On March 23, 2010, President Obama signed into law the comprehensive health reform legislation: The Patient Protection and Affordability Act. This page will help to explain the new law, which includes provisions to expand coverage, control health care costs, and improve the health care delivery system. Read the full bills: the original bill, H.R. 3590 Patient Protection and Affordable Care Act, and H.R. 4872 Health Care and Education Reconciliation Act of 2010.
The Mayors Health Line has been at the forefront of the Health Care Reform working as Bostonians advocates and helping to increase awareness around the rapid changes occurring within health care. We encourage you to call us with any questions about the Health Care Reform (617.534.5050).
As always, for personal assistance obtaining health care coverage, the Mayor’s Health Line is available at 617-534-5050. For nearly 25 years, our free and multilingual service is here to help you understand your options and get the coverage that you need.
Table of Contents
How Will the Federal Law Impact Boston Residents
Important Changes in 2010
Changes By 2014
Important Current News
Highlighted Populations:
Women I Seniors I Early Retirees I Families I Children I Young Adults
African Americans I Latinos I Small Businesses I Rural Americans
Other Helpful Information about National Health Reform
Useful Links
How Will the Federal Law Impact Boston Residents?
Since 2006, Massachusetts has also been working to expand health insurance coverage (See Chapter 58 of the Massachusetts General Laws). With health reforms well underway in Massachusetts, the Boston Public Health Commission has published an easy-to-read fact sheet about how the national legislation will impact our state.
How the final bill affects Massachusetts
- The final bill provides Massachusetts with $2.15 billion to ensure we are not inadvertently punished for expanding health coverage before other states did. This is almost $2 billion more than the Senate bill provided and $850 million more than the House bill. This money will be used to protect and improve our regional health care, expand research, and both save and create jobs in Massachusetts.
- The final bill does NOT alter the Geographic Variation aspect of current Medicare law. This protects billions of dollars per year for our research hospitals. This victory was secured after many hours of internal debate, and by resisting a very aggressive push from those states that would have benefited greatly by our loss. If we had lost this issue, Massachusetts could have lost thousands of jobs very quickly and our health care system would have been harmed irreparably.
- The final bill protects our Area Wage Index that will bring Massachusetts about $300 million per year from the federal government - funds we do not currently receive.
- The final bill reduces the cut in Disproportionate Share Hospital payments AND retains language beneficial to Massachusetts. These provisions should protect millions of dollars paid to our hospitals that service our most vulnerable citizens – like Boston Medical Center and the Cambridge Health Alliance.
- 70,700 small businesses will be helped by the reforms (see Small Business Majority).
The Patient Protection and Affordable Care Act (PPA), Pub. L. No. 111-148, includes a provision that clarifies the meaning of “medical assistance” in the federal Medicaid Act. The clarification confirms the original intent of Congress that states, in providing “medical assistance,” must operate their programs to ensure that beneficiaries actually receive covered services with reasonable promptness, not simply be reimbursed if they manage to acquire services on their own. 
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Visit the Mass.gov for more information on how the bill will affect Massachusetts.
The Mayor’s Health Line and its partners will continually provide updates about how the federal law will affect Boston and Massachusetts. We will also be posting news and updates on the Mayor's Health Line blog.
Important Changes in 2010
- New help for some uninsured: People with a medical condition that has left them uninsurable may be able to enroll in a new federally subsidized insurance program that is to be established within 90 days (by June 2010).
- Discounts and free care in Medicare: The approximately four million Medicare beneficiaries who hit the so-called “doughnut hole” in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting this year.
- Coverage for kids: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.
- Tax credits for businesses: Businesses (including non-profit organizations) with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.
- Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud.
- Government oversight: Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.
- Read More Changes in 2010: Fact Sheet - "From Day One: Immediate Benefits of Health Care Reform"
Changes by 2014
While much of the law will be put into effect almost immediately, many of the law's changes won't actually begin until 2014. These include:
Implementing insurance marketplaces called "exchanges" (similar to the Massachusetts Connector)
Rules requiring insurers to accept all applicants, even those with health problems
An expansion of state Medicaid programs
Here is a great video from the Kaiser Family Foundation, summarizing the expected changes for the Health Care Reform.
For more current information and news coverage, check out the resource page at
Community Catalyst.
Highlighted Populations
Women 
Preventative care, primary care services, and maternity care are all subject to change. The reform seeks to create a move inclusive and understanding outlook on women's health as it takes into consideration the intersectionality of women's health.
For more information on how the Health Care Reform will affect Women's Health visit the National Women's Law Center and Kaiser Family Foundation.
For more information:
Health Reform for Women
Seniors
From annual checkups to cancer screenings, many preventive services will be free for those who receive Medicare. No co-pays or deductibles will be required. The new law will close this gap for Medicare prescription drug plans by 2020 through a series of reforms, beginning in July 2010. This year, seniors will receive a 50 percent discount on brand-name drugs.To learn more about the specific changes visit.
For more information:
Health Reform for Seniors
BPHC Fact Sheet: Health Reform for Seniors
Early Retirees
Under the Reform, early retirees will benefit from a guaranteed choice of quality, affordable health insurance, even if they retire early or lose access to employer-sponsored insurance. Exchanges are of particular benefit to Americans aged 55 to 64, fewer than half of whom work full-time. Visit Early Retiree Reinsurance Program, How Health Reform Will Help Early Retirees, and Health Care Reform for Early Retirees for more information.
