Health-Care Reform Timeline

2010
Effective Jan. 1, 2010 / 2010 Tax Year:

• Taxes/Subsidies: Provide a tax credit to small employers with fewer than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees. For 2010 through 2013, the tax credit is up to 35% (25% for nonprofits) of the employer’s contribution toward the employee’s health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. This credit will increase in 2014 to 50% (35% for nonprofits). (PPA, Sec. 1421)
• IRS Factsheet (PDF) and FAQ (html)

Effective June 1, 2010:

• Coverage – Optional: Starting 90 days after enactment (July 26, 2010) and ending Jan. 1, 2014, a $5 billion temporary reinsurance program is established to provide reimbursement to participating employment-based plans for part of the cost of providing health benefits to retirees (age 55-64) and their families. Participating employment-based plans will be reimbursed for 80% of the cost of benefits provided per enrollee in excess of $15,000 and below $90,000. Plans are required to use the funds to lower costs borne directly by participants and beneficiaries. (PPA, Sec. 1102)
• Department of Health and Human Services Issues Interim Final Rule on Early Retiree Reinsurance Program - Beginning June 1, companies can begin applying for the early retiree reinsurance program offered through the new health-care reform law. Beginning June 29, companies can submit applications to the HHS Department for funding through the early retiree reinsurance program.
• The Centers for Medicare & Medicaid Services announced that as of May 5, 2011, the Department of Health and Human Services would no longer accept ERRP applications due to insufficient funds.

Effective Sept. 23, 2010:

• Coverage – Required: Starting six months after enactment of the bill (Sept. 23, 2010), all existing health insurance plans must provide coverage for dependant and non‐dependent children up to age 26. For coverage of non‐dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage. (PPA, Sec. 2714; HRA, Sec. 2301)
• Interim Final Rule (html)
• Issue Summary: Interim Final Rule on Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 under the Patient Protection and Affordable Care Act
• WorldatWork's comment letter to the Employee Benefits Security Administration regarding the interim final rules on the extension of dependent care to adult children up to age 26
• Coverage – Required: Starting six months after enactment of the bill (Sept. 23, 2010), individual and group plans are prohibited from placing lifetime limits on the value of coverage and, prior to 2014, may only impose annual limits on coverage as determined by the Secretary of Health and Human Services. (PPA, Sec. 1302; HRA, Sec. 2301)
• Interim Final Rule (PDF)

2011
Effective Jan. 1, 2011 / 2011 Tax Year:

• Workplace Wellness: Establishes a $200 million grant program to help small businesses that do not currently offer wellness programs to cover the cost of implementing a qualified wellness program for their workplace. Grants can only be given for up to five years or until the funds are exhausted. (PPA, Sec. 10408)
• Small Business Health Care Reform website
• Penalty: The penalty for distributions from HSAs that do not pay for health-related expenditures increases from 10% to 20%. Nontaxable reimbursements from health FSAs, HRAs and HSAs can no longer be used for medicine or drugs unless the medicine or drug is prescribed or is insulin. (PPA, Sec. 9003, 9004)
• IRS Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans (PDF)
• Coverage – Optional: Establishes a simple cafeteria plan for businesses with 100 or fewer employees during either of the two years prior to the establishment of the plan. (PPA Sec. 9022)
• IRS Employer’s Tax Guide to Fringe Benefits (html)
• Disclosure: The Secretary shall develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to enrollees a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage based on standards laid out in the text of the law. (PPA, Sec. 2715)
  
  • Comment Letter: Summary of Benefits and Coverage and Uniform Glossary Requirements
  • Comment Letter: Letter Requesting Delay in Implementation Date of Summary of Benefits and Coverage Regulations

2013
Effective Jan. 1, 2013 / 2013 Tax Year:

• Employer Disclosure: Employers are required to disclose the cost of each employee’s employer-sponsored group health insurance coverage on the annual 2012 Form W-2, that is, on the Forms W-2 that employers generally are required to furnish to employees in January 2013 and then file with the Social Security Administration. (PPA, Sec. 9002)
• This was originally effective for the 2011 Form W-2, but the Internal Revenue Service issued Notice 2010-69 (PDF), delaying mandatory reporting to the 2012 Form W-2
• Notice 2011-28 Interim Guidance on Informational Reporting (PDF)
• Notice 2012-9 Interim Guidance on Informational Reporting (PDF)
• Deductibles & Contributions: Health FSA contributions are limited to $2,500/year, and the limit is indexed to cost-of-living adjustments in the following years in increments of $50. (PPA, Sec. 9005; HRA Sec. 1403)
• Taxes/Subsidies: The FICA tax paid on wages above $200,000 ($250,000 in the case of joint returns) increases by 0.9%. Increase is only applicable to amounts paid by the employee. (HRA, Sec 1402)
• Taxes/Subsidies: Eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees. (PPA, Sec. 9012; HRA, Sec. 1407)
• Workplace Wellness: By 2013, the Centers for Disease Control will have studied and evaluated best practices in employer-based wellness programs and created an educational campaign and technical assistance to promote the benefits of worksite health programs. This study will be conducted in regular intervals after the initial one. (PPA, Sec. 4303)
• Taxes/Subsidies: Limit the deductibility of executive compensation under Section 162(m) to $500,000 for insurance providers if at least 25% of the insurance provider’s gross premium income from health business is derived from plans that meet the minimum essential coverage requirements of the bill. This applies to all officers, employees, directors and other workers or service providers performing services for or on behalf of a covered health insurance provider. (PPA, Sec. 9014)

