President Obama signed the Affordable Care Act (ACA) into law on March, 23 2010. But not all parts of the law, called provisions, took effect right away. Healthcare reform will continue to change over the next several years.

Here’s a timeline of healthcare reform, including what’s already law and what’s to come.

Changes That Will Take Effect in 2022
Changes That Take Effect in 2019
Changes That Took Effect in 2014
Changes That Took Effect in 2013
Changes That Took Effect in 2012
Changes That Took Effect in 2011
Changes That Took Effect in 2010

Changes That Will Take Effect in 2022

  • January 1, 2022
    • A tax on high-cost insurance plans (sometimes called the “cadillac” tax), will be imposed on insurers of employer health plans with aggregate expenses exceeding the threshold. Currently, the threshold is $10,200 (for individual)/$27,500 (for families). These amounts will be updated before the tax takes effect.

Changes That Take Effect in 2019

  • January 1, 2019
    • The requirement that most people have health insurance remains intact, but as a result of the passing of the Tax Cuts and Jobs Act of 2018, the tax penalty for individuals not having health insurance is eliminated.

Changes That Took Effect in 2014

  • January 1, 2014
    • Individuals required to have health insurance or pay a tax. A similar penalty for employers delayed until 2015 or later, depending on group size.
    • Annual limits on essential health benefits eliminated
    • No denying coverage due to pre-existing conditions or gender
    • Families with incomes between 133 (138 in Ohio) percent and 400 percent of the federal poverty may receive subsidies and premium tax credits to buy coverage through health insurance exchanges; cost-sharing subsidies available for those with incomes between 133 (138 in Ohio) and 250 percent of the poverty level
    • Expanded Medicaid eligibility in some states, including Ohio, for all people not eligible for Medicare under age 65 with incomes up to 138 percent of the federal poverty level ($15,282 for an individual and $31,322 for a family of four)
    • Federally mandated fees implemented, including the Market Share Fee, Transitional Reinsurance Program Fee, Risk Adjustment User Fee and Federally-facilitated Exchange User Fee. Learn more about the fees for individuals and employers.

Changes That Took Effect in 2013

  • October 1, 2013
    • Health benefit exchanges launched by states or the U.S. Department of Health and Human Services (HHS) so individuals and small businesses can buy affordable coverage (with January 1, 2014, and beyond effective dates)

Changes That Took Effect in 2012

  • January 1, 2012
    • Incentives given to physicians for forming Accountable Care Organizations (ACOs) for Medicare patients, which improve patient care by encouraging communication and coordination between doctors. ACOs tie the Medicare reimbursements doctors receive to metrics around the overall health of the Medicare patients they treat - healthier people mean a higher reimbursement.
  • September 23, 2012
    • Uniform summary of benefits and coverage (also called the Summary of Benefits and Coverage”) given to all applicants and enrollees by health insurance plans and presented in a consistent format across all insurance companies so it’s easy to compare plans from different carriers
  • September 30, 2012
    • PCORI fee implemented. Learn more about the fee for individuals and employers.

Changes That Took Effect in 2011

  • January 1, 2011
    • Medical loss ratio targets implemented, which requires insurers to spend at least 80 to 85 percent of premiums collected on paying customer claims or providing programs to improve customers’ health, leaving insurers with 15 to 20 percent to cover administrative costs
    • Free preventive services for Medicare recipients available, such as wellness visits, without a copay
    • Medicare Part D coverage gap or “donut hole” closed as seniors who reached the coverage gap receive a 50 percent discount on Part D-covered brand name prescription drugs
    • Premiums for Medicare Parts B and D segmented so individuals with higher incomes pay higher premiums
    • The Center for Medicare and Medicaid Innovation established to improve healthcare quality and affordability
  • October 1, 2011
    • Community First Choice Options created to help states provide home- and community-based services to disabled individuals
    • Independent Payment Advisory Board created, which recommends Medicare spending cuts if spending exceeds targeted growth rates

Changes That Took Effect in 2010

  • January 1, 2010
    • Tax credits implemented for employers with no more than 25 full-time employees and average annual wages paid to employees of less than $50,000. Beginning in 2014, the tax credits are only available through plans purchased on the Small Business Health Options Program (SHOP) Marketplace.
    • Rebates for Medicare Part D coverage gap or “donut hole,” started, which provides seniors who reached the coverage gap a $250 rebate
  • March 23, 2010
    • Grandfathered Plan provision became effective. If a business keeps the same group plan it had on March 23, 2 010, the plan is “grandfathered” and excused from many Affordable Care Act provisions.
  • April 2, 2010
    • Federal funding for Medicaid increased so states can provide coverage to more individuals
  • June 1, 2010
    • Early Retiree Reinsurance Program, temporary financial help for employer plans so they can continue to provide valuable coverage to early retirees available. Early retirees are individuals age 55 and older who are not an active employee or eligible for Medicare, as well as spouses, surviving spouses, and dependents. Please note: The $5 billion allocated to this program was exhausted in 2012 and the program ended early.
  • July 1, 2010
    • Pre-Existing Condition Insurance Plan (also called a “high-risk pool”), a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months, created
  • September 23, 2010
    • Lifetime limits (or “caps”) eliminated on insurance coverage, which limited how much an insurance company would pay for a single member
    • Annual limits on insurance coverage more closely monitored
    • Children’s pre-existing condition provision eliminated so children under 19 can’t be denied or their coverage canceled due to a pre-existing condition (except in cases of fraud)
    • Coverage for preventive services like immunizations, annual physicals and screenings included on all new plans
    • Dependent coverage extended to age 26 and children can stay on their parents’ plan until age 26 (the age limit varies from state to state).
    • Insurance companies prohibited from canceling health insurance if a member becomes ill
    • More ways to appeal coverage determinations or claims. An external review process for appeals is also established