For more information: Health Reform for Early Retirees
Families
The Reform will create a state based Exchanges to provide families with the same private insurance choices that the President and Members of Congress will have, including multi-state plans to foster competition and increase consumer choice. Ensures that families always have guaranteed choices of quality, affordable health insurance whether they lose their job, switch jobs, move or get sick, through the creation of Exchanges. Visit White House: Putting Americans In Charge of their Health Care, and Health Care Reform:How Health Care Reform Will Lower Costs and Increase Choices to learn more about the reform's affect on families.
The Georgetown Center for Children and Families has produced an excellent
summary of Medicaid, CHIP, and low-income provisions in health care reform and a timeline of the key health reform dates for children and families.
For more information: Health Reform for Families
Children
The reform creates extensions and additions to CHIP, creates coverages for children aging out of foster care, eliminates existing exclusions for children, as well as creating other benefits. Visit The Kaiser Family Foundation to get more information about this portion of the reform.
For more information:
Health Reform for Children
NEACH has created an overview of some of the key health reform provisions that affect children.
Young Adults
To learn more about how the reform affects young adults ( which includes tax credits, dependent coverage extensions, and more affordable choices) please visit How The Health Reform Affects Young Adults, and Young Adults and the Affordable Care Act.
For more information: Health Reform for Young Adults
African Americans
Attention to minor health is an important focus of the health care reform. It is a priority to monitor health, health care trends, and quality of care among minority patients and evaluate the success of minority health programs and initiatives. It is important that we move toward elimination of disparities that African Americans currently face both in their health and in their health care by investing in data collection and research about health disparities. Visit The Kaiser Family Foundation, FamiliesUSA, and White House: What Health Reform Means for African Americans.
For more information: Health Reform for African Americans
Latinos
The reform will affect Latino health, in that there will be more Medicaid funding for Puerto Rico, management of chronic disease, and work to continually decrease health disparities within this ethnic group. Visit The Kaiser Family Foundation, and Health Care Reform for Latinos to understand the reform changes more.
For more information:Health Reform for Latinos
Small Businesses
Provided with up to 100 employees access to state based Small business Health Options Program (SHOP) Exchanges. Tax credits will be issued to small employers with less than 25 full time equivalent employees and average annual wages of less than 50,000 that purchase health insurance from employees. To learn about these changes in more detail, visit these sites. Visit these sites to find more information: IRS: Small Business Health Care Tax Credit for Small Employers, The White House: Six Ways Health Reform Will Help Small Businesses, The White House: The Economic Effects of Health Care Reform on Small Businesses and their Employees, and U.S. Small Business Administration.
For more information: Health Reform for Small Businesses
Rural Americans
To read more about the reform and its plan to lower health care costs in rural areas, increase access to health care workers, and protect access to care in rural communities visit CFRA, Ruralhealthweb, SBA, Whitehouse,IRS.
For more information: Health Reform for Rural Americans
Other Helpful Information about National Health Reform
Thanks to our partners at the Massachusetts Law Reform Institute for these important links:
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03/29/2010 Kaiser Family Foundation
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03/24/2010 Kaiser Family Foundation
Useful summary in side-by-side format of the Senate Health Reform Bill and the House Reconciliation (fix) Bill. Read More
02/22/2010 Georgetown Center for Families and Children
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12/01/2009 Simon Lazarus; American Constitutional Society
From the introduction to the paper: "Recently, some opponents of comprehensive health insurance reform have introduced a new contention - namely, that a cornerstone of the reform bills pen Read More
Healthreform.gov
04/30/2010 ProgramsAssociation of Maternal and Child Health Programs
04/30/2010 The Commonwealth Fund
Timeline of Health Reform Implementation
04/30/2010 Ropes and Gray LLP
Helping People with Long-Term Health Care Needs: Improving Acces to Home- and Community-Based Services in Medicaid
04/30/2010 Families USA
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04/30/2010 Families USA
04/30/2010 Ropes and Gray LLP
Useful Links
Kff.org: The Kaiser Family Foundation Web site has a lot of thorough information. To get started, under "New & Noteworthy," click on "summary of the law" for a good synopsis, and on "timeline" to see when various provisions of the law are scheduled to kick in.
Familiesusa.org: Families USA is a nonprofit advocacy organization for health-care consumers. Click on the link to "Health Reform Central" to see just about everything you need to know about the new law. To get a recap of the major changes, click on the link that begins "Help is on the way" on the homepage.
Healthinsuranceproviders.com: Click on "Health Care Reform" to see a timeline that's less descriptive than Kaiser's, but easier to grasp visually. The site belongs to an online insurance broker; if you're looking for health insurance, be sure to shop around other sites and brokers.
Bankrate.com: From a Web site where borrowers hunt for low mortgage rates and savers look for high-interest CDs, there's a summary with a good focus on costs. Type "reform" into the search box, and click on "What's in it for you."
Whitehouse.gov/healthreform: Putting Americans in Charge of Their Health Care is the White House's online center for all things health reform. Whether you own a small business, have private health insurance, or have Medicare, this website provides a variety of helpful materials, including details on what's in the law, a list of the law's immediate benefits, and frequently asked questions about the health reform.
Medicarerights.org: The Medicare Rights Center summarizes key new provisions for seniors; click on the big box that says "learn more about health reform and Medicare."