The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
Provisions by effective date
Effective at enactment, March 23, 2010 The Food and Drug Administration is now authorized to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed. The Medicaid drug rebate for brand name drugs, paid by drug manufacturers to the states, is increased to 23.1% (except for the rebate for clotting factors and drugs approved exclusively for pediatric use, which increases to 17.1%), and the rebate is extended to Medicaid managed care plans; the Medicaid rebate for non-innovator, multiple source drugs is increased to 13% of average manufacturer price. A non-profit Patient-Centered Outcomes Research Institute is established, independent from government, to undertake comparative effectiveness research. This is charged with examining the "relative health outcomes, clinical effectiveness, and appropriateness" of different medical treatments by evaluating existing studies and conducting its own. Its 19-member board is to include patients, doctors, hospitals, drug makers, device manufacturers, insurers, payers, government officials and health experts. It will not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment. Medicare may take the institute's research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input. The bill prohibits the institute from developing or employing "a dollars per quality adjusted life year" (or any similar measure that discounts the value of a life because of an individual's disability) as a threshold to establish what type of health care is cost effective or recommended. This makes it different from the UK's National Institute for Health and Clinical Excellence, which determines cost-effectiveness directly based on quality-adjusted life year valuations. The Prevention and Public Health Fund was created to fund programs and research designed to increase chronic disease prevention. A National Prevention, Health Promotion and Public Health Council (National Prevention Council) was created to develop a national strategy on prevention, health promotion and public health; by, for example, disseminating evidenced-based recommendations on the use of clinical and community prevention services. The Indian Health Care Improvement Act was reauthorized and amended. Chain restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate, and sodium content, must also be made available upon request. But first, the Food and Drug Administration has to come up with regulations. Two regulations – one applicable to restaurants and another to vending machines – have been proposed, but have not yet been made final. States can apply for a "State Plan Amendment" to expand family planning eligibility to the same eligibility as pregnancy related care through a state option rather than having to apply for a federal waiver.
Effective June 21, 2010 Adults with existing conditions became eligible to join a temporary high-risk pool, which will be superseded by the health care exchange in 2014. To qualify for coverage, applicants must have a pre-existing health condition and have been uninsured for at least the past six months. There is no age requirement. The new program sets premiums as if for a standard population and not for a population with a higher health risk. Allows premiums to vary by age (up to 3:1), geographic area, family composition and tobacco use (up to 1.5:1). Limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.
Effective July 1, 2010 The President established, within the Department of Health and Human Services (HHS), a council called the National Prevention, Health Promotion and Public Health Council to help begin to develop a National Prevention and Health Promotion Strategy. The Surgeon General shall serve as the chairperson of the new Council. A 10% sales tax on indoor tanning took effect.
Effective July 19, 2010 The Departments of Health and Human Services, Labor, and Treasury published interim final regulations requiring new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers.
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