Health overhaul: Immediate change, long term steps

Published: Monday, March 22 2010 12:00 a.m. MDT

House Speaker Nancy Pelosi of California, looks over her notes during a news conference on health care on Capitol Hiil in Washington last week.

Pablo Martinez Monsivais, Associated Press

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WASHINGTON — When President Lyndon Johnson signed the Medicare law in 1965, seniors got their health insurance cards less than a year later.

President Barack Obama held his signing ceremony for his health care overhaul on Tuesday, but the major expansion of coverage for uninsured workers and their families won't come until 2014 — after the next presidential election.

Parts of the plan won't be fully phased in for a decade, but ultimately 94 percent of eligible Americans would have coverage.

Here's a timeline of some changes:


Sets up a high-risk health insurance pool to provide affordable coverage for uninsured people with medical problems.

Starting six months after enactment, requires all health insurance plans to maintain dependent coverage for children until they turn 26; prohibits insurers from denying coverage to children because of pre-existing health problems.

Bars insurance companies from putting lifetime dollar limits on coverage, and canceling policies except for fraud.

Provides tax credits to help small businesses with up to 25 employees get and keep coverage for their employees.

Begins narrowing the Medicare prescription coverage gap by providing a $250 rebate to seniors in the gap, which starts this year once they have spent $2,830. It would be fully closed by 2020.

Reduces projected Medicare payments to hospitals, home health agencies, nursing homes, hospices and other providers.

Imposes 10 percent sales tax on indoor tanning.


Creates a voluntary long-term care insurance program to provide a modest cash benefit helping disabled people stay in their homes, or cover nursing home costs. Benefits can begin five years after people start paying a fee for the coverage.

Provides Medicare recipients in the prescription coverage gap with a 50 percent discount on brand name drugs; begins phasing in additional drug discounts to close the gap by 2020.

Provides 10 percent Medicare bonus to primary care doctors and general surgeons practicing in underserved areas, such as inner cities and rural communities; improves preventive coverage.

Freezes payments to Medicare Advantage plans, the first step in reducing payments to the private insurers who serve about one-fourth of seniors. The reductions would be phased in over three to seven years.

Boosts funding for community health centers, which provide basic care for many low-income and uninsured people.

Requires employers to report the value of health care benefits on employees' W-2 tax statements.

Imposes $2.3 billion annual fee on drugmakers, increasing over time.


Sets up program to create nonprofit insurance co-ops that would compete with commercial insurers.

Initiates Medicare payment reforms by encouraging hospitals and doctors to band together in quality-driven "accountable care organizations" along the lines of the Mayo Clinic. Sets up a pilot program to test more efficient ways of paying hospitals, doctors, nursing homes and other providers who care for Medicare patients from admission through discharge. Successful experiments would be widely adopted.

Penalizes hospitals with high rates of preventable re-admissions by reducing Medicare payments.

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