Here's a breakdown of what's happened so far and what to expect in the near future.

On March 23, 2010, President Obama enacted the Patient Protection and Affordable Care Act ("the Act"), more commonly known as the federal healthcare reform legislation. While it's no secret that rising healthcare costs are one reason behind the need for healthcare reform, an even bigger driver is the need to increase access to affordable healthcare in the United States.

Today, a majority of Americans who have health insurance get it through their employers. But high costs have forced many employers to reduce or eliminate the coverage they offer their employees. The Act is designed to bridge this gap, helping to extend healthcare coverage to 94 percent of non-elderly Americans, reducing the number of the uninsured by roughly 32 million. (As of early 2010, nearly 46 million didn't have health insurance, and another 25 million were underinsured.)

Another important driver is the need for vastly improved health outcomes in the United States, which are significantly worse than other countries. Outcomes are based on quality of care, and measures include inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variations in quality and cost; administrative costs; preventable mortality; and use of information technology. Healthcare reform will also introduce several initiatives aimed at improving quality outcomes.

A HEALTHCARE REFORM TIMELINE
Since March 23, there have been a lot of updates, information—and even misinformation—about what the impact of healthcare reform will be. But just what does healthcare reform involve, what does it mean for our local healthcare system, for healthcare insurers, and ultimately, for you? This timeline gives a broad overview of what's already happened so far this year, as well as some of the major milestones to come in the near term (through 2014).

MARCH 23, 2010
The Patient Protection and Affordable Care Act is signed into law. It will require individuals to have coverage, and employers with 50 or more employees to offer it. Some of the significant new requirements for insurers are related to plan benefits, marketing, consumer protection, and taxes.

JULY 2010
The federally funded high-risk health insurance pool begins. This plan provides low-cost health coverage for uninsured individuals who are considered most at risk—those with pre-existing conditions (such as chronic health conditions). As part of this three-year program, Blue Cross & Blue Shield of Rhode Island (BCBSRI) contracted with the U.S. Department of Health & Human Services (HHS) to administer the program in Rhode Island and began accepting applications for the Pre-existing Condition Insurance Plan for Rhode Island (PCIPRI) on August 15. The program is contingent on continued federal funding.

Early retiree reinsurance becomes effective, and will remain so until January 2014. Employers receive reinsurance payments based on medical claims for certain retirees aged 55 to 64 who are in group plans. These payments cover 80 percent of claims between $15,000 and $90,000 in a given year. Employers must use these payments to offset future rate increases or reduce employee cost-sharing, and cannot put these payments toward general funds. HHS has launched ERRP.gov to provide information about this program.

HHS creates an online portal at HealthCare.gov that allows individuals and small businesses to obtain information about health insurance options at the state level.

SEPTEMBER 23, 2010
For plan years after this date, new disclosure and transparency requirements take effect. Insurers and group health plans will be required to submit detailed information regarding coverage and cost sharing to HHS, which will be posted online. (BCBSRI must also post this information on its website and send this information to the Rhode Island Office of the Health Insurance Commissioner.)

For plan years after this date, coverage for preventive services without cost-sharing, coverage for dependent children up to age 26, and the prohibition of lifetime and annual limits on essential health benefits will go into effect. Changes will generally take effect upon your employer's renewal date. If you are enrolled in direct pay, these changes will take effect April 1, 2011.

LATE 2010
The government provides $250 to beneficiaries who reach the coverage gap (also known as the "donut hole") for Medicare Part D.

EARLY 2011
Uniform coverage regulations and standard definitions will be issued by HHS. The new forms will be available in 2012.

2013
The Comparative Effectiveness Research (CER) Assessment will begin. A fee of $1 per year per covered life will be assessed to insurers and self-funded group health plans to fund CER beginning in 2013, increasing to $2 from 2014 to 2019. These funds will support research that looks at the effectiveness of healthcare treatments and strategies, comparing things like clinical outcomes, appropriateness of service, and electronic health data.

2014
All plans will provide coverage for "essential health benefits," which include services such as maternity and newborn care, prescription drugs, lab services, preventive and wellness services, pediatric services, and more.

Most individuals will be required to obtain and maintain "minimum essential coverage," with monetary penalties for not meeting the requirement. The coverage requirement will be satisfied by participation in a group plan. Individuals and families who fall below 400 percent of the federal poverty level will be eligible for federal subsidies to reduce the cost of obtaining coverage. If employers with 50 or more employees do not offer coverage, they may also be subject to penalties.

Individuals and small employers will have the option to purchase coverage through state-run American Health Benefit Exchanges, which will provide information about coverage options. In order to receive federal subsidies, individuals must purchase coverage through the Exchange.

An $8 billion insurer tax will be imposed on health insurers, increasing to $14.3 billion in 2018. An insurer's liability will be based on its ratio of net premiums written (i.e., insured business).

(Please Note: This timeline is not meant to be an exhaustive list of all healthcare reform provisions; it is a look at the near term only based on details available at the time of publication.)