Affordable Care Act - What's left to Accomplish, timeline below: 

�         Linking Payment to Quality Outcomes

Effective for payments for discharges occurring on or after October 1, 2012

The law establishes a hospital Value-Based Purchasing Program (VBP) in Original Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients' perception of care.

�         Improving Preventive Health Coverage

Effective January 1, 2013

To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.

�         Increasing Medicaid Payments for Primary Care Doctors

Effective January 1, 2013

As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.

�         Expanded Authority to Bundle Payments

Effective no later than January 1, 2013.

The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment "bundling,"  hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a "bundled" payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program.

�         Additional Funding for the Children's Health Insurance Program (CHIP)

Effective October 1, 2013

Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid.

�         Establishing Affordable Insurance Exchanges

Effective January 1, 2014

Starting in 2014 if your employer doesn't offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans.  Exchanges will offer you a choice of health plans that meet certain benefits and cost standards.  Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too.

�         Promoting Individual Responsibility

Effective January 1, 2014

Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption.

�         Increasing Access to Medicaid

Effective January 1, 2014

Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.

�         Makes Care More Affordable

Effective January 1, 2014

Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It's also refundable, so even moderate income families can receive the full benefit of the credit.  These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).

�         Ensuring Coverage for Individuals Participating in Clinical Trials

Effective January 1, 2014

Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies to all clinical trials that treat cancer or other life-threatening diseases. 

�         Eliminating Annual Limits on Insurance Coverage

Effective January 1, 2014

The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.

�         No Discrimination Due to Pre-Existing Conditions or Gender

Effective January 1, 2014

The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual's pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status.

�         Increasing Small Business Health Insurance Tax Credit

Effective January 1, 2014   

The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer's contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.

�         Paying Physicians Based on Value Not Volume

 Effective January 1, 2015

A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. 

Excerpt from Healthcare.gov (a Federal Government website managed by the U.S. Department of Health & Human Services)