2014
Effective Jan. 1, 2014 / 2014 Tax Year:

• Coverage – Required: All individuals, with certain exceptions, are mandated to have health insurance with a phased in tax penalty structure for those who do not. (PPA, Sec. 1501)
• Coverage – Required: Employers with more than 200 full-time employees and that offer employees enrollment in one or more health benefit plans are required to automatically enroll new full-time employees in one of the plans offered (subject to any waiting period authorized by law).  (PPA, Sec. 1511)
  • In February 2012, the Department of Labor released Technical Release 2012-01 addressing Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods.
  • In February 2012, the Internal Revenue Service released Notice 2012-17 addressing Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods.
• Penalty: Employers that employ 50 or more full-time employees (defined as 30 or more hours of service per week), including part-time employees (determined by dividing the aggregate number of hours of service of employees who are not full-time employees for the month by 120), and don’t offer health insurance are subject to a fine if one of their employees receives a subsidy for coverage in the Exchange. The amount of the assessment is determined by subtracting the first 30 full-time employees from the number of 50 or more FTES. Then, for any number of employees above that first 30, the employer must pay an assessment of $2,000 per full-time employee. (HRA, Sec.1003)
  • In February 2012, the Department of Labor released Technical Release 2012-01 addressing Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods.
  • In February 2012, the Internal Revenue Service released Notice 2012-17 addressing Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods.
• Taxes/Subsidies: Health insurance exchanges open and act as a clearinghouse through which individuals and small groups may buy health insurance. This is also the first year that premium credits and cost-sharing subsidies will be available to help people buy insurance. (PPA, Sec. 1311, 1312, 1401)
• Taxes/Subsidies: Small businesses that purchase insurance coverage through a state-based exchange will be eligible for a tax credit of up to 50% of the employer’s contribution toward health insurance coverage as long as the employer covers at least 50% of the total premium cost. This credit is available for two years. (PPA, Sec. 1421)
• Deductibles & Contributions: Beginning this year, deductibles in the small group market are limited to $2,000 for individual plans and $4,000 for family plans, unless contributions are offered that would offset deductible amounts above those limits. (PPA, Sec. 1302)
• Coverage – Required: Beginning this year, any waiting period for coverage is limited to 90 days. (HRA, Sec.1003)
• Miscellaneous: An essential health benefits package is created with an actuarial value of at least 60% that limits cost-sharing to $5,950 for individual plans and $11,900 for family plans; that provides for a comprehensive set of services; and that is not more extensive than the “typical” employer plan. (PPA, Sec 1302, 1312)
• Workplace Wellness: Employers are permitted to encourage participation in wellness programs by establishing premium discounts or rebates, or modify co-pays or deductibles of up to 30%. The Secretary of Health and Human Services would have authority to issue regulations to allow financial incentives up to 50%. (PPA, Sec. 2705)
• Coverage – Required: Employers are required to provide a voucher worth the same amount as the largest premium contribution the employer makes to a health plan for qualifying employees to purchase health insurance through an exchange. To qualify for the voucher, employees must be eligible for coverage under an employer plan, whose required premium contribution is between 8 and 9.8% of their income, and their total household income does not exceed 400% of the federal poverty level. (PPA, Sec. 10108)

2017
Effective Jan. 1, 2017 / 2017 Tax Year:

• Coverage – Optional: Beginning this year, states may allow large group issuers of health insurance (employers with more than100 employees) to purchase health insurance through the exchanges. (PPA, Sec 1312)

2018
Effective Jan. 1, 2018 / 2018 Tax Year:

• Taxes/Subsidies: An excise tax of 40% will be levied on insurance companies for any health coverage plan (not including stand-alone dental and vision plans) with an annual premium that is in excess of $10,200 for individuals and $27,500 for families. For retirees (55+) and plans that cover “high-risk professions,” the limits are $11,850 for individual coverage and $30,950 for family coverage. (HRA, Sec. 1401)

Unspecified Effective Date

• Miscellaneous: The Secretary of Labor shall conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, including multi-employer plans, and provide a report on such survey. (PPA, Sec. 1302)
• Coverage – Optional: Includes a "young invincible plan" for people 30 and younger that only includes catastrophic coverage in the individual market. (PPA, Sec. 1302)
• Coverage – Required: Employers that provide health coverage would be prohibited from limiting coverage eligibility based on the wages or salaries of full-time employees. (PPA, Sec. 2716)
• Workplace Wellness: Any wellness or health-promotion activity implemented under this Act may not require the disclosure or collection of any information relating to the lawful use or possession of a firearm. (PPA, Sec. 2716)
• Taxes/Subsidies: Would amend the Fair Labor Standards Act (FLSA) to ensure that employees who receive premium tax credits are not discriminated against with respect to their compensation, terms, conditions or other privileges of employment. (PPA, Sec. 1558)
• Workplace Wellness: Would amend the FLSA to require employers with 50 or more employees to provide break time and a place for breastfeeding mothers to express milk. (PPA, Sec. 4207)
• Issue Summary: Reasonable Break Time for Nursing Mothers Request for Information
• Department of Labor guidance on break time for nursing mothers