Here’s what I could find on what health care reform means in practice (as opposed to in theory), with a time line showing when provisions go into effect. Again, surprisingly difficult to pull together, considering the level of interest and confusion.

As of right now, March 24, 2010

Small Businesses get relief and can start applying for tax credits to buy health insurance for their employees. Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance. Small businesses that offer health coverage to employees will be eligible for tax credits of up to 50 percent of premium costs.

Senior citizens on Medicare will get help paying for prescription drugs as the dreaded doughnut hole begins to close. For seniors who have already hit the doughnut hole, $250 rebate checks are on the way.

As of June 21, 2010

Americans who are uninsurable because of pre-existing conditions get a path toward health coverage. High risk pools will be set up so they can purchase the insurance they could never get before. Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds. Those high risk pools will be up and running as of June 21, 2010.

As of September 23, 2010

It will longer be legal for insurance companies to deny children under age 19 coverage for pre-existing conditions.

Insurance companies can no longer drop customers for being sick.

Insurance companies can no longer impose lifetime limits on benefits.

Adult children may remain as dependents on their parents’ policy until their 27th birthday.

As of January 1, 2011

Insurance companies will be required to spend 80-85% of what they take in premiums on actual medical care. If they don’t they will owe the difference in the form of a rebate.

Medicare patients will start receiving free preventive care — no copays.

As of January 1, 2014

Health option exchanges will be administered by either a government agency or a nonprofit organization. To contact the exchange, there will be national call centers. For the most part, however, their design is up to the states.

The exchanges would inspect offered policies to make sure they meet government standards and that plans are “in the interest” of buyers, according to the guidelines of the healthcare reform bill.

Exchanges are prohibited from setting premiums. They can, however, ask insurers to justify rate hikes – and if they’re unsatisfied with the answer can use price as a reason to exclude that particular plan from the group of insurance prodcuts.

There will be four levels of plans offered, labeled “platinum,” “gold,” “silver,” and “bronze.”

Individuals can purchase health insurance outside the exchanges. An insurer would have to charge the same rates outside the exchange as it does inside, for comparable plans, in order to remain on the exchange.

The exchange is not available to people who work for a medium or large company, or if your employer offers health insurance benefits. If you lose your employer-related insurance, however, you will be able to move seamlessly into the exchange.

Insurance companies will not be able to impose annual limits on coverage.

It will longer be legal to deny anyone coverage because of pre-existing conditions.

Waiting periods for coverage may not exceed 90 days.

Premiums would be capped at a percentage of income, ranging from 3 percent of income to as much as 9.5 percent. People of any age who cannot find a plan that costs less than 8 percent of their income would be allowed to buy a catastrophic policy otherwise intended for people under age 30.

Penalties for the insurance mandate will kick in, but it is unclear how strict the enforcement of that penalty would actually be. There will be no criminal penalty for not buying insurance, nor will there be criminal penalties for not paying the penalty. (Makes one wonder how enforceable this provision will be.)

The first year, consumers who did not have insurance would owe $95, or 1 percent of income, whichever is greater. But the penalty would subsequently rise, reaching $695, or 2 percent of income. Families who fall below the income-tax filing thresholds would not owe anything. Nor would people who cannot find a policy that costs less than 8 percent of their income.

As of January 1, 2018

Insurance plans must cover preventive services for all customers, not just medicare customers, without co-payments or deductibles.

A new excise tax will apply to insurance plans that cost more than $10,200 for an individual or more than $27,500 for a family.

Employers with 50 or fewer workers would be exempt from coverage provisions. For firms with more than 50 employees that do not offer health insurance as a benefit, if at least one full-time employee gets a subsidy from the federal government to purchase health insurance on his or her own, the company will have to pay a penalty fee of $2,000 for every full-time worker. One final item: if you’re a firm with more than 200 employees, and you do offer health insurance, you would have to automatically enroll your workers in the plan. They could opt out of the coverage. But they are the ones that would have to make that decision

Still checking the timeline on the provisions below. I will update as I read through the sources.

Community centers are slated to receive $11 billion additional funds for medical staff and expansions of buildings and services.

More lower-income individuals under age of 65 will be covered . Medicaid eligibility expands to 133 percent of the poverty level — $29,327 for a family of four. This is likely to encourage more people to seek preventive care from community centers.

More than $400 billion in higher taxes will be raised over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000.

Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.

EMPLOYER COVERAGE People who receive coverage through large employers would be unlikely to see any drastic changes, nor should premiums or coverage be affected. But almost everyone would benefit from new regulations, like the ban on pre-existing conditions that would apply to all policies come 2014.

