MARCH 23, 2010 | AFFORDABLE CARE ACT IS PASSED

PHOTOGRAPH Win McNamee/Getty Images

Over eight years, President Obama’s signature health-care legislation will expand coverage to all Americans and try to cut costs by squeezing out inefficiencies.

2010

PRE-EXISTING CONDITIONS

The law will eventually bar insurers from denying coverage for pre-existing conditions. Until then, the government provides temporary insurance.

YOUNG ADULTS

Kids can stay on their parents’ plans through age 26. About 3 million are already benefiting.

2011

CUTTING WASTE

Insurers must spend at least 80 percent of premiums on patient care or pay rebates to policyholders. Payments totaling $1 billion started going out this summer.

CUTTING PAYMENTS

The government freezes reimbursement rates at 2010 levels to private insurers that provide Medicare Advantage plans. Projected savings: $136 billion by 2019.

2012

IMPROVING HOSPITAL CARE

Starting in October, hospitals that readmit a large percentage of patients within 30 days of discharge will be penalized with lower Medicare payments. Projected savings: about $25 billion a year.

INSURANCE EXCHANGES

States must submit plans detailing how their exchanges will work. If they don’t, the federal government will step in and do it for them.

2013

AVERAGE FAMILY HEALTH INSURANCE PREMIUM ESTIMATES

WITHOUT AFFORDABLE CARE ACT $15,843

WITH AFFORDABLE CARE ACT $15,614

PAYING THE BILL

In January, two big taxes go into effect: Medical devices are subject to a 2.3 percent excise tax, expected to raise $20 billion over 10 years; Medicare taxes on wages jump from 1.45 percent to 2.35 percent, though only for individuals earning more than $200,000, or $250,000 for couples.

EXCHANGES RAMP UP

States must start enrolling people in their insurance exchanges by October.

2014

WITHOUT AFFORDABLE CARE ACT $16,617

WITH AFFORDABLE CARE ACT $16,101

MEDICAID EXPANSION

Beginning in January, anyone under 65 earning up to 133 percent of the federal poverty level qualifies for Medicaid.

A SHORTAGE OF DOCTORS

Millions of newly insured people will flood the system, making the current doctor shortage worse.

INSURANCE FOR ALL

By Jan. 1, state health exchanges will open for business.

PRE-EXISTING COVERAGE

The restriction on barring people with pre-existing conditions goes into effect.

2015

WITHOUT AFFORDABLE CARE ACT $17,114

WITH AFFORDABLE CARE ACT $16,293

2016

WITHOUT AFFORDABLE CARE ACT $17,705

WITH AFFORDABLE CARE ACT $16,527

2018

WITHOUT AFFORDABLE CARE ACT $18,769

WITH AFFORDABLE CARE ACT $17,182

TAXING PREMIUM PLANS

A 40 percent tax on “Cadillac” plans — private plans costing more than $27,500 for families or $10,200 for individuals — kicks in. The tax will raise a projected $12 billion in its first year.

THE COST OF GETTING OLDER

The growing number of Americans over 65 will continue to push health-care costs higher.

WITHOUT AFFORDABLE CARE ACT $19,348

WITH AFFORDABLE CARE ACT $17,566

SOURCES Annual Review of Medicine, Bloomberg, Commonwealth Fund, Henry J. Kaiser Family Foundation, New England Healthcare Institute, U.S. Department of Health and Human Services

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