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PATIENT PROTECTION AND AFFORDABLE CARE ACT (PUBLIC LAW 111-148) “OBAMACARE”

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Page 1: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

PATIENT PROTECTION AND AFFORDABLE CARE ACT (PUBLIC LAW 111-148)

“OBAMACARE”

Page 2: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

Immediately

Medicare Drug Rebates

Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication.

Immediately effective (expires March 2011)

Page 3: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

Immediately

Tanning Salon Tax

A tax of 10% would be imposed on the cost of indoor tanning services

Business Tax Credit.

Small businesses with 25 or less employees and average wages of $40,000 would receive tax credits to help provide insurance to employees . Tax credit would be up to 35% of employer’s contribution if employer pays 50% of total premium cost.

Page 4: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Temporary Reinsurance Program

$5 billion temporary reinsurance program would be created for employers to provide health care coverage for retirees over the age of 55 who are not eligible for Medicare.

June 2010 (expires Jan. 1, 2014)

Page 5: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Temporary High-Risk Insurance Pool

$5 billion temporary national high-risk insurance pool would be created for employers to provide health care coverage to individuals with pre-existing conditions who have been uninsured for at least 6 months.

June 2010 (expires Jan 1, 2014)

Page 6: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Pre-existing Conditions

Insurance companies would be barred from denying coverage to children who have pre-existing medical conditions

September 2010

Page 7: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Adult Dependent Children

Insurance companies would have to provide coverage dependent children up to the age of 26.

September 2010

Page 8: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Insurance Coverage Limits

Insurance plans would be prohibited from imposing lifetime caps on coverage and from denying coverage except in cases of fraud.

September , 2010

Page 9: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2010

Preventive Services

Health insurance plans would be required to cover preventive services such as immunizations for children and cancer screenings for women.

September 2010

Page 10: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

Patient-Centered Outcomes Research Institute

Established to contract with federal agencies or the private sector for comparative effectiveness research.

Fiscal Year 2010

Page 11: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Tax Changes on Health Care Savings Accounts

Federal taxes on individuals whop spend money from health care savings accounts on ineligible medical expenses doubles to 20%

January 1, 2011

Page 12: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Medicare “Doughnut Hole”

Drug companies would provide a 50% discount on brand name drugs for seniors who face a gap in drug coverage. More subsidies would be phased in through 2020 when the coverage gap would close.

January 1, 2011

Page 13: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Long-Term Care

A voluntary long-term care program called CLASS would be created. After at least 5 years of contributions, enrollees would be entitled to a $50-a-day cash benefit to pay for long-term care.

January 1, 2011

Page 14: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Insurance Rebates

Health insurance companies would be required to provide rebates to enrollees if they spent less than 80% on individual or small group plans and 85% for large group plans, of their premium dollars on health care as opposed to administrative costs.

January 1, 2011

Page 15: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011 Physician Quality Reporting Initiative

Effective 2011-2014 with 1% bonus in 2011 and 0.5 for the remaining years.

January 1, 2011

Page 16: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Liability Reforms

Authorizes grants to states for demonstration projects to evaluate alternative liability reform models. Authorized for 5 fiscal years.

Fiscal year 2011

Page 17: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2011

Community Health Centers

Funding would increases to $11 billion for community health centers that provide medical to patients who can’t afford it.

October 2, 2011

Page 18: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2012

New Annual Fee on Drug Makers

A total annual fee of $2.8 billion would be imposed on pharmaceutical manufactuers. It would increase to $3 billion iin 2014-16, $4 Billion in 2018 and $2.8 billion in 2019 and later.

January 1, 2012

Page 19: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2012

Accountable Care Organizations

Allows providers organized as accountable care organizations (ACOs) to share in the cost savings achieved for Medicare as a means to encourage efficiencies and improve quality.