There might even be cases where people would be eligible to buy insurance through an exchange instead of through their employer, Professor Jost said: those who must pay more than 9.5 percent of their income for premiums, or those whose plans do not cover more than 60 percent of the cost their benefits.

CHANGES IN MEDICARE One of the biggest changes involves the Medicare prescription drug program. Its unpopular “doughnut hole” — a big, expensive gap in coverage that affects millions — would be eliminated by 2020. Starting immediately, consumers who hit the gap would receive a $250 rebate. In 2011, they would receive a 50 percent discount on brand name drugs.

HIGH-COST INSURANCE Starting in 2018, employers that offer workers pricier plans — or those with total premiums of $10,200 or more for singles and $27,500 for families — would be subject to a 40 percent tax on the excess premium, said C. Clinton Stretch, managing principal of tax policy at Deloitte. Retirees and workers in high-risk professions like firefighting would have higher thresholds ($11,850 for singles, or $30,950 for families), pegged to inflation.

Although the taxes would be levied on the insurer, experts expect the assessment to be passed on to the consumer in the form of higher premiums or reduced benefits.


The Patient Protection and Affordable Care Act, Immediate Benefits
The Rachel Maddow Show
Ten immediate benefits of HCR
For Consumers, Clarity on Health Care Changes
Obama Has Signed the Bill. Now What?
Big Medicaid changes loom under health-care reform
When health care provisions take effect
Health care reform bill 101: What the bill means to you

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Nellie, Just looking at a rundown of the HCR bill. Does “small business” mean a business with under 50 employees? (anyone know?)


Excellent compilation, Nellie.

I noticed the day after passage of the bill that local news actually highlighted the benefits in a positive note, but that didn’t last long.

The local news is back to highlighting the Republican view and the fight the Republicans are pledging to fight reform and repeal it.

Our Democratic AG in Arizona has refused to file a suit against HCR, so now the Republican governor is threatening to file for the state.

Terry Goddard is our AG and he is running for governor, but in the meantime he has asked the current governor to restore Child Care funding in the state as not to lose billions of federal dollars that fund the program.

Brewer has refused and is denying thousands of poor children health care, and instead tells parents to take their children ERs for treatment.

No mention is ever made of children who need long term care.

KQµårk 死神

FYI nellie here is a excellent healthcare premium calculator after exchanges fully kick in on 2014 on WashPo.

Just put in your income, marital status and family size and it calculates your yearly premium range under the final bill.

I guarantee if most working family heads who are against this reform who have no coverage now or wanted to start or work for a small business did this calculation they would change their tune on HCR and their only complaint would be it’s not happening fast enough.

Pepe Lepew

My mom has said she might be interested in coming back to the States to be closer to her grandkids and great-grandkids in California, but says she could never get coverage here. She’s diabetic and has COPD. It sounds like this couldn’t really help her until 2014, at least the way I interpret it.

Now, my mom ALSO has a tendency to make excuses for not making decisions…


John McGramps is going off on the “Louisiana Purchase.” I will admit that I saw it as a favor for a vote, nothing new, it happens on every bill. Grumpy acts like it is the debils work. Yesterday Matt Yglesias had a explanation on why it is really needed. McGrump can’t understand this.

the Louisiana Purchase is in fact a perfectly justifiable policy response to a weird situation. The crux of the matter is that the Medicaid formula is supposed to provide more help to poor states than to rich states, and Hurricane Katrina had the weird result of making Louisiana register as suddenly much richer than it used to be:


I hate to say it, but unlike all the others, McGrumps is at least more consistent on this issue.

To pretend as if this is anything new though puts me beyond myself in laughter. They act as if Obama’s Soviet Czars are behind it.


Hehe– one man’s pork is McCains’ “other white meat.”

2006, McCain and senator Jon Kyl (R) funnelled $10 million toward the University of Arizona for an academic center named after Justice William Rehnquist.

2003–McCain also slipped $14.3 million into a defense appropriations bill to
create a buffer zone around Luke Air Force Base in Arizona.


This was a famous Kyl ad fro 2006:

Kyl: I’m Jon Kyl and I approve this message.
Announcer: Jim Pederson spending millions to buy a Senate seat, now he wants to spend your tax dollars on pork.
Pederson: Bring the bacon home, they call that pork.
Announcer: We sure do Jim, pork means higher taxes, higher deficits. No surprise Pederson is pushing a trillion dollar tax hike just like John Kerry, higher income taxes, taxes on small business for more pork
Pederson: Bring the bacon home, they call that pork.
Announcer: Hey Jim it’s taxpayers money, not yours.

