Thanks to nopc.info for the summary:
Summary Timeline for Major Items in Senate Health Care Bill
Provisions that take effect immediately upon enactment:
Insurance Regulations
• Prohibition on pre-existing condition exclusions for private insurance on the individual market.
• Prohibition on revoking insurance for patients who falsify applications to fraudulently obtain private insurance coverage (however, penalties for fraud against federal health programs are increased).
Taxes
• “Annual Fee” tax on prescription drugs of $2.3 billion, allocated according to market share.
• New 10% tax on indoor tanning services effective July 1, 2010.
Other
• New restrictions on not-for-profit hospitals.
Special Favors
• Special tax benefit for BCBS organizations that maintain medical loss ratios of at least 85%.
Medicare
• Physician payments decrease 21% effective March 1, 2010.
Provisions that take effect six months after enactment:
Insurance Regulations
• Group and Individual policies issued after this date may not contain lifetime coverage limits, must provide first-dollar coverage for preventive care as defined by the U.S. Preventive Services Task Force, and must cover “children” of primary policyholders up to age 26.
Taxes
• FSA plans limited to $2,500 per year (currently no limit).
• New limits on what health care can be paid for with FSA, HSA, and HRA funds.
• Deduction for Part D eliminated.
• “Annual Fee” tax on medical devices of $2.0 billion, allocated according to market share (rises to $3.0 billion after 2017).
• “Annual Fee” tax on health insurance, allocated according to share of total premiums. Begins at $2 billion in 2011, then increases to $4 billion in 2012, $7 billion in 2013, $9 billion in the years 2014, 2015, and 2016, and eventually $10 billion for 2017 and every year thereafter. Two insurers in Nebraska and one in Michigan are exempt from this tax.
Medicare
• 10% Bonus for primary care physicians and general surgeons.
• Restrictions and substantial cuts to Medicare Advantage plans.
Medicaid
• Allows states to expand eligibility to 133% of the federal poverty line (FPL) for childless adults.
Other
• Private health plans must maintain a “medical loss ratio” of at least 85%. Failing that, they may rebate policyholders or increase medical expenditures. “Annual fee” tax does not count toward this ratio.
• First phase of small business tax credit for certain qualified small employers.
Taxes
• “Annual Fee” tax on health insurance increases to $4 billion.
Medicare
• Payment penalties for hospitals with the highest readmission rates for selected conditions.
Other
• Health insurance company employees may not be paid more than $500,000 per year.
Tax Increases
• “Annual Fee” tax on health insurance increases to $7 billion (does not count toward the required 85% medical loss ratio).
• 40% excise tax on health insurance premiums above $8,500 (individual plans) or $23,000 (family plans). Higher thresholds apply to the 17 highest-cost states until 2015, and indefinitely to retirees over age 55, and employer-provided plans for certain professions. This tax does not count toward the required 85% medical loss ratio.
• Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI (currently 7.5%); those over age 65 can use the 7.5% rate until 2016.
• Medicare tax increased from 2.9% to 3.8% for incomes over $250,000 (joint filers) or $200,000 (all others). (This is stated as an increase of 0.9 percentage points, to only the employee’s share of the FICA tax.)
Primary health reform takes effect:
Tax Increases
• “Annual Fee” tax on health insurance increases to $9 billion (does not count toward the required 85% medical loss ratio).
• Individual mandate begins: Tax penalties for not having insurance begin at $95 or 0.5% of income, whichever is higher, rising to $495 or 1% of income in 2015 and $750 or 2% of income thereafter (indexed for inflation after 2016). These penalties are per adult, half that amount per child, to a maximum of three times the per-adult amount per family. The penalty is capped at the national average premium for the “bronze” plan.
• Employer mandate begins:
– Provide “qualified” insurance or pay $750 tax per employee.
– Even if qualified insurance is provided, pay $3,000 tax per employee who qualifies for “affordability credit” (premium subsidy) based on family income and size, and opts to accept it.
Other
• Strict federal regulation of health plan benefit packages, premiums, and rating rules for both Exchange-participating and employer-sponsored group health plans.
• Imposition of actuarial value restrictions (in addition to restriction on medical loss ratio in effect since 2011).
• Health Insurance Exchanges.
• OPM-managed plans for the general public (in lieu of public option).
• “Affordability Credits” to those with family income under four times FPL who do not qualify for Medicaid in their state.
Medicaid
• Medicaid eligibility expanded to 133% of FPL for everyone under age 65 in participating states (such as Nebraska).
• All states except Nebraska must pay a share of the cost or drop Medicaid.
Tax Increases
• Individual mandate penalty rises to $495 per adult ($247.50 per child), maximum $1,485 per family, or 1% of family income, whichever is higher (capped at the national average premium for the “bronze” plan).
Insurance Regulations
• Limits on deductibles and co-payments imposed on Exchange-participating and employer-sponsored group health plans ($2,000 for single plans, $4,000 for family plans, indexed for inflation in health insurance premiums).
Medicare • Establishment of Independent Medicare Advisory Board (IMAB) to recommend cuts in Medicare benefits; these cuts will go into effect automatically unless Congress passes, and the President signs, an override bill.
Other
• Second phase of small business tax credit for certain qualified small employers.
Tax Increases
• 40% excise tax on health insurance premiums above $8,500 (individual plans) or $23,000 (family plans) applied to remaining 17 states.
• Individual mandate penalty rises to $750 per adult ($375 per child), maximum $2,250 per family, or 2% of family income, whichever is higher (capped at the national average premium for the “bronze” plan). After 2016, the penalty will be increased each year to adjust for inflation.
• “Annual Fee” tax on health insurance increases to $10 billion (does not count toward the required 85% medical loss ratio).
• Itemized deduction for out-of-pocket medical expenses is limited to expenses over 10% of AGI for those over age 65.
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