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Health Care Reform Explained

The Health Care Law and When It Will Take Effect

Your questions answered

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Provisions of the health care law are scheduled to come online through 2014, and even beyond. — Photo by Jon Feingersh/Blend Images/Corbis

Q. If health reform is so important, why do we have to wait until 2014 for it?

A. You don't have to wait. Some provisions of the 2010 Affordable Care Act are already in effect, while other more complex changes begin on Jan. 1, 2014.

It takes some time because Congress gave a long to-do list to the U.S. Department of Health and Human Services, other federal agencies and, in some cases, state governments. On the to-do list:

  • Set up state insurance purchasing exchanges to help consumers do comparison shopping for health coverage
  • Close the Medicare drug coverage gap
  • Require insurance companies to accept applicants with pre-existing health problems
  • Require most people to have insurance and offer help with premiums to make insurance affordable
  • Provide tax credits to small businesses that offer employees health coverage
  • Expand coverage to an estimated 32 million uninsured people

And the list goes on.

"This health reform law is quite far-reaching and touches nearly every aspect of our heath care system," says Jennifer Tolbert, a health policy expert at the Kaiser Family Foundation, an independent health research organization based in California.

The foundation has produced one of the easiest to use and most comprehensive time lines covering deadlines in 13 subject areas, from making health care more affordable to increasing the number of doctors and nurses and providing more long-term care options for older Americans.

For those who prefer just the deadline highlights, AARP offers a one-page fact sheet geared to beginners.

One glance at these time lines and you'll know why health reform is impossible to roll out completely in a couple of months.

Still, some parts of health insurance and health care are already changing because of the law.

While critics continue vehement attacks on the law and threaten to repeal it, Health and Human Services officials counter that Americans are just beginning to experience some of its benefits.

For example, the website, required by the law, helps people find insurance coverage now and provides health reform updates for families with children, individuals, people with disabilities, older people, young adults and employers.

"Already, people who were uninsured because of a preexisting condition are getting coverage through new Pre-Existing Condition Insurance Plans, and young adults are able to stay on their parents' coverage until age 26," said Jessica Santillo, an HHS spokeswoman. "Businesses are getting help providing their employees and early retirees with health coverage, and insurers are prohibited from denying coverage to children with health conditions or dropping coverage for Americans when they get sick just because they made an unintentional mistake on their paperwork."

In addition, people in Medicare Part D who end up in the drug coverage gap known as the "doughnut hole," now receive discounts on drugs purchased whlie in the gap. Also, Medicare patients get free annual wellness exams and free preventive health care benefits like cancer screenings.

See also: Health Law: What's in effect, what's still to come.

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin's weekly column, Health Care Reform Explained: Your Questions Answered.

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