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This week has been one for the history books. The fact that the Supreme Court, led by conservative Chief Justice Roberts, upheld the Affordable Care Act was a surprise to many (myself included).  This legislation will impact millions of citizens — just as the passage of the Social Security Act did in 1935 — another act that provoked intense controversy, a court-packing plan from President Roosevelt, and another major shift for the Supreme Court:
“Despite the intense controversy the court-packing plan provoked, and the divided loyalties it produced even among the President’s supporters, the legislation appeared headed for passage, when the Court itself made a sudden shift that took the wind out of the President’s sails. In March 1937, in a pivotal case, Justice Roberts unexpectedly changed his allegiance from the conservatives to the liberals, shifting the balance on the Court from 5-4 against to 5-4 in favor of most New Deal legislation. In the March case Justice Roberts voted to uphold a minimum wage law in Washington state just like the one he had earlier found to be unconstitutional in New York state. Two weeks later he voted to uphold the National Labor Relations Act, and in May he voted to uphold the Social Security Act. This sudden change in the Court’s center of gravity meant that the pressure on the New Deal’s supporters lessened and they felt free to oppose the President’s plan. This sudden switch by Justice Roberts was forever after referred to as “the switch in time that saved nine.” http;//

How ironic that it was another Justice Roberts who made the shift that saved another important piece of legislation, that will ultimately change health care in America, as Social Security changed retirement.
Just like Social Security, implementing the ACA will be a major challenge for the federal government and the states. My favorite provision is the one that calls for no co-pay for birth control, something I have to take to control my endometriosis (and which saved my fertility) and which insurance companies have given me grief for over the years — but that provision is still facing litigation.
Here are the key provisions:

Effective in 2010

Dependent coverage: Children can stay on their parents’ policies up to age 26. As of June 2012, 3.1 million young adults had gained insurance – a 75 percent rise in the proportion of insured adults ages 19 through 25.
Preventive benefits: New health plans must provide, without cost-sharing, certain preventive health services including vaccinations, mammograms, prenatal care, and contraception. By February 2012, about 54 million Americans had received preventive care under the law – and religious groups had filed lawsuits challenging the birth-control benefits.
Lifetime limits: Health plans can’t put lifetime dollar limits on coverage.
Preexisting conditions: People who can’t get health insurance because of continuing health problems could be covered by Preexisting Condition Insurance Plans (PCIP), a transitional program that will expire when insurance exchanges are available in 2014. As of April 2012, 67,000 people had enrolled in PCIPs, including more than 5,000 Pennsylvanians and about 900 in New Jersey.
Small-business tax credits: Employers with up to 25 employees, each earning less than $50,000, began getting tax credits for providing health insurance to workers. In 2014, the credits will rise to 50 percent of employer costs if coverage is bought through an insurance exchange.
Indoor tanning: A 10 percent tax was imposed on tanning services.
Medicare prescription drugs: Medicare recipients began receiving annual rebates or discounts on prescription drugs that ultimately will close the “doughnut hole” coverage gap. As of June 2012, more than 5.2 million seniors and disabled people had received checks and discounts worth $3.7 billion.

Effective 2011

80/20 rebates: Insurers must spend at least 80 percent of consumers’ premium dollars on medical care, and no more than 20 percent on administrative costs – or give customers a rebate for the difference. As of June 2012, 12.8 million Americans, including 576,000 Pennsylvanians, got $1.1 billion in rebates; the average per family was $151.
Medicare Preventive benefits: Co-pays and other cost-sharing are eliminated for Medicare-covered preventive services such as colon cancer screening.
Income-related premiums: Medicare recipients whose incomes exceed a certain threshold must pay higher premiums.

Effective 2012

Pharma Industry: Drugmakers pay new fees in January to help fund the law.
Hospital readmissions: Beginning in October, Medicare payments will be cut to hospitals with excessive, preventable readmissions.

Effective 2013

Medicare tax increase: The tax rate on wages for Medicare hospital coverage rises from 1.45 percent to 2.35 percent on earnings over $200,000 for individuals and $250,000 for married couples.

Effective 2014

Individual mandate: Most citizens must be covered or pay a phased-in tax penalty.
Insurance exchanges: These online sites to buy insurance must be established by Jan. 1. Track your state at
Curbs on insurers: Annual coverage limits are prohibited, and insurance must be renewable regardless of health status.
Employer penalty: Employers with more than 50 employees who do not offer health coverage will be assessed a per-worker fee. – Marie McCullough