Health Care Act Implementation Timeline

The timing and implementation highlights of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act are outlined on this page. (You can download a 2-page pdf file of the timeline at the bottom of the page.) The Small Business Health Care Calculator from the Center for American Progress is also included.

Immediate or for Tax Year 2010

  • Medicare part D donut hole begins to close - $250 rebates in 2010, coinsurance rates reduced from 100% to 25% by 2020.
  • Small business tax credits for tax years 2010-2013. See the Small Business Health Calculator to estimate how much a business will save.
  • Loss ratio minimums for health insurance companies – 85% for large group market plans, 80% for individual and small group markets (the amount of premiums that must go to medical claims); consumer rebates if minimums not met.
  • Establish a process for reviewing increases in health plan premiums and require plans to justify increases.
  • Require states to report on trends in premium increases and recommend whether plans should be excluded from the Exchange.

June 2010

  • Temporary high-risk pools (until 2014) to provide health coverage to individuals with pre-existing conditions.
  • Temporary reinsurance program for early retirees.

September 2010 and Later

  • State option to expand Medicaid eligibility for childless adults up to 133% of the federal poverty level.
  • Require dependent coverage option for children through age 26 for all individual and group policies.
  • Prohibit individual and group health plans from placing lifetime limits on dollar value of coverage.
  • Prohibit insurers from rescinding coverage except in cases of fraud.
  • Prohibit pre-existing condition exclusions for children.
  • Eliminate co-payments and deductibles for preventive care under new private plans.
  • Grants to states for consumer-based support programs.
  • Funding to establish school-based health centers.
  • Require qualified health plans to provide at a minimum coverage without cost-sharing for certain preventive services, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.
  • Impose a tax of 10% on the amount paid for indoor tanning services.


  • Phase-in lower Medicare Advantage payment rates.
  • Eliminate cost-sharing for preventive services for Medicare and Medicaid recipients.
  • Establish CLASS, a voluntary program for purchasing community living assistance and supports.
  • Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nation’s health.
  • Increased funding for community health centers.
  • Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations.
  • Provide grants for up to five years to small employers that establish wellness programs.
  • Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.


  • Begin quality-based payments under Medicare.


  • Increase Medicare tax on earnings over $200,000 for individuals and $250,000 for married couples filing jointly, and impose a 3.8% tax on unearned income for high-income taxpayers.
  • Elimination of employer Medicare Part D retiree prescription drug subsidy.
  • Begin Medicare bundled payment pilot program.
  • Create the Consumer Operated and Oriented Plan (CO-OP) program, for non-profit, member-run health insurers in all states.
  • Impose an excise tax of 2.3% on the sale of any taxable medical device.


  • Begin state-based Health Insurance Exchanges.
  • Exchange premium and cost-sharing credits for individuals and families with incomes up to 400% of poverty level.
  • Expand Medicaid to individuals and families with incomes up to 133% of poverty level.
  • Individual mandate to have health insurance begins; penalties begin (phased in from $95 in 2014 4o 2.5% of taxable income in 2016).
  • Employer mandate to provide health insurance to employees begins (for employers with 50+ employees); penalties begin.
  • 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 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.
  • Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.
  • Medicare payment Advisory Board begins – submit recommendations for Medicare payment reductions if spending exceeds determined thresholds.


  • States may form health care choice compacts; insurers may sell policies in any state in the compact.


  • Excise tax on insurers (40% tax on plans with aggregate value above $10,200 for individual coverage and $27,500 for family coverage).
To learn more, contact Jon Bailey, or 402.687.2103 x 1013.
PDF icon HC-Implementation-Timeline.pdf90.43 KB