8/9/2019 Health Reform Immediate Benefits

1/2

KEY PROVISIONS THAT TAKE EFFECT IMMEDIATELYUNDER SENATE BILL AS AMENDED BY RECONCILIATION BILL

FOR SMALL BUSINESSES

SMALLBUSINESSTAXCREDITSOfferstaxcreditstosmallbusinessestomakeemployeecoveragemore

affordable. Taxcreditsofupto35percentofpremiumswillbeimmediatelyavailable. Effectivebeginningforcalendaryear2010. (Beginningin2014,smallbusinesstaxcreditswillcover50percentofpremiums.)FOR SENIORSBEGINSTOCLOSETHEMEDICAREPARTDDONUTHOLEProvidesa$250rebatetoMedicarebeneficiaries

whohitthedonutholein2010. Effectiveforcalendaryear2010. (Beginningin2011,institutesa50%discountonbrandnamedrugsinthedonuthole;alsocompletelyclosesthedonutholeby2020.)

FREEPREVENTIVECAREUNDERMEDICAREEliminatescopaymentsforpreventiveservicesandexempts

preventiveservicesfromdeductiblesundertheMedicareprogram. EffectivebeginningJanuary1,2011.HELPFOREARLYRETIREESCreatesatemporaryreinsuranceprogram(untiltheExchangesareavailable)to

helpoffsetthecostsofexpensivehealthclaimsforemployersthatprovidehealthbenefitsforretireesage55

64.

Effective90

days

after

enactment

FOR THOSE PRIVATELY INSURED

NODISCRIMINATONAGAINSTCHILDRENWITHPREEXISTINGCONDITIONSProhibitshealthplansfrom

denyingcoveragetochildrenwithpreexistingconditions. Effective6monthsafterenactment. (Beginningin2014,thisprohibitionwouldapplytoadultsaswell.)

NORESCISSIONSBanshealthplansfromdroppingpeoplefromcoveragewhentheygetsick. Effective6monthsafterenactment.NOLIFETIMELIMITSONCOVERAGEProhibitshealthplansfromplacinglifetimecapsoncoverage. Effective6monthsafterenactment.NORESTRICTIVEANNUALLIMITSONCOVERAGETightlyrestrictsnewplansuseofannuallimitstoensure

accesstoneededcare. ThesetightrestrictionswillbedefinedbyHHS. Effective6monthsafterenactment.(Beginningin2014,theuseofanyannuallimitswouldbeprohibitedforallplans.)

FREEPREVENTIVECAREUNDERNEWPLANSRequiresnewprivateplanstocoverpreventiveserviceswith

nocopaymentsandwithpreventiveservicesbeingexemptfromdeductibles. Effective6monthsafterenactment.

8/9/2019 Health Reform Immediate Benefits

2/2

NEW,INDEPENDENTAPPEALSPROCESSFORNEWPLANSEnsuresconsumersinnewplanshaveaccesstoan

effectiveinternalandexternalappealsprocesstoappealdecisions. Effective6monthsafterenactment.MOREFORYOURPREMIUMDOLLARRequiresplanstoputmoreofyourpremiumsintoyourcare,andless

intoprofits,CEOpay,etc. Thismedicallossratiorequiresplansintheindividualandsmallgroupmarketto

spend80percentofpremiumsonmedicalservices,andplansinthelargegroupmarkettospend85percent.

Insurersthatdontmeetthesethresholdsmustproviderebatestopolicyholders. EffectiveonJanuary1,2011.NODISCRIMINATIONBASEDONSALARYProhibitsnewgrouphealthplansfromestablishinganyeligibility

rulesforhealthcarecoveragethathavetheeffectofdiscriminatinginfavorofhigherwageemployees.

Effective6monthsafterenactment.FOR THOSE UNINSUREDIMMEDIATEHELPFORTHEUNINSUREDWITHPREEXISTINGCONDITIONS(INTERIMHIGHRISKPOOL)

ProvidesimmediateaccesstoinsuranceforAmericanswhoareuninsuredbecauseofapreexistingcondition

throughatemporaryhighriskpooluntiltheExchangesupandrunningin2014. Effective90daysafterenactment.(Beginningin2014,healthplansarebannedfromdiscriminatingagainstallpeoplewithpre

existingconditions,sohighriskpoolswouldphaseout).

EXTENDINGCOVERAGEFORYOUNGPEOPLEUPTO26TH

BIRTHDAYTHROUGHPARENTSINSURANCE

Requireshealthplanstoallowyoungpeopleuptotheir26th

birthdaytoremainontheirparentsinsurance

policy,attheparentschoice. Effective6monthsafterenactment.GENERAL REFORMS

COMMUNITYHEALTHCENTERSIncreasesfundingforCommunityHealthCenterstoallowfornearly

doublingthenumberofpatientsservedoverthenext5years. Effectivebeginninginfiscalyear2010.MOREPRIMARYCAREDOCTORSProvidesnewinvestmentintrainingprogramstoincreasethenumberof

primary

care

doctors,

nurses,

and

public

health

professionals.

Effectivebeginning

in

fiscal

year

2010.

HEALTHINSURANCECONSUMERASSISTANCEProvidesaidtostatestoestablishofficesofhealthinsurance

consumerassistancetohelpconsumersfilecomplaintsandappeals. EffectivebeginninginFY2010.CREATESNEW,VOLUNTARY,PUBLICLONGTERMCAREINSURANCEPROGRAMCreatesalongtermcare

insuranceprogramtobefinancedbyvoluntarypayrolldeductionstoprovidebenefitstoadultswhobecome

functionallydisabled. EffectiveonJanuary1,2011.MORE REFORMS THAT BEGIN IN 2014 (WHEN EXCHANGES HAVE FORMED)

NODISCRIMINATIONAGAINSTADULTSWITHPREEXISTINGCONDITIONS

BANONHIGHERPREMIUMSFORWOMEN

PREMIUMSBASEDONAGECANONLYVARYBYAMAXIMUMOF3TO1RATIO

CAPONOUTOFPOCKETEXPENSESforprivatehealthplans

OFFICEOFSPEAKERNANCYPELOSI

MARCH22,2010