Effective January 1, Provide states that offer Medicaid coverage of and remove cost-sharing for preventive services recommended rated A or B by the U. Preventive Services Task Force and recommended immunizations with a one percentage point increase in the federal medical assistance percentage FMAP for these services. Effective January 1, Authorize Medicare coverage of personalized prevention plan services, including a comprehensive health risk assessment, annually.
Require the Secretary to publish guidelines for the health risk assessment no later than March 23, , and a health risk assessment model by no later than September 29, Effective January 1, Provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
Effective January 1, or when program criteria is developed, whichever is first Require Medicaid coverage for tobacco cessation services for pregnant women. Effective October 1, Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women. Effective six months following enactment Wellness programs Provide grants for up to five years to small employers that establish wellness programs.
Funds appropriated for five years beginning in fiscal year Provide technical assistance and other resources to evaluate employer-based wellness programs. Conduct a national worksite health policies and programs survey to assess employer-based health policies and programs.
Employers must offer an alternative standard for individuals for whom it is unreasonably difficult or inadvisable to meet the standard. Effective January 1, Establish state pilot programs by July to permit participating states to apply similar rewards for participating in wellness programs in the individual market and expand demonstrations in if effective. Require a report on the effectiveness and impact of wellness programs.
Report due three years following enactment Nutritional information Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.
The program is financed through voluntary payroll deductions: all working adults will be automatically enrolled in the program, unless they choose to opt-out. Effective October 1, Establish the Community First Choice Option in Medicaid to provide community-based attendant supports and services to individuals with disabilities who require an institutional level of care.
Provide states with an enhanced federal matching rate of an additional six percentage points for reimbursable expenses in the program.
Effective October 1, Create the State Balancing Incentive Program to provide enhanced federal matching payments to eligible states to increase the proportion of non-institutionally-based long-term care services. Effective October 1, through September 30, Skilled nursing facility requirements Require skilled nursing facilities under Medicare and nursing facilities under Medicaid to disclose information regarding ownership, accountability requirements, and expenditures.
Publish standardized information on nursing facilities to a website so Medicare enrollees can compare the facilities. Require employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers. Impose new regulations on health plans in the Exchanges and in the individual and small group markets.
Beginning after , the penalty will be increased annually by the cost-of-living adjustment. Other requirements Require employers with more than employees to automatically enroll employees into health insurance plans offered by the employer. Employees may opt out of coverage. All newly eligible adults will be guaranteed a benchmark benefit package that meets the essential health benefits available through the Exchanges.
The Supreme Court ruling on the constitutionality of the ACA upheld the Medicaid expansion, but limited the ability of HHS to enforce it, thereby making the decision to expand Medicaid optional for states. States have the option to expand Medicaid eligibility to childless adults beginning on April 1, , but will receive their regular FMAP until CHIP benefit package and cost-sharing rules will continue as under current law. Provide states with the option to provide CHIP coverage to children of state employees who are eligible for health benefits if certain conditions are met.
CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state Exchanges. Legal immigrants who are barred from enrolling in Medicaid during their first five years in the U. Trending: ACA's Future. Require most U. Require U. Require employers with more than employees to automatically enroll employees into health insurance plans offered by the employer.
Limit availability of premium credits and cost-sharing subsidies through the Exchanges to U. Beginning in , further adjust the premium contributions to reflect the excess of premium growth over CPI if aggregate premiums and cost sharing subsidies exceed.
Provisions related to the premium and cost-sharing subsidies are effective January 1, Provide cost-sharing subsidies to eligible individuals and families. Require verification of both income and citizenship status in determining eligibility for the federal premium credits. Ensure that federal premium or cost-sharing subsidies are not used to purchase coverage for abortion if coverage extends beyond saving the life of the woman or cases of rape or incest Hyde amendment.
If an individual who receives federal assistance purchases coverage in a plan that chooses to cover abortion services beyond those for which federal funds are permitted, those federal subsidy funds for premiums or cost-sharing must not be used for the purchase of the abortion coverage and must be segregated from private premium payments or state funds.
The credit phases-out as firm size and average wage increases. The credit will be available for two years. Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan. Effective 90 days following enactment through January 1, Effective January 1, Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.
The threshold amounts may be adjusted upwards if health care costs rise more than expected prior to implementation of the tax in The threshold amounts will be increased for firms that may have higher health care costs because of the age or gender of their workers. The aggregate value of the health insurance plan includes reimbursements under a flexible spending account for medical expenses health FSA or health reimbursement arrangement HRA , employer contributions to a health savings account HSA , and coverage for supplementary health insurance coverage, excluding dental and vision coverage.
Effective January 1, Eliminate the tax deduction for employers who receive Medicare Part D retiree drug subsidy payments. Effective January 1, Impose an excise tax of 2.
Effective July 1, Exclude unprocessed fuels from the definition of cellulosic biofuel for purposes of applying the cellulosic biofuel producer credit. Effective January 1, Clarify application of the economic substance doctrine and increase penalties for underpayments attributable to a transaction lacking economic substance.
