The Affordable Care Act Timeline

The Affordable Care Act (ACA) contains provisions to expand health care coverage, improve the delivery system and outcomes, and control costs. Implementation of many provisions has already begun and will continue to be rolled out, with most major changes occurring in 2014.

This ACA timeline is updated to reflect the June 28th, 2012 Supreme Court ruling. It highlights key health reform provisions taking effect from 2010 – 2018 including the establishment of key programs and new agencies, new requirements for industry, and changes to Medicare and Medicaid.

Note: There is a downloadable version of this report. It is best printed on 11x17 paper and folded into an 8.5x11 booklet.

State government
Health plans
Life sciences
Access Quality Cost
  • 12-year exclusivity before generic development
  • 340B drug discount program eligibility expansion
  • Auto enrollment for employers of 200+
  • Health plan web portal
  • Insurance market coverage protections (no rescissions, no lifetime maximums, no-pre-existing condition exclusions for children, restricts annual coverage limits, standard internal, external appeals process, and adult dependent coverage to age 26)
  • Maintenance of effort requirements for Medicaid and Children's Health Insurance Program (CHIP)
  • U.S Food and Drug Administration (FDA) to approve generic biologic drugs
  • Tax credits for some small employers to purchase insurance
  • Temporary early retiree reinsurance program
  • Temporary high-risk pool
  • Establishes Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation
  • Establishes Patient Centered Outcomes Research Institute (PCORI)
  • Establishes the Federal Coordinated Health Care Office to improve the coordination of Medicare and Medicaid benefits for dual-eligibles
  • Private plan coverage with no cost sharing for preventive health services rated A or B by the U.S. Preventive Services Task Force
  • 0.25% market basket reduction for hospitals (inpatient acute, long-term) and inpatient rehabilitation facilities
  • Annual premium rate review requirement
  • Establishes Medicare self-referral disclosure protocol
  • Health insurance tax to fund PCORI
  • Increases minimum Medicaid rebate for brand drugs to 23.1% of average manufacturer price (AMP), 13% for generics
  • Increases state workforce grant opportunities
  • Medicaid drug rebate extended to Medicaid managed care plans
  • Medicaid global payment system demo
  • Redefinition of AMP
  • Sets federal upper limit (FUL) for multiple source drugs to at least 175% of the weighted average AMP for products nationally available at commercial pharmacies
  • 10% Medicare payment bonus for primary care physicians and general surgeons in professional shortage areas
  • Employers establish appeals process for coverage and claims determinations
  • Incentives for prevention of chronic diseases in Medicaid
  • Health insurance exchange planning grants
  • Medicaid Community First Choice Option
  • Medicaid home health for chronically ill
  • Medicare Part D Coverage Gap discount program
  • Establishes national strategy to improve the delivery of health care services, patient health outcomes, and population health
  • Prohibits physician-owned hospitals from participating in Medicare that do not already have a provider agreement
  • Medicaid payment reductions for provider-preventable conditions
  • Eliminates reimbursement for over-the-counter medications from Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), or Health Reimbursement Arrangements (HRAs)
  • Establishes biosimilars approval pathway
  • Limits Medicare Advantage (MA) cost-sharing to fee-for-service levels
  • Maintains MA reimbursement at 2010 levels and creates new MA benchmarks for 2012 and beyond
  • Medicare coverage of annual wellness visit
  • Minimum medical loss ratio (MLR) reporting requirement
  • Prohibits cost-sharing on Medicare preventive services
  • Imposes annual fees on brand-name pharmaceutical manufacturers and importers
  • Health plans and employers distribute a uniform summary of benefits and coverage explanation prior to enrollment or re-enrollment
  • Employers disclose value of health benefits on Form W-2
  • Medicare Advantage (MA) quality bonuses begin
  • Medicaid pediatric accountable care organization (ACO) demonstration
  • Medicare acute inpatient hospitals value-based purchasing (VBP)
  • Medicare Shared Savings ACO Program
  • Reduces Medicare acute inpatient hospital payments for potentially avoidable readmissions
  • Medicaid hospital and physician bundled payment demonstrations in up to eight states
  • Productivity adjustment into the market basket update for inpatient hospitals, post-acute care, and long-term care providers
  • Medical Loss Ratio (MLR) rebate distribution begin
  • Employers notify employees of existence of the health insurance exchanges and available coverage options
  • Increases federal medical assistance percentage (FMAP) for states eliminating cost-sharing on Medicaid preventive services
  • Medicaid payment rates for primary care no less than 100% of Medicare 2013 and 2014 payment rates
  • Administrative simplification (first of three waves)
  • Eliminates deduction for cost of retiree drug coverage offset by Medicare Part D subsidy
  • Establishes Medicare national, voluntary episode-based payments pilot program to start
  • Imposes annual 2.3 % excise tax on sales of medical devices sold by manufacturers and importers
  • Limits Federal Savings Account annual contributions to $2,500
  • Requires life science manufactures to disclose transfers of value to providers
  • Transparency reporting of physician ownership or investment
  • Reduces federal Medicaid and Medicare disproportionate share hospital (DSH) allotments
  • Consumer Operated and Oriented Plans (CO-OPs) operational
  • Employers furnish information on health benefits to employees and government
  • Health insurance exchanges operational
  • Individual mandate
  • Individual tax credits and cost sharing for health insurance exchange plan coverage
  • Insurance market coverage protections (guaranteed issue and renewal, rating restrictions, no annual limits)
  • Medicaid expansion to 133% federal poverty level (FPL) for participating states
  • Essential health benefit benchmark plans active; out-of-pocket limits set at Health Savings Account (HSA) levels
  • Streamlined enrollment for Medicaid, Children's Health Insurance Program (CHIP), health insurance exchanges
  • Transitional reinsurance for individual and small group markets
  • Wellness program participation incentives (for employers and in up to ten states in the individual market)
  • Removes smoking cessation drugs, barbiturates, and benzodiazepines from Medicaid's excluded drug list
  • Quality and patient satisfaction data published on health insurance exchanges for qualified health plans
  • 1% payment reduction for inpatient hospitals with hospital acquired conditions
  • First Independent Payment Advisory Board (IPAB) recommendations due
  • Imposes annual fee on health insurance providers
  • Requires 85% Medical Loss Ratio (MLR) for Medicare Advantage plans
  • Additional federal Children's Health Insurance Program (CHIP) funding
  • Permits state Basic Health Plans for individuals between 133-200% FPL
  • Employer coverage responsibilities
  • Reduces Medicare payments for not successfully reporting measures under the Physician Quality Reporting System
  • Permits compacts to offer plans across state lines (Health Care Choice Compacts)
  • Health insurance exchanges may be expanded to employers with 100 or more employees (state option)
  • Waiver for state innovation
  • Imposes excise tax on high cost employer-sponsored coverage