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Introduction
On 23 March 2010, President Obama signed into law the most sweeping healthcare system reform legislation since Medicare was enacted in 1965. The debate has been both heated and divisive. There is a substantial literature that has emerged both in support of and in opposition to the Patient Protection and Affordable Care Act of 2010 (the ACA, for short). 1-3
Supporters of the law maintain that the passage of comprehensive healthcare reform legislation presents tremendous opportunities to improve the way that America's healthcare system works. They believe that the reforms to expand coverage hold the potential to help millions of Americans. The opponents of the healthcare reform claim that ACA will transfer one-sixth of the US economy into the hands of politicians and agency bureaucrats.
Manchikanti et al 3 recently published an article on the impact that the ACA will have on interventional pain management. There were elements of that review that would serve as useful background for NeuroInterventional specialists. For that reason, this brief communication was undertaken.
ACA implementation
The Act is divided into 10 titles. It contains provisions that went into effect starting on 21 June 2010, with the majority of the provisions going into effect in 2014 and later ( table 1 ). 4
2010 |
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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... |