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Health Care Reform: What's New in 2010 and 2011

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), commonly known as the health care reform law. Readers are likely familiar with many of its major provisions, including the individual health insurance mandate, creation of health insurance exchanges, and insurance subsidies. While some provisions were effective immediately or within 2010, with a lengthy phase-in period, many of these key PPACA provisions have effective dates as late as 2014 or beyond.

In an ongoing series in Bioethics in Brief, we will summarize certain key provisions effective in the upcoming years. First up, select provisions (by primary category) effective in 2010 and 2011:



  • Permits parents to keep adult children up to age 26 on their plans.
  • Prohibits lifetime limits on essential benefits.
  • Prohibits plans from rescinding coverage.
  • Prohibits pre-existing condition exclusions for children (under the age of 19).
  • Requires coverage without cost-sharing for certain preventive services, recommended immunizations, preventive care for infants, children and adolescents, and preventive care and screenings for women.
  • Establishes Pre-Existing Condition Insurance Plan to extend coverage to individuals with pre-existing medical conditions who have been uninsured for 6 months or more.


  • Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (the “doughnut hole”).
  • Creates a state option to cover childless adults through a Medicaid State Plan Amendment.


  • Creates a non-profit Patient-Centered Outcomes Research Institute to support comparative effectiveness research.


  • Supports availability of primary care by creating incentives to expand the number of primary care physicians, nurses, and physician assistants through scholarships, and loan repayment programs for services in under-served or health professional shortage areas.


  • Imposes additional requirements on non-profit hospitals to conduct community needs assessments and to develop financial assistance policy; imposes a $50,000 tax per year if fail to meet requirements.

This timeline is adapted from Kaiser Family Foundation, Health Reform Implementation Timeline, available at http://healthreform.kff.org/timeline.aspx and from the HealthCare.gov site, specifically, “About the Law / Provisions of the Affordable Care Act, By Year,” available at:http://www.healthcare.gov/law/about/order/byyear.html See both sites for more information on these and additional reforms.

— Amy T. Campbell



  • Requires insurance companies to report the proportion of premium dollars spent on health care clinical services and health care quality improvement; requires insurers to provide rebates to consumers if < 85% of premium dollars collected by insurance companies from large employer plans (or < 80% of premium dollars collected from individual and small group markets) is spent on health care services and health care quality improvement in a given year.
  • Authorizes $50 million for states to develop, implement, and evaluate medical malpractice reform 5-year demonstration projects.


  • Addresses the “doughnut hole” in prescription drug coverage for seniors by requiring that pharmaceutical manufacturers provide a 50% discount on Medicare Part D covered brand-name prescriptions once seniors reach the coverage gap; over next 10 years, phases in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
  • Provides a 10% Medicare bonus payment for primary care services and a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas.
  • Provides certain free preventive services, such as annual wellness visits and personalized prevention plan; waives the Medicare deductible for colorectal cancer screening tests.


  • Provides states funding to develop 3-year grant-funded programs for Medicaid enrollees encouraging participation in comprehensive health lifestyle programs and the meeting of certain health behavior targets.
  • Creates the Community First Choice Option, a new Medicaid state option to permit certain persons with disability to receive home and community based services through Medicaid rather than as institutional care in nursing homes; provides states with enhanced federal matching payments to increase non-institutionally based long-term care services.
  • Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.


  • Establishes the Center for Medicare and Medicaid Innovation; Center to test new ways to deliver and pay for services with intent to reduce costs and improve quality of care.


  • Provides payments for primary care residency programs in community-based ambulatory patient care centers.
  • Increases the number of Graduate Medical Education training positions and promotes training in outpatient settings.

About us

Bioethics in Brief is a newsletter of the Center for Bioethics and Humanities, committed to promoting clinical health care and health policy which is patient-centered, compassionate, and just. Opinions expressed in the newsletter are those of the authors and do not represent the position of the Center.

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