Permits states to form health care choice compacts and allows insurers to sell policies in any state participating in the compact.

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Provides for a 23 percentage point increase in the Children’s Health Insurance Program (CHIP) match rate up to a cap of 100%.

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Expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 138% FPL and provides enhanced federal matching payments for new eligibles.

States have the option to expand coverage to childless adults beginning April 1, 2010

Requires U.S. citizens and legal residents to have qualifying health coverage (there is a phased-in tax penalty for those without coverage, with certain exemptions).

Update: On July 1, 2013, HHS issued a final rule that establishes the standards and processes for the Exchanges to determine eligibility for and grant exemptions from the individual shared responsibility payment.

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Provides refundable and advanceable tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the Exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

Update: On May 23, 2012, the IRS released final regulations related to the health insurance premium tax credits. Corrections to this regulation were published on July 17, 2012. Additionally, on January 30, 2013, IRS released a final rule on the premium tax credit test for affordability of employer-sponsored insurance.

Prohibits annual limits on the dollar value of coverage.

Update: On June 28. 2010, HHS issued interim final regulations prohibiting lifetime and annual limits on coverage.

Requires the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

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Permits states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.

Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards; establishes 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

Implementation: Changes to employer wellness plans effective January 1, 2014; 10-state pilot programs established by July 1, 2014

Reduces states’ Medicaid Disproportionate Share Hospital (DSH) allotments and requires the Secretary to develop a methodology for distributing the DSH reductions.

Creates the Consumer Operated and Oriented Plan (CO-OP) to foster the creation of non-profit, member-run health insurance companies.

Implementation: CO-OPs established by July 1, 2013

Imposes an excise tax of 2.3% on the sale of any taxable medical device.

Increases the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and imposes a 3.8% assessment on unearned income for higher-income taxpayers.

Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; waives the increase for individuals age 65 and older for tax years 2013 through 2016.

Provides a one percentage point increase in federal matching payments for preventive services in Medicaid for states that offer Medicaid coverage with no patient cost sharing for services recommended (rated Br B) by the U.S. Preventive Services Task Force and recommended immunizations.

States indicate to the Secretary of HHS whether they will operate an American Health Benefit Exchange.

Learn more: Where are states in establishing and implementing their health insurance exchanges? Check out HCR Central for the latest news on the ACA and exchanges.

Reduces Medicare payments that would otherwise be made to hospitals to account for excess (preventable) hospital readmissions.

Reduces annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals and units and adjusts payments for productivity. Implementation: Beginning fiscal year 2010; productivity adjustments added to market basket update in 2012

Creates new demonstration projects in Medicaid for up to eight states to pay bundled payments for episodes of care that include hospitalizations and to allow pediatric medical providers organized as accountable care organizations to share in cost-savings.

Implementation: January 1, 2012 through December 31, 2016

Allows providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.

Authorizes an Independent Advisory Board, comprised of 15 members nominated by the President and Congress, subject to Senate confirmation, to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds targeted growth rates.

Implementation: Funding available October 1, 2011; beginning in 2013, CMS Chief Actuary issues determination of whether Medicare spending exceeds target growth rates; first recommendations would be due January 15, 2014 to take effect in 2015 if the Medicare spending growth rate exceeds the target growth rate.

Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.

Provides grants to states to begin planning for the establishment of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of insurance by individuals and small employers.

Implementation: Grants awarded starting March 23, 2011; applications will be accepted through October 15, 2014

Requires the Secretary of the federal Department of Health and Human Services to develop and update annually a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health

Implementation: Initial strategy due to Congress by January 1, 2011

Creates a new Medicaid state option to permit certain Medicaid enrollees to designate a provider as a health home and provides states taking up the option with 90% federal matching payments for two years for health home-related services.

Freezes the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels resulting in more people paying income-related premiums, and reduces the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waives the Medicare deductible for colorectal cancer screening tests; authorizes Medicare coverage for a personalized prevention plan, including a comprehensive health risk assessment.

Requires pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begins phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap. In 2013, begins phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (reducing coinsurance from 100% in 2010 to 25% in 2020, in addition to the 50% manufacturer brand-name discount).

Implementation: January 1, 2011 (drug discount) and January 1, 2013 (federal subsidies)

Authorizes $50 million for five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigation.

Implementation: Authorizes funding beginning fiscal year 2011.

Requires new health plans to implement an effective process for allowing consumers to appeal health plan decisions and requires new plans to establish an external review process.

Implementation: Plan or policy years beginning on or after September 23, 2010

Extends dependent coverage for adult children up to age 26 for all individual and group policies.

Implementation: Plan or policy years beginning on or after September 23, 2010

Expands eligibility for the 340(B) drug discount program to sole-community hospitals, critical access hospitals, certain children’s hospitals, and other entities.

Requires the Department of Health and Human Services to develop an internet website to help residents identify health coverage options.

Creates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government.

Imposes additional requirements on non-profit hospitals to conduct community needs assessments and develop a financial assistance policy and impose a tax of $50,000 per year for failure to meet these requirements.

Establishes the Federal Coordinated Health Care Office to improve care coordination for dual eligibles (people eligible for both Medicare and Medicaid).

Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011.