Reform Timeline


  • Small businesses become eligible to receive tax credit to help pay for healthcare benefit premiums
  • Rebate checks issued to Medicare Part D beneficiaries who enter into the prescription drug coverage gap known as the "donut hole"
  • Elimination of the pre-existing exclusion period for people under age 19
  • Early Retiree Reinsurance Program provides assistance to employers who provide coverage to early retirees
  • launches website for consumers to compare insurance coverage options
  • Grandfathered health plan status established
  • Restrictions on annual benefit limits
  • Mandatory availability of coverage for dependents up to age 26
  • Restrictions on rescissions of health plan benefits 
  • Mandatory full coverage for certain preventive services
  • HHS internet portal for individuals and small group
  • National high-risk pool begins
  • Elimination of lifetime maximum limits
  • Medical Loss Ratio Reporting
  • Appeal process changes
  • Medicare Advantage overpayments to insurance companies will be eliminated gradually
  • Seniors who reach the coverage gap will receive a 50% discount when buying Medicare Part D brand-name prescription drugs
  • Discrimination in favor of highly compensated employees prohibited (on hold pending issuance of federal rules)
  • Quality reporting (on hold pending issuance of federal rules)
  • Medical loss ratio rebates
  • Uniform coverage descriptions; Summary of Benefits and Coverage document


  • Medicare payroll tax increased for high-wage employees and new tax on unearned income
  • Cap on salary-reduction contributions to health FSAs
  • Large employers (250+ W2s) must report cost of coverage on W2 forms
  • Oregon Health Insurance Exchange opens for enrollment in October


  • Large employers must offer affordable, comprehensive coverage or pay a fee
  • Individual health coverage mandate
  • Health Insurance Exchanges operational
  • Premium and cost-sharing subsidies for low- and middle-income individuals
  • Medicaid eligibility expansion (under 65)
  • Additional consumer protections and market reforms
  • Coverage for participation in approved clinical trials is required
  • Eligibility Waiting Periods reduced to 90 days
  • Pre-existing exclusions prohibited for all adults and children
  • No annual maximums on essential benefits
  • All individual and small group plans must offer coverage for essential benefits


  • Exchanges offer coverage to employers with 51 to 100 employees


  • Excise tax on high-cost group health plans (Cadillac Plan Tax)