January 2012

Page 20: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2012

Hospital Readmissions Penalty

Directs CMS to track hospital readmission rates for certain high-cost conditions and reduces Medicare payments for hospitals with the highest readmission rates

October 2, 2012

Page 21: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2012

Value-Based Purchasing Program

Establishes a value-based purchasing program for acute care hospitals based on performance on quality measures.

October 1,2012

Page 22: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2013

Contribution limits on health care savings accounts.

The limit on how much individuals can contribute to flexible savings accounts would be set at $2,500.

January 1, 2013

Page 23: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2013

Physician Performance Reporting

Public reporting of physician performance information starts

January, 2013

Page 24: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2013

Itemized Deductions for Unreimbursed Medical Expenses

The threshold for deducting such expenses would increase from 7.5% of adjusted gross income to 10%.

January 1, 2013

Page 25: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2013

Medicare Taxes

The Medicare tax rate would increase from 1.45% to 2.35% on earnings over $200,000 for individuals and $250,000 for families. Also a 3.8% Medicare Tax is imposed on unearned income.

January 1, 2013

Page 26: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2913

Pilot Program on Payment Bundling

Establishes a Medicare pilot program on payment bundling for acute, inpatient hospital services, physician services, outpatient hospital services and post-acute care services.

January 1, 2013 w/expansion in 2016

Page 27: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Individual Mandate

Most Americans will be required to buy health insurance or pay fines of $95 per individual up to $285 per family or 1% of taxable household income, whichever is greater. Increases to $352/$975 or 2% of taxable income in 2015 and $695/$2,085 or 2.5% of taxable income in 2016. Fee is adjusted for inflation after 2016.

January 1, 2014

Page 28: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Employer Requirement Penalty

Companies with 50 or more employees would pay a fine if any of their full-time employees qualified for federal health care subsidies

January 1, 2014

Page 29: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Medicaid Expansion

Increases the income eligibility to 133% of the federal poverty level, or $29,327 for a family of four.

January 1, 2014

Page 30: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Annual Caps

No annual limits on dollar value of coverage.

January 1, 2014

Page 31: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Additional Insurance Market Reforms

Requires guarantee issue and renewabilitiy, limited rate variation, risk adjustment in the individual/small group markets, no pre-existing exclusions (adults), limits waiting periods to 90 days.

January 1, 2014

Page 32: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Federal Subsidies

Federal subsidies, which vary based on household income, would help offset the cost of buying insurance, for Americans and legal residents that qualify.

January 1, 2014

Page 33: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Annual Fee on Insurance Companies

An annual fee totaling $8 billion would be imposed on health insurance companies. The fee increases to $11.3 billion in 2015-16, $13 billion in 2017, and $14.3 billion in 2018. For years after, the fee will be based on the previous year and adjusted for the premium growth rate.

January 1, 2014

Page 34: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Health Insurance Exchanges

A state-based health care exchange would be created (marketplace where uninsured individuals and small businesses could comparison shop for insurance policies)

January 1, 2014

Page 35: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

New Value-based Payment Modifier

Initial implementation of a value-based payment modifier to the Medicare Physician Fee Schedule based on relative quality compared to relative cost.

January 1, 2014 January 1, 2017 for all physicians

Page 36: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2014

Premium and Cost-Sharing Subsidies

Provides subsidies for individuals and families earning up to 400% of the FPL to purchase health insurance.

January 1, 2014

Page 37: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2015

Independent Payment Advisory Board

First implementation year of IPAB Medicare cost reduction recommendations.

January 1, 2015

Page 38: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2016

Multi-State Compacts

Multi-state compacts allow insurers to sell policies across state lines. (regulations issued by July 1, 2013)

January 1, 2016

Page 39: Medicare Drug Rebates Medicare patients who face a gap in prescription drug coverage would received a one-year, $250 rebate to help pay for medication

2018

Excise Tax on High Cost Insurance Plans

A 40% excise tax would be imposed on health care plans that cost more than $12,000 for individual coverage and $27,500 for family coverage.

January 1, 2018


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