Table 1.

Timeline for Implementation of Major Provisions of the ACA

2010	Employers are provided funding to cover individuals retiring between the ages of 55 and 65
	Federal government offers tax credits to cover a portion of the employer's contribution for small businesses with less than 25 employeesa
	Establishes a new Patient's Bill of Rightsb
	Requires all plans to include certain preventive services without cost‐sharingb
	Insurance companies cannot deny coverage to children under age 19 with preexisting conditionsb
	Creates a new process to monitor premium rate increases and report the minimum medical loss ratioa
	*Young adults are covered by their parent's health insurance until age 26 (dependent coverage provision)b
	Provides financial incentives to PCPs, nurses, and physician assistants, and increases payments to PCPs in rural communities, underserved areas, and community health centersc
2011	Provides a 10% bonus payment from Medicare to PCPs for 5 years
2012	Imposes new annual fees on the pharmaceutical manufacturing sectora
	Creates a Medicare Value‐Based Purchasing programd
2013	*Initial open enrollment in the individual health insurance marketplace beginsd
	The Bundled Payments for Care Improvement Initiative begins to test models for reimbursement
	*Increases Medicaid reimbursement rates for primary care services provided by PCPs to 100% of the Medicare rates for 2013 and 2014
	Increases Medicare Part A tax rate from 1.45% to 2.35% on individuals earning over $200,000 and couples earning $250,000, as well as a 3.8% tax on unearned income for high‐income tax payers
	Imposes 2.3% excise tax on the sale of any taxable medical device
	Modifies tax treatment of health savings and flexible spending accounts
2014	Insurance companies cannot deny coverage based on preexisting conditions and can only vary rates based on rating area, family size, tobacco use, and age (but not on health status, previous claims history, or gender)
	Risk adjustment, reinsurance, and risk corridor programs go into effect to help stabilize premiums and reduce adverse selection
	*Increases small business tax credits for those participating in the state insurance exchangesa
	*Provides tax credits to individuals or families earning between 100% and 400% of the federal poverty level who purchase their health insurance through the exchanges
	All health insurance plans must provide an “essential health benefits package”
	*Expands federally funded Medicaid coverage to cover individuals earning up to 133% of the federal poverty level in certain states
	Initial enrollment in the Small Business Health Options Program (SHOP) begins on November 15
	Imposes annual fees on the health insurance sectora
	*U.S. citizens without health insurance pay a tax penalty (individual mandate)a
2015	*Employers with 100 or more full‐time employees pay a penalty if they fail to offer health insurance coverage (employer mandate)
2016	*Employers with 50 or more full‐time employees pay a penalty if they fail to offer health insurance coverage (employer mandate)
2018	Excise tax of 40% imposed on employer‐sponsored private health insurance plans above a certain value (“Cadillac tax”)

Provisions went into effect on January 1, unless noted otherwise. The provisions discussed in this review are marked with an asterisk (*). PCP stands for primary care physician.

^aAssessed annually.

^bEffective for plans beginning on or after September 23, 2010.

^cEffective dates vary.

^dEffective October 1.

Source: Compiled by the authors using information from the US Department of Health and Human Services (http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html) and Kaiser Family Foundation (http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/) websites.