A woman holds a sign during a rally. Most of the key provisions of the law won't… (Nam Y. Huh / Associated Press )
WASHINGTON — After two years of heated debate, the Supreme Court, in largely upholding President Obama's healthcare law, provided much-needed clarity to consumers, insurers, states and others. While some provisions of the law have already gone into effect, many of the most significant ones — including a requirement that almost all Americans have health insurance — won't kick in until 2014.
Here's a look at where things stand:
Provisions are already in effect to bar insurers from imposing lifetime limits and from canceling coverage if consumers make technical errors on their insurance applications. Young adults are permitted to stay on their parents' health plans until age 26 and children with preexisting medical conditions cannot be denied coverage.
Beginning in 2014, adults with preexisting conditions will be guaranteed coverage and won't have to pay higher rates than healthier people. Annual dollar limits on essential services will be prohibited.
Also starting in 2014, state-based insurance exchanges will offer people a way to comparison shop for individual health policies that meet minimum government standards. The government will subsidize these purchases for millions of people. Individuals who don't get insurance would be required to pay a penalty of at least $95 in 2015; the fee increases to at least $695 in 2017.
Seniors are already getting preventive services without having to pay co-payments or deductibles. And many are saving money on prescription drugs due to a provision, already in effect, that will finish phasing out a coverage gap known as the "doughnut hole" by 2020.
Hospitals are big winners in the court decision. Because millions more people will have either private or government health insurance, hospitals will get paid for the care they provide to the previously uninsured. Starting in October, hospitals will be able to get payment incentives based on the quality of their care. And next year, hospitals and providers will start getting bundled payments for delivering integrated care to Medicare patients. The law's survival is also expected to accelerate the transition to electronic records by doctors and hospitals.
Beginning in 2015, doctors will be paid higher rates for providing better care. Doctors and nurses who work in underserved areas already get perks like scholarship funding and loan repayments.
The court upheld the part of the law that would provide coverage to millions more low-income Americans by extending Medicaid eligibility to those who make less than 138% of the poverty level, or about $15,400. But the court ruled that states can't be penalized for refusing to take part in the Medicaid expansion. One possible result: States like California and Massachusetts will probably embrace the expansion, but others, like Florida and Texas, might balk — leaving their low-income residents without any coverage.
The law already requires insurers to spend at least 80% of insurance premiums on medical care, or refund the difference to their customers. Individuals and businesses could receive as much as $1.3 billion in refunds for 2011. Managed-care companies will probably benefit from a big expansion of Medicaid; states are increasingly asking these insurers to handle their Medicaid programs.
Starting in 2014, firms with more than 50 employees will be required to offer health insurance or pay a tax. The penalty is low enough that some employers might choose to drop their insurance plans and pay the tax instead.
Companies with fewer than 50 employees will not be required to offer insurance, but those who do can already receive a tax credit worth as much as 35% of the amount they contribute to employees' premiums. By 2014, the credit will increase to 50% of the employer contribution.