Basic provisions, timeline for U.S. health law

(Reuters) – A U.S. appeals court in Atlanta will hear a lawsuit Wednesday challenging the constitutionality of President Barack Obama’s signature healthcare law.

Many deadlines are approaching for implementing the law to expand health insurance to roughly 30 million Americans.

Charged with establishing key health programs, states have been sent into overdrive to meet these deadlines, some of which already had passed by the time the measure was signed into law a year ago because of the drawn-out process Congress used to approve it.

Here are some of the law’s major provisions and when they were implemented or are set to take effect:


Several consumer protection rules took effect in September, including allowing children to stay on their parents’ health insurance plan until age 26, banning lifetime coverage limits and ending denial of coverage for children because of pre-existing health conditions.

A temporary insurance program was created to help provide coverage to “high risk” patients with pre-existing conditions.

States that opted to add low-income people and families to their Medicaid rolls who had not previously qualified received additional federal funds.

All new insurance plans were required to cover preventative services such as mammograms without charging a deductible, co-pay or coinsurance starting in September.


Small businesses are now eligible for tax credits to help provide insurance benefits to their workers that are worth up to 35 percent of the insurance payment.

Health insurance companies — including Aetna Inc and WellPoint Inc — face new limits that call for at least 85 cents of every premium dollar to go toward medical costs, with 15 cents for overhead and salaries.

Small group or individual plans must spend at least 80 cents per dollar on care.

Drugmakers must offer a 50 percent discount on brand name drugs for elderly or disabled Americans enrolled in Medicare’s Part D prescription drug plans who also hit the so-called ”doughnut hole” coverage gap. Generic drugs will also cost less.


Private Medicare plans called Medicare Advantage will see lower government reimbursement payments. The plans may offer more benefits than traditional Medicare coverage but can cost more.

To help pay for the overhaul, the pharmaceutical industry — including Pfizer Inc, Merck & Co Inc and other drugmakers — begin paying more than $2 billion a year in taxes.


Taxes on medical devices begin. The fees for device makers such as Boston Scientific Corp and Medtronic Inc will come in the form of a 2.3 percent sales tax.

Medicare beneficiaries with Part D prescription plans will see additional savings on branded medicines when they hit the doughnut hole, this time from government subsidies.

A national pilot program for payment “bundling” begins in January where hospitals, doctors and providers are paid a flat rate for an episode of care.

States must increase payments to primary care physicians within Medicaid, with full reimbursements from the federal government.


People must have health insurance or pay a fine. Penalties for those who do not buy coverage will be phased in and reach $695 by 2016 or 2.5 percent of household income, whichever is greater. Subsidies will be offered to help people buy plans.

States must now cover Americans who earn less than 133 percent of the poverty level with Medicaid, in a great expansion of the program, with the federal government reimbursing 100 percent of the costs of new enrollees.

State-based health insurance exchanges aimed at one-stop shopping for plans will start, aiming to help people more easily compare coverage and prices.

More consumer protections kick in, including the end of coverage denials to adults with pre-existing health conditions and a ban on yearly coverage limits.

Health insurance companies begin paying a $67 billion, 10-year tax to help pay for the overhaul.

Employers with more than 50 workers that do not offer health insurance will have to pay a fee per employee.

Tax credits become available in January for middle-class families that can be advanced in order to help cover premium payments. More small business tax credits also become available.


Premium health insurance plans offered by employers face new taxes. (Reporting by Lisa Lambert, Jeremy Pelofsky, Susan Heavey and Lisa Richwine in Washington; Editing by Sandra Maler)