Not sure where the overhaul stands? Here’s a rundown of changes in the law—assuming it survives some challenges along the way.

With its many moving parts, the health care reform law passed in 2010 can be tough to track. Dollar limits, pre-existing conditions, preventive services—what’s in, what’s out, and when does it all happen?

Some provisions have already taken effect. Others won’t kick in for years—assuming they survive legal and political challenges. Here’s a rundown of key provisions in the contentious Patient Protection and Affordable Care Act:

Reforms Now in Effect

• Dollar limits: Insurers can’t cap the number of dollars they’ll spend on your health care in your lifetime.
• Preventive services and screenings: New health plans have to offer mammograms, colonoscopies, and the like at no cost. Medicare beneficiaries can get similar services.
• Coverage for adult children: They can now stay on their parents’ health plans up to age 26.
• Medicare Part D’s “doughnut hole”: In 2012, users whose prescription drug costs reach the gap where costs aren’t covered get a 50 percent discount on name-brand prescriptions and a 14 percent discount on generics. These discounts will grow until the doughnut hole closes in 2020.
• Pre-existing conditions: Insurers can’t deny coverage to children with pre-existing conditions. They also can’t refuse to cover adults who have been uninsured for six months and have been denied coverage because of a pre-existing condition.
• Small businesses: Some firms with fewer than 25 employees can qualify for a tax credit to help them pay for providing health insurance to their workers. This credit will grow in two years.
• Denials based on errors: Health insurers can’t deny payment and cancel coverage based on a technical error they might find in your insurance application after you’ve become ill.

Future Scheduled Reforms
Many key reforms won’t take effect until January 2014. These include:

• Mandatory health insurance: Most people who can afford it will be required to buy basic health insurance coverage. If they don’t, they’ll pay a fee to help offset the costs of caring for uninsured Americans. You wouldn’t have to pay that fee, however, if you can’t afford coverage or for other reasons, such as religious beliefs. Fee waivers would be available if you don’t automatically qualify.
• Affordable insurance exchanges: People whose employers don’t offer health insurance would be able to buy it through one of these state-based exchanges. They’ll offer a choice of health plans that meet certain benefit and cost standards. The exchanges will be open to small businesses, too.
• Moving your employer’s contribution: If you can’t afford the health insurance coverage your employer offers, you might be able to take the funds your employer is willing to contribute and use them to help you buy more affordable coverage through an exchange.
• Middle-class tax credits: People with incomes from one to four times the federal poverty level could get tax credits to make health insurance more affordable. Four times the federal poverty level in 2011 worked out to about $43,600 for individuals and $89,400 for a family of four.
• Annual limits on coverage: For essential benefits, such as hospital stays, annual coverage limits would be banned for group policies and new individual policies issued by all insurers.
• Pre-existing conditions: The law will bar insurers from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions.
• Gender or health status: Insurers won’t be able to charge higher rates due to your gender or health status if you have an individual or small-group policy.
• Low-income earners: More people, including all those who earn less than 133 percent of the poverty level, will be able to get health coverage through Medicaid.

Costs and Benefits
What would be the effect of these changes if they’re all implemented?

Estimates predict the number of Americans covered by employerbased group plans would stay about the same. But according to analysts at the Urban Institute and the Robert Wood Johnson Foundation, the number of nonelderly Americans without health insurance would drop by more than half, to 22 million.

As for costs, people currently covered shouldn’t be affected much. Employer spending, according to the two groups’ analysis, would stay about the same.

U.S. individuals’ total spending on health care would rise nearly 9 percent, they say. However, almost all that extra spending would be due to the previously uninsured paying health care premiums or fees for not getting health insurance.

And what will happen to your premiums? For years, your premiums have been going up. According to another analysis by the Urban Institute and the Robert Wood Johnson Foundation, whether or not your rate increases slow down will depend on whether reforms in the Affordable Care Act prod insurers into tougher negotiations with health care providers.

What’s The Future of Health Care Reform?
The voters or the courts may decide whether the Patient Protection and Affordable Care Act takes full effect.

Democrats who passed the act contend it will hold insurance companies more accountable, lower health care costs, expand coverage options, and improve the quality of care for all of us.

Republicans who oppose the bill contend it’s killing jobs, raising taxes, and increasing the cost of health care. In January 2011, the GOP-controlled House voted to repeal the law, but the Democratic-led Senate declined to go along.

Given Republican opposition to the act, the outcome of the 2012 presidential and congressional elections could affect whether the act is repealed, modified, or fully put into practice.

In addition, several lawsuits have challenged the act. In particular, they question the constitutionality of requiring that Americans who can afford it must maintain basic health insurance coverage starting in 2014.

Federal appeals courts have rejected several lawsuits. But in August 2011, the Atlanta-based 11th Circuit Court of Appeals ruled that requiring individuals to buy and maintain private health insurance violates the U.S. Constitution. Its two-to-one ruling came in response to a lawsuit brought by 26 states, two individuals, and the National Federation of Independent Business.

In November 2011, the U.S. Supreme Court agreed to review that decision. The court could hear arguments this spring and issue a ruling on the law’s fate this summer.

By Bruce E. Beans, a feature writer for Vitality. To learn more, visit this U.S. Department of Health and Human Services website: www.healthcare.gov/law.

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