Timeline: Implementing Health Reform in America



The Affordable Care Act was signed into law on March 23, 2010, and guaranteed issue coverage was offered for the first time on a national scale beginning October 1, 2013. Both were considered major events in the history of American health insurance, and major events in the law’s rollout, but certainly not the only important dates.


The law contains numerous provisions spread across an 10-year implementation plan, and deadline reschedules throughout the process have kept consumers on their toes.


And why overhaul the healthcare system?


If you didn’t buy your own coverage before 2014, like most Americans who are covered by an employer, the behind-the-scenes of health insurance wouldn’t matter much to you. However, if you had health problems and couldn’t get covered at your job, on the individual market, or as a dependent, access to care would be very limited.


Too Many Uninsured

The annual 2011 Census Bureau report showed that although the uninsured rate was decreasing, 48.6 million people were still without coverage. Cost is one of the largest factors preventing people from gaining coverage, and limited access to public programs for poor people is another.

The ACA helps decrease the number of uninsured people by adding new ways to get insured for a lesser cost. This includes subsidized health plans, risk pools and Medicaid expansion.

It also changes underwriting, the process insurers use to determine eligibility and pricing for health plans. The law prohibits insurers from doing much underwriting at all in an attempt to level the playing field for applicants.


Medicare Donut Hole

Seniors covered by Medicare would lose their coverage for prescription drugs once they reached the “donut hole,” making it hard to pay for medications. The health reform initiative fills the donut hole so patients can keep a consistent treatment plan.


Annual and Lifetime Limits

Before the ACA, insurers could stop covering your care once you reached your policy’s annual or lifetime limit. This usually applied to people with chronic conditions, which made it that much worse as they need care and coverage more than the average policyholder.


Premium Rate Increases

Individual health plan premiums could increase based on your health status, gender, occupation or hobbies, to make sure the health plan had enough to compensate for your risk. Under the ACA, the only factors that can change an individual’s rates are their age and use of tobacco.


Denial of Pre-Existing Conditions

If you were sick and tried to apply for individual health insurance, the carrier could increase your rates or deny you coverage altogether. The health law eliminates discrimination in the individual market, so you can be pregnant, HIV-positive or allergic to pollen and still get insured.


The Affordable Care Act’s Plan: 2010-2020


Affordable Care Act Timeline Infographic