Table 5.

Select Provisions of the Affordable Care Act Likely to Have a Profound Impact on Stroke Mortality, Prevalence, and Costs

ProvisionImplementation Date (Effective Date)Government Agency/Level Responsible for Implementation
Principle 1: Health insurance coverage/reform
 Interim high-risk pool for Americans who are uninsured because of a preexisting condition (§1101)6/23/2010HHS; can contract with states
 Prohibits insurance companies from putting lifetime caps on coverage (§2711)Plan years beginning on or after 9/23/2010HHS
 Prohibits health plans from requiring prior authorization for emergency services and from charging differential cost sharing for out-of-network emergency care (§1001)Plan years beginning on or after 9/23/2010HHS
 Prohibits insurance companies from denying coverage to children and adults with preexisting conditions (§10103 and §2704)09/23/2010 for children; 1/1/2014 for adultsHHS/states
 Prohibits higher premiums based on health status; establishes rating areas for variation based on age, tobacco use, etc (§2704)1/1/2014States, with review by HHS Secretary and consultation with NAIC
 Defining of “essential health benefits”: statute requires inclusion of 10 categories of services, including rehabilitative care (§1302)Before 1/1/2014HHS Secretary (DOL conducts employer survey first)
 Establishment of health insurance exchanges as new marketplace for buying coverage for those in individual and small group markets. Tax credits available on sliding income scale for those with incomes up to 400% FPL to help make coverage affordable (§1311)1/1/2014States (with federal fallback for states that choose not to establish an exchange)
 Increased Medicaid eligibility to 133% FPL for all nonelderly individuals (§2001)1/1/2014States
Principle 2: Prevention and wellness
 Creation of Prevention and Public Health Trust Fund; mandatory appropriations of $15 billion over 10 yearsEnactmentHHS
 Community Transformation Grants to state or local governments or nonprofit organizations to conduct evidence-based community preventive health activities (§4201)EnactmentHHS (CDC)
 Requires new private health plans to cover evidence-based preventive services with no cost sharing (§2713)9/23/2010HHS
 Menu labeling requirements for chains with >20 restaurants and vending machines (§4205)7/23/2010, voluntary registration; promulgation of proposed rules, 3/23/2011HHS (FDA)
 Elimination of cost sharing for preventive services under Medicare (§4104)1/1/2011CMS
 Establishes new annual wellness visit for Medicare beneficiaries (§4103)1/1/2011CMS
 Provides 1% Medicaid FMAP increase for states to cover evidence-based preventive services with no cost sharing. (§4106)1/1/2013States/HHS
Principle 3: Quality and delivery system reform
 Authorizes at least 4 competitive grants or contracts for regionalized systems for emergency care, including for stroke and cardiac emergencies. Matching funds required. Subject to appropriations. (§3504)FY2010–2014Assistant Secretary for Emergency Preparedness and Response
 Establishment of Community Care Transitions Program for high-risk Medicare beneficiaries (§3026)1/1/2011CMS
 Creation of Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models that address a defined population for which there are deficits in care leading to poor outcomes or potentially avoidable expenditures, including specifically the use of telehealth services in treating stroke, particularly in medically underserved areas and IHS facilities (§3021)1/1/2011CMS
 Establishment of a Medicare Shared Savings Program through ACOs (§3022)1/1/2012CMS
 ProvisionImplementation Date (Effective Date)Government Agency/Level Responsible for Implementation
 Establishment of acute hospital value-based purchasing program under Medicare (§3001)1/1/2012CMS
 Begin tracking hospital readmission rates for certain conditions (CHF, CABG, and COPD initially) and implement payment penalty for hospitals with highest readmission rates (§3025)10/1/2012CMS
 National pilot program on payment bundling (around a hospital stay) (§3023)1/1/2013CMS
 Creation of physician value-based payment program under Medicare (§3002 and §3007)1/1/2015 (Begin implementing during 2013 physician fee schedule rulemaking)CMS
 Establishment of independent payment advisory board for Medicare (15 members appointed by President, with Senate confirmation), including representatives of consumers; section also provides for a 10-member consumer advisory council appointed by GAO to advise the Board (§3403)1/15/2014HHS
Principle 4: Addressing health disparities
 Collaboration with health professional societies, experts in prevention, etc for development of model curricula for cultural competency, prevention, training (§5307)EnactmentHHS (HRSA)
 Requires any federally conducted or supported healthcare program or survey to collect and report data by race, ethnicity, sex, primary language, and disability status (§4302)3/23/2012HHS
Principle 5: Research
 Establishment of Patient-Centered Outcomes Research Institute, a private, nonprofit entity to fund comparative effectiveness research (§6301)EnactmentGAO
Principle 6: Workforce issues
 Establishment of National Health Care Workforce Commission, with 15 members appointed by GAO (§5101)EnactmentHHS
 10% Medicare bonus payment for primary care services (§5501)1/1/2011HHS (CMS)
  • ACO indicates accountable care organization; CABG, coronary artery bypass graft surgery; CDC, Centers for Disease Control and Prevention; CHF, congestive heart failure; CMS, Centers for Medicare and Medicaid Services; COPD, chronic obstructive pulmonary disease; DOL, US Department of Labor; FDA, US Food and Drug Administration; FMAP, federal medical assistance percentage; FPL, federal poverty level; FY, fiscal year; GAO, US Government Accountability Office; HHS, US Department of Health and Human Services; HRSA, Health Resources and Services Administration; IHS, Indian Health Service; and NAIC, National Association of Insurance Commissioners.