Effective upon enactment. Create state-based American Health Benefit Exchanges and Small Business Health Options Program SHOP Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to employees can purchase qualified coverage.
Permit states to allow businesses with more than employees to purchase coverage in the SHOP Exchange beginning in States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area.
Funding available to states to establish Exchanges within one year of enactment and until January 1, Restrict access to coverage through the Exchanges to U. Require the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.
Each multi-state plan must be licensed in each state and must meet the qualifications of a qualified health plan. If a state has lower age rating requirements than , the state may require multi-state plans to meet the more protective age rating rules. These multi-state plans will be offered separately from the Federal Employees Health Benefit Program and will have a separate risk pool.
Create the Consumer Operated and Oriented Plan CO-OP program to foster the creation of non-profit, member-run health insurance companies in all 50 states and District of Columbia to offer qualified health plans. To be eligible to receive funds, an organization must not be an existing health insurer or sponsored by a state or local government, substantially all of its activities must consist of the issuance of qualified health benefit plans in each state in which it is licensed, governance of the organization must be subject to a majority vote of its members, must operate with a strong consumer focus, and any profits must be used to lower premiums, improve benefits, or improve the quality of health care delivered to its members.
This plan is only available in the individual market. Require guarantee issue and renewability and allow rating variation based only on age limited to 3 to 1 ratio , premium rating area, family composition, and tobacco use limited to 1. Require qualified health plans participating in the Exchange to meet marketing requirements, have adequate provider networks, contract with essential community providers, contract with navigators to conduct outreach and enrollment assistance, be accredited with respect to performance on quality measures, use a uniform enrollment form and standard format to present plan information.
Require the Exchanges to maintain a call center for customer service, and establish procedures for enrolling individuals and businesses and for determining eligibility for tax credits. Permit states to prohibit plans participating in the Exchange from providing coverage for abortions.
Unless otherwise noted, provisions relating to the American Health Benefit Exchanges are effective January 1, Prohibit abortion coverage from being required as part of the essential health benefits package. Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. Effective within 90 days of enactment until January 1, To understand the impact of these developments and to monitor the effects of the ACA, RAND used COMPARE , a microsimulation modeling tool that allows us to estimate the likely effects of policy changes in key areas of health reform on key outcomes, including health coverage, employer-based insurance, consumer costs, and government spending.
What makes this tool unique is its ability to follow the same nationally representative sample of individuals from month to month to identify changes in their health care coverage as well as shifts in opinion and knowledge about the ACA. Below we highlight what we have learned from our studies of the ACA to date as implementation continues to unfold. Despite its goal of universal health coverage, the ACA leaves substantial numbers of Americans without access to insurance.
More than three years after the law's enactment, enrollment in the online Marketplaces began in October Notwithstanding widely reported problems with the rollout of the Marketplace websites, sizable numbers of previously uninsured people were able to obtain coverage over the first and second enrollment periods. Analysis of survey data about Americans' health insurance enrollment from October to April showed that The total number of uninsured Americans dropped from Much of this increase was driven by gains in employer-sponsored coverage.
Among those newly insured, 9. The study also estimated that One of the reasons why people are signing up is the individual mandate. After the law was enacted, the Supreme Court took up a legal challenge to the individual mandate.
The plaintiffs sued to have the individual mandate voided as unconstitutional. In the run-up to the court decision, RAND analyzed the likely effect of eliminating the individual mandate and found that without it, an estimated 12 million people who would otherwise sign up for coverage would be uninsured. The analysis found that eliminating the individual mandate would cause the number of people enrolled in the individual exchanges to fall by more than 20 percent.
During the early enrollment period, debate erupted over the enrollment of young adults in the individual exchanges. Some news stories and commentators maintained that unless roughly 40 percent of enrollees in the individual exchanges were young adults — between ages 18 and 34 — then the costs associated with older, less healthy adults would lead to higher premiums and ultimately destabilize these markets. At the end of the first open enrollment period in March , enrollment figures from the U.
Department of Health and Human Services showed that 28 percent of enrollees were between the ages of , while 48 percent were 45 or older. In addition, the spending data used as input to COMPARE suggest that, for most enrollees of all ages, premium payments exceed health care spending.
To encourage enrollment in the new individual insurance exchanges, the ACA offers tax credits to help lower-income individuals and families buy coverage. These tax credits have faced multiple court challenges. In late , the U. Supreme Court agreed to hear King v Burwell , a case that challenges the legality of government subsidies that help low- and moderate-income people buy health insurance in marketplaces operated by the federal government.
The legal challenge to these subsidies rests on the grounds that the wording of the law allows such aid only to people who buy policies through state-run marketplaces. They estimated that eliminating subsidies for low- and moderate-income people who purchase ACA-compliant plans would reduce enrollment in those 34 states from Washington, D.
A-Z Index. About the Affordable Care Act. The Internal Revenue Service IRS is responsible for tax provisions of the current law that will be implemented during the next several years. A list of these provisions now in effect, and additional information soon to be added, can be found at www.
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