Seriously, not only are they disingenuous lying sacksofshit, but why should I vote for someone who won’t go and fight for my state?

I guess their philosophy is to keep tax money in people’s pockets in the first place – so even RuPaul can rationalize his earmark requests i this regard.

I never said McCain was perfect, and don’t like defending him, but once-upon-a-time, he called out both parties.

Now, and Bito can correct me, I heard (very optimistic) some numbers that say Hayworth is closing in. I can’t believe he’ll win the primary, though. I need to find some numbers on this to find out where the guy on the TV was getting this…


Here you go, Khirad.

Longtime incumbent John McCain now leads conservative challenger J.D. Hayworth by just seven points in Arizona


If only we had someone to tap. The AZ Democratic Party is pathetic…


Saw this character J.D. Hayworth on Rachel the other day (I’m behind on my Podcasts) he makes lying on tv look so darned easy until you see his dead eyes.


Khirad, we may have such a candidate.

As Sen. John McCain works to beat back a primary challenge from the right, Arizona businesswoman Nan Stockholm Walden is taking a look at entering the Senate race on the Democratic side, according to Democrats in Arizona and in Washington.

Walden, an executive at Farmers Investment Co. who served as a staffer for former Democratic Sens. Bill Bradley and Daniel Patrick Moynihan, could provide her party with a credible, well financed candidate in the event that McCain loses or is severely wounded in his nomination fight with former Rep. J.D. Hayworth, Democrats said.

“She could be quite formidable. She has a national network. She’s been very plugged in with women donors


I have heard and read these questions many months ago and don’t know the answers. After everyone has healthcare, will states still require employers to ave workers comp? Will you still have to carry the medical part in auto insurance? If no, it would seem to mean large savings.


Workers comp:

Auto ins.

Bito, I would guess in those states, you still need to carry medical liability, as ins won’t cover everything 100%.

“If you are not in a no-fault state, you are probably not required to have medical payments insurance. Medical payments insurance pays medical expenses that result from an auto accident, regardless of who is at fault. It covers people riding in your car. It also covers you and your family if you are hit by a car while you are walking, or if you are injured while riding in someone else


Thanks Cher, seems like it’s a …depends or maybe! ?


Wonderful article and recap, Nellie! These provisions, especially the ones coming into effect this year and next need to be hammered into the public through November.


By 49%-40% those surveyed say it was “a good thing” rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms, as “enthusiastic” or “pleased,” while about four in 10 describe it in negative ways, as “disappointed” or “angry.”

The largest single group, 48%, calls the bill “a good first step” that should be followed by more action on health care. An additional 4% also have a favorable view, saying the bill makes the most important changes needed in the nation’s health care system.


I know two folks, dear friends, in the ‘angry’ group! I tried to explain what the Bills meant, based on the Kaiser comparison and, boy-o-boy, did I ever get ripped apart! I’m glad the poll numbers are showing favorably as I’m worried about the costs to low-income folks who are just outside the range to get subsidies. Even with subsidies, it’s going to be hard for them to find the money to pay for insurance premiums. I hope the issue is revisited in terms of alleviating financial hardships caused by the mandates.


from Nancy-Ann De Parle:

This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.


Penalties for the insurance mandate will kick in, but it is unclear how strict the enforcement of that penalty would actually be. There will be no criminal penalty for not buying insurance, nor will there be criminal penalties for not paying the penalty. (Makes one wonder how enforceable this provision will be.)

Won’t this be enforced by the IRS?

Blues Tiger
Blues Tiger


KQµårk 死神

Cheers for the info I did not know if garnishing wages was a power they would use or not.

KQµårk 死神

Even though there are no criminal charges the IRS has plenty of power to fine, block student loans, some home loans, refunds, rebates etc. So it’s not the free ride it seems. I’m not sure if they can do it for these fines but the IRS has the power to put liens on your property and garnish wages as well.

The other thing I can attest to personally is that the healthcare providers are much more sympathetic with uninsured people now. I’ve literally had six figure costs of my care written off. I guarantee you once the vast majority of people have affordable access they will not be so forgiving.

Like Tiger says it’s good politics to not make the mandates criminal.


(In addition to what you posted) From an email today from Nancy-Ann De Parle:

Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.

* This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.

* This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.

Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.

There are more, but I think you’ve covered them. Thanks, Nellie.

Blues Tiger
Blues Tiger