Implementation schedule of ACA
| Issue | What legislation would do | Effective date |
| 2010 | ||
| Business tax credits | Small businesses with no more than 25 employees and average annual wages of $40 000 would receive tax credits to help provide insurance to employees. The tax credit would be up to 35% of the employer's contribution if the employer pays 50% of the total premium cost. | 2010 tax year, with the credit increasing up to 50% in 2014 |
| Temporary reinsurance program | A $5 billion temporary reinsurance program would be created for employees to provide healthcare coverage for retirees over the age of 55 who are not eligible for Medicare. | 90 days after enactment |
| Temporary high-risk insurance pool | A $5 billion temporary national high-risk insurance pool would be created to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least 6 months. | 90 days after enactment |
| Pre-existing conditions | Insurance companies would be barred from denying coverage to children who have pre-existing medical conditions. | 6 months after enactment |
| Adult dependent children | Insurance companies would have to provide coverage for dependent children up to the age of 26. | 6 months after enactment |
| Insurance coverage limits | Insurance plans would be prohibited from placing lifetime limits on how much they pay out to individual policyholders and from rescinding coverage except in cases of fraud. | 6 months after enactment |
| Medicare drug rebates | Medicare patients who face a gap in prescription drug coverage would receive a 1-year, $250 rebate to help pay for medication. | Immediately |
| Tanning salon tax | A tax of 10% would be imposed on the cost of indoor tanning services. | Immediately |
| Preventive services | Health insurance plans would be required to cover preventive services such as immunization for children and cancer screenings for women. | 6 months after enactment |
| 2011 | ||
| Tax changes on healthcare savings accounts | The federal tax on individuals who spend money from heathcare savings accounts on ineligible medical expenses would double to 20%. | 1 January 2011 |
| Community health centers | Funding would increase by $11 billion for community health centers that provide medical care to patients who can not afford it. | 1 October 2011 |
| Medicare ‘doughnut hole’ | Drug companies would provide a 50% discount on brand-name prescription drugs for seniors who face a gap in drug coverage. More subsidies would be phased in through 2020, when the coverage gap would be closed. | 1 January 2011 |
| Primary care | Primary care doctors and general surgeons practicing in areas that lack primary care doctors would receive a 10% bonus payment under Medicare. | 1 January 2011 through 2015 |
| Long-term care | A voluntary long-term care program called CLASS* would be created. After at least 5 years of contributions, enrollees would be entitled to a $50-a-day cash benefit to pay for long-term care. | 1 January 2011 |
| New annual fee on drug-makers | A total annual fee of $2.5 billion would be imposed on pharmaceutical manufacturers. | 1 January 2011 |
| Insurance rebates | Health insurance companies would be required to provide rebates to enrollees if they spend <85% of their premium dollars on healthcare as opposed to administrative costs. | 1 January 2011 |
| 2012–2013 | ||
| Annual fee on drug-makers | The annual fee on pharmaceutical manufacturers would increase to $3 billion each year through 2016. | 1 January 2012 |
| Contribution limits on healthcare savings accounts | The limit on how much individuals could contribute to flexible savings accounts that let people set aside money tax free for health costs would be set at $2500. Currently employers set the limit. | 1 January 2013 |
| Itemized deductions for unreimbursed medical expenses | The threshold for deducting such expenses would increase from 7.5% of adjusted gross income to 10%. | 1 January 2013 |
| Medicare taxes | The Medicare tax rate would increase by 0.9 percentage points—from 1.45% to 2.35%—on earnings over $200 000 for individuals and $250 000 for families. Also, for the first time, a 3.8% Medicare tax would be imposed on unearned income. | 1 January 2013 |
| 2014 | ||
| Individual mandate | Most Americans would be required to buy health insurance or pay fines of $95 per individual up to $285 per family or 1% of taxable household income, whichever is greater. | 1 January 2014 |
| Employer requirements | Companies with ≥50 employees would pay a fine if any of their full-time workers qualified for federal healthcare subsidies. | 1 January 2014 |
| Medicaid expansion | The program for low-income Americans under the age of 65 would expand by increasing the income eligibility to 133% of federal poverty, or $29 327 for a family of four. | 1 January 2014 |
| Federal subsidies | Federal subsidies, which vary based on household income, would help offset the cost of buying insurance for Americans and legal residents who qualify. | 1 January 2014 |
| Annual fee on insurance companies | An annual fee totaling $8 billion would be imposed on heath insurance companies. | 1 January 2014 |
| Health insurance Exchanges | A state-based healthcare Exchange—a marketplace where uninsured individuals and small businesses could comparison shop for insurance policies—would be created. | 1 January 2014 |
| 2015–2016 | ||
| Individual mandate | Penalties for not carrying insurance would increase to $325 for each family member up to $975 per family or 2% of taxable household income, whichever is greater. | 1 January 2015 |
| Annual fee on insurance companies | The annual fee on health insurance companies would increase to $11.3 billion. | 1 January 2015 |
| Individual mandate | Penalties for not carrying insurance would increase to $695 for each family member up to $2085 per family or 2.5% of taxable household income, whichever is greater. | 1 January 2016 (adjusted for inflation after 2016) |
| 2017–2018 | ||
| Annual fee on drug-makers | The annual fee on pharmaceutical manufacturers would increase to $3.5 billion in 2017 and $4.2 billion in 2018. | 1 January 2017 |
| Annual fee on insurance companies | The annual fee on health insurance companies would increase to $13.9 billion in 2017 and $14.3 billion in 2018. | 1 January 2017 |
| Excise tax on high-cost insurance plans | A 40% excise tax would be imposed on healthcare plans that cost more than $10 200 for individual coverage and $27 500 for family coverage. | 1 January 2018 |
↵* Community Living Assistance Services and Support.
Source: Kaiser Family Foundation, White House, The Commonwealth Fund.