Signed into law in March 2010, the Affordable Care Act (ACA) establishes a series of health-care reforms spread over eight years. The goals of the ACA are threefold: expand access to health care so that few Americans are left uninsured, slow the rise in health-care costs and improve systems for health-care delivery. Unrelenting political attacks have obscured the reforms achieved thus far.

ACA for 2010: Twenty-six projects are under way. Adult dependents may remain on family health insurance plans until age 26. This expands coverage to more than 1 million young adults.

A temporary insurance plan is available for people with pre-existing health conditions who have been uninsured for at least six months.

Small businesses with 25 or fewer employees qualify for tax credits up to 35 percent of premiums when they provide health insurance.

Funding is provided to determine which among competing therapies are most effective in treating various illnesses. A second commission addresses health manpower issues to ensure adequate numbers of practitioners for the future.

Programs to address prevention of obesity, heart disease, stroke, cancer, and smoking are launched. These conditions generate huge health-care costs.

Support is offered those states that choose to increase Medicaid coverage for childless adults whose income is less than 133 per cent of the Federal poverty level.

ACA for 2011: Seventeen of 21 projects are underway.

Providers of primary care services for Medicare patients receive a 10 percent increase in payment. The goal is to bolster a shrinking primary-care workforce.

Medicare patients no longer pay deductibles or co-payments for approved screening and preventive services such as mammography, colonoscopy and immunizations.

Programs to prevent chronic illnesses among Medicaid recipients are initiated.

Support is provided for primary care training programs in community-based patient care centers.

States may obtain funding to plan for health insurance exchanges which will be required in all states by 2014. States may also obtain funding to develop alternatives to current systems for dealing with medical malpractice litigation.

At least 85 percent of expenditures of health insurance companies must be directed to clinical services.

Pilot programs are funded to develop alternatives to institutional care for chronically disabled patients.

ACA for 2012: The most dramatic change will be the establishment of Accountable Care Organizations (ACO). These are voluntarily formed groups of hospitals, physicians, and other providers who will each assume care of 5000 or more Medicare patients who enroll for comprehensive care. ACOs are awarded bonuses for meeting standards of quality and effectiveness of care. Unlike health maintenance organizations, patients in an ACO may drop out at any time. ACOs will rely upon electronic health records to facilitate care and reduce errors. ACOs are already forming across the country. Care plans similar to ACOs have demonstrated for years their ability to provide effective care at lower costs.

Pilot programs will be developed to provide primary care services in the homes of Medicare patients who would otherwise require institutional care.

Efforts to identify and eliminate fraud and abuse in health care will be intensified.

ACA for 2014: The highly contentious requirement that everyone purchase health insurance takes effect this year unless the Supreme Court rules this measure unconstitutional.

A detailed time-line for the ACA is available at

In this season of political vitriol some candidates for president say that they will immediately terminate the ACA following inauguration. Does this mean that all provisions of the legislation would be reversed?

No clearly defined alternatives to the ACA have been offered thus far by critics of the law. A return to the fragmented, unaffordable health care system that existed prior to the enactment of the ACA is not an option.

Contact Clif Cleaveland at