‐on" biologics
·
Increase brand name pharmaceutical Medicaid rebate (from 15.1% to 23.1%)
·
Medicare payments to physicians in primarily rural areas increase (2 years)
·
Deny "black liquor" eligibility for cellulosic biofuel producers credit
·
Tax credits provided to certain small employers for health care‐related expenses
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Increase adoption tax incentives for 2 years
·
Codify economic substance doctrine and impose penalties for underpayments (transactions on/after 3/23/10)
·
Provide income exclusion for specified Indian tribe health benefits provided after 3/23/10
·
Temporary high‐risk pool and high‐cost union retiree reinsurance ($5 B each for 3.5 years) (6/23/10)
·
Impose 10% tax on indoor UV tanning (7/1/10)
·
Medicare cuts to inpatient psych hospitals (7/1/10)
·
Prohibits lifetime and annual benefit spending limits (plan years beginning 9/23/10)
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Prohibits non‐group plans from canceling coverage (rescissions) (plan years beginning 9/23/10)
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Requires plans to cover, at no charge, most preventive care (plan years beginning 9/23/10)
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Allows dependents to stay on parents’ policies through age 26 (plan years beginning 9/23/10)
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Provides limited protections to children with pre‐existing conditions (plan years beginning 9/23/10)
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Hospitals in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare payments (FY11)
·
Hospitals in “low‐cost” areas receive higher Medicare payments for 2 yrs ($400 million, FY11)
2011
·
Medicare Advantage cuts begin
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No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over‐thecounter medicines
·
Medicare cuts to home health begin
·
Wealthier seniors ($85k/$170k) begin paying higher Part D premiums (not indexed for inflation in Parts B/D)
·
Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc.
·
Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durable medical equipment
·
Impose new annual tax on brand name pharmaceutical companies
·
Americans begin paying premiums for federal long‐term care insurance (CLASS Act)
·
Health plans required to spend a minimum of 80% of premiums on medical claims
·
Physicians in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare payments
·
Prohibition on Medicare payments to new physician‐owned hospitals
·
Penalties for non‐qualified HSA and Archer MSA distributions double (to 20%)
·
Seniors prohibited from purchasing power wheelchairs unless they first rent for 13 months
·
Brand name drug companies begin providing 50% discount in the Part D “donut hole”
·
10% Medicare bonus payment for primary care and general surgery (5 years)
·
Employers required to report value of health benefits on W‐2
·
Steps towards health insurance administrative simplification (reduced paperwork, etc) begins (5 yr process)
·
Additional funding for community health centers (5 years)
·
Seniors who hit Part D “donut hole "in 2010 receive $250 check (3/15/11)
·
New Medicare cuts to long‐term care hospitals begin (7/1/11)
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Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient rehab facilities begin (FY12)
·
New tax on all private health insurance policies to pay for comp. eff. research (plan years beginning FY12)
2012
·
Medicare cuts to dialysis treatment begins
·
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 psych hospitals (7/1/12)
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Hospital pay‐for‐quality program begins (FY13)
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Medicare cuts to hospitals with high readmission rates begin (FY13)
·
Medicare cuts to hospice begin (FY13)
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 , nonactive business income for those earning over $200k/$250k (not indexed to inflation)
·
Generally increases (7.5% to 10%) threshold at which medical expenses, as a % of income, can be deductible
·
Eliminate deduction for Part D retiree drug subsidy employers receive
·
Impose 2.3% excise tax on medical devices
·
Medicare cuts to hospitals who treat low‐income seniors begin
·
Post‐acute pay for quality reporting begins
·
CO‐OP Program: Secretary 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 gov't‐approved coverage are subject to a tax of the greater of $695 or 2.5% of income
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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 fulltime employee
·
More Medicare cuts to home health begin
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States must have established Exchanges
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Employers with more than 200 employees can auto‐enroll employees in health coverage, with opt‐out
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All non‐grandfathered and Exchange health plans required to meet federally mandated levels of coverage
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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
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Insurers cannot impose any coverage restrictions on pre‐existing conditions (guaranteed issue/renewability)
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Modified community rating: individual or family coverage; geography; 3:1 ratio for age; 1.5 :1 for smoking
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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)
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Insurance plans must include government‐defined "essential benefits " and coverage levels
·
OPM must offer at least two multi‐state plans in every state
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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 (FY15)
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 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 multiemployer coverage)
