What Is the Obamacare Timeline?

What Happens Next?

healthcare-clock
Make sure you know the next Obamacare deadline.. Photo: Ken Chernus/Getty Images

The Patient Protection and Affordable Care Act, also known as Obamacare, is underway now. What are the upcoming deadlines you need to know?

November 1, 2015, to January 31, 2016 - Open enrollment on the health insurance exchanges for 2016. If you don't have insurance for at least nine months in 2016, you will be assessed an additional tax of 2.5% of your income. See How to Get Obamacare in 4 Simple Steps.

Businesses with 50 workers or more will be taxed $2,000 per employee (except for the first 30) if they don’t offer health insurance. Those that do will receive a tax credit of 50% of the premium cost.

2020 - Businesses who offer so-called "Cadillac" health insurance plans must pay a 40% excise tax on this benefit. These plans are defined as those with premiums of at least $10,200 (individuals) or $27,500 (families). They offer exceptional coverage, such as small copayments or unusual circumstances, such as marriage counseling. However, they also cover those with high health needs. For example, a business may have to offer Cadillac plans if the pooled risk of its employees is greater than usual. This happens if many of them are sick, older, female or live in an area with expensive health costs. Cadillac plans are also required for those in dangerous jobs.(Source: Kaiser, Cadillac Tax Explained, March 18, 2010; Tax Impacts of Obamacare)

Timeline of How Obamacare Rolled Out:

March 23, 2010 - President Obama signed the Affordable Care Act, making health care reform the law of the land. 

June 17, 2010 - Federal regulations allowed some health plans that were in existence on March 23, 2010, to be "grandfathered in." That meant they were exempt from the provisions of the Affordable Care Act.

January 2011 - The House voted to repeal the law. That was largely symbolic since the Senate rejected the repeal. However, 22% of Americans thought the act had already been repealed.

September 2011 - The Justice Department petitioned the Supreme Court to decide whether the Affordable Care Act was constitutional. The 11th Circuit Court of Appeals found that the mandate did not fall within Congress' power to regulate interstate commerce, but that the rest of the Act was fine. Two other federal courts of appeal, the Sixth Circuit and the Fourth Circuit, ruled that the Act was constitutional.

March 28, 2012 - The Supreme Court held hearings on the constitutionality of the Affordable Care Act. At issue was whether the Act's mandate that people either have insurance or pay a fine, violates the Constitution. On Day Three, the justices considered whether the entire Act could stand if this statute were struck down. On Day Two, the justices questioned whether the Federal government had the right to compel people to buy health insurance from a private company.

On Day One, the justices argued whether they had the authority to review the Act at this time, or needed to wait until someone paid the penalty in 2014.

June 28, 2012 - The Supreme Court upheld the legality of the Affordable Care Act. For more, see Obamacare Ruling

January 1, 2013 - Tax changes kicked in. For individuals, medical expenses must be at least 10% of income before they are deductible for those under 65. Those who make more than $200,000 ($250,000 for couples) will pay higher taxes. That includes 3.8% Medicare taxes on dividends, capital gains, rent and royalties and 2.35% (up from 1.45%) Medicare taxes on income. For businesses, those who manufacture or import medical devices will pay a 2.3% tax.

States benefit from additional Federal funds to offer free preventive services for Medicaid recipients and extend CHIP for an additional two years. They'll also receive Federal funds to pay primary care physicians 100% of the Medicare fee. Medicare will launch a pilot program to help hospitals bundle services before they submit them for payment. (Source: Healthcare.gov)

October 1, 2013 - The initial open enrollment period began. Medicaid benefits were extended to those with incomes up to 138% of the Federal poverty level (for example, $31,321.50 for a family of four). Those with incomes up to 400% of the poverty level (for example, $94,200 for a family of four) receive subsidies. All plans must cover the ten essential health benefits to be listed on the exchange. Find out How Much Will Obamacare Cost Me?

March 31, 2014 - The initial period of open enrollment closed. Everyone must be covered, or pay taxes of 1% of income in 2014.

June 25, 2015 - The Supreme Court ruled that the federal government has the right to offer subsidies in states that did not set up their exchanges. The ACA specifically mentions subsidies should only go to exchanges "established by the State," even though the writers said that was not their intention. The Supreme Court stuck with the intent, not the wording, of the law.  

Timeline of How Obamacare Came to Be

Follow the twists and turns back through the different bills proposed by the House and Senate in 2009, ending at the beginning -- Obama's original campaign proposals in 2008.

March 22, 2010 - The House of Representatives passed the Reconciliation Act, which amended the Senate Health Care Reform Bill by including elements of the health care plan put forth by President Obama on February 22.

February 22, 2010 - Obama launched a new health care plan that combined the best elements of the Senate and the 2009 House health care reform bills. Obama's Health Care Reform proposal regulated the health insurance industry under a seven-member Health Insurance Rate Authority that could deny or limit substantial premium increases. That was traditionally a state responsibility. Like the Senate Bill, it created an exchange that allowed families and small businesses to shop for insurance plans. It kept restrictions on federal funding for abortion but cut back taxes on the high-end health plans.

January 28, 2010 - Obama supported health care reform in the 2010 State of the Union Address.

January 27, 2010 - House Democrats protested the excise tax on high-value insurance plans in the Senate plan, which adversely affected union households. However, this created a $300 billion deficit over ten years. The other option was to create a smaller health care reform bill with the best features of both the Senate and House plans.

January 26, 2010 - Republican Scott Brown won the key Democratic seat in Massachusetts, destroying the Democrats’ filibuster-proof 60-vote majority in the Senate. Many thought this ended hopes of passing any health care reform bill at all.

December 24, 2009 - The Senate passed the 2009 Senate Health Care Reform Bill. Its programs would cost $871 billion over ten years. However, it would lower the budget deficit by $132 billion during that same period by increasing taxes on health care providers. It offered subsidies to families and small businesses to shop for insurance on an exchange. It fined companies for not providing insurance but gave them a tax break for small businesses if they couldn't afford to offer health insurance to their employees. 

November 8, 2009 - The House of Representatives passed the 2009 House Health Care Reform Bill. Its programs would cost $894 billion over ten years. However, it proposed a surtax on high-income earners thereby reducing the deficit by $104 billion. Like Obama's 2009 bill, the House bill proposed a government-run health insurance program, known as the public option. It offered direct subsidies to uninsured people to help them buy insurance through exchanges. For more details, see 2009 House Health Care Reform Bill.

January 2009 - Soon after Obama was elected, he announced the Health Care for America Plan. The most controversial element was known as the "public option," which was a government-run program like Medicare -- only it would not be restricted by age. That was a critical way to reduce health care costs by 1.5% per year since the federal government had the ability to bargain for lower prices and reduce inefficiencies. However, opponents said it was socialized medicine, and took power away from the states and individuals. 

For more the behind-the-scenes story of how Obamacare was created, see my book The Ultimate Obamacare Handbook (2015 - 2016).

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