Publicity about the Patient Protection and Affordable Care Act (“PPACA” or the “law”) has been plentiful since the law’s enactment on March 23, 2010. Media outlets, pundits, and commentators weighed in on various aspects of PPACA since the President signed it into law. Often, the opinions and commentary centered on whether the requirements of PPACA would become a reality given the intense resistance some individuals and groups waged against the law’s implementation.

Initially, the constitutional challenges to the law’s “individual mandate” and its provisions about expanded Medicaid eligibility that ended up before the United States Supreme Court (the “Court”) received much attention. In June 2012, the Court upheld the constitutionality of the majority of PPACA. The result . . . implementation of the law continues. Then, many observers suggested the potential for a repeal of the law after the Presidential election in November 2012. The result . . . Congress did not repeal PPACA and implementation of it continues. Now, renewed focus on the constitutionality of PPACA via a challenge to it in the case Liberty University v. Geithner has once again caused speculation about the viability of the law.

There are no assurances regarding the outcome of the Liberty case. However, if history can shed any light on the matter it is that the law will survive the Liberty case. If history is right, the result is . . . implementation of PPACA will continue.

PPACA provisions affect individuals, employers, health insurers, and health care providers. Many of the law’s provisions are already in effect and many more will come into effect in 2013 and beyond. Individuals, employers, health insurers, and health care providers need to be certain they are compliant with provisions already in effect and to start preparing to comply with provisions that will come into effect in 2013 and beyond. To help those efforts, below is a summary of the provisions of PPACA set to take effect in 2013 and their respective effective dates.

• Flexible Spending Accounts—Effective January 1, 2013: Limits the amount of contributions to a flexible spending account for medical expenses to $2,500 per year, increased annually by the cost of living adjustment.
• Medicare Part D Subsidy—Effective January 1, 2013: Employers who receive the government retiree drug subsidy will no longer be able to take the tax deduction for retiree prescription drug payments.
• Itemized Deductions for Medical Expenses—Effective January 1, 2013: The threshold for itemized deductions for unreimbursed medical expenses increases from 7.5% to 10% of adjusted gross income. This increased threshold does not apply to individuals age 65 or older for tax years 2013 to 2016.
• Medicare Tax Increase—Effective January 1, 2013: Increases the Medicare Part A tax rate on ages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. Also imposes a 3.8% assessment on unearned income for higher-income taxpayers. The employer’s rate remains at 1.45%.
• Net Investment Income Tax—Effective January 1, 2013: Imposes a 3.8% tax on individuals that have certain investment income above specified thresholds. Individuals will owe the tax if they have net investment income and also have modified adjusted gross income over $200,000 for single individuals and $250,000 for married couples filing jointly. Investment income includes, but is not limited to, dividends, capital gains, rental and royalty income, and non-qualified annuities. 
• Tax on Medical Devices—Effective January 1, 2013: Imposes a 2.3% excise tax on the sale of any taxable medical device.  
• Medicare Bundled Payment Pilot Program—Effective January 1, 2013: Establishes a national Medicare pilot program to develop and evaluate making bundled payments for acute, inpatient hospital, physician, outpatient hospital, and post-acute care services for an episode of care.
• Medicaid Coverage of Preventive Services—Effective January 1, 2013: Provides a one percentage point increase in federal matching payments (“FMAP payments”) for preventive services in Medicaid for states that offer Medicaid coverage with no patient cost sharing for services recommended by the U.S. Preventive Services Task Force and recommended immunizations.
• Medicaid Payments for Primary Care—Effective January 1, 2013 through December 31, 2014: Increases Medicaid payments for primary care services provided by primary care doctors to 100% of the Medicare payment rate.
• Employee Notice Requirement—Effective March 1, 2013: Requires employers to notify employees and subsequent new hires about the availability of an insurance exchange, if applicable, and premium subsidies. Also requires employers to notify employees that if the employee purchases a qualified health plan through the Exchange the employee will lose the employer contribution to any health benefits plan offered by the employer. 
• Extension of CHIP—Effective October 1, 2013: Extends authorization and funding for the Children’s Health Insurance Program through 2015.
• Medicare Disproportionate Share Hospital Payments—Effective October 1, 2013: Initially reduces Medicare Disproportionate Share Hospital (“DSH”) payments by 75% and subsequently increases payments based on the percent of the population uninsured and the amount of uncompensated care provided.
• Medicaid Disproportionate Share Hospital Payments—Effective October 1, 2013: Reduces state’s Medicaid DSH allotments and requires the U.S. Department of Health and Human Services to develop a methodology for distributing the DSH reductions.

The uncertainty about PPACA from March 23, 2010 until the 2012 Presidential election is gone, and, at least for the foreseeable future, PPACA is here to stay. Compliance with the provisions currently in effect is imperative. Individuals, employers, health insurers, and health care providers also need to focus on provisions that become effective going forward. The task of becoming compliant is a significant responsibility and may seem daunting. It is important that professional legal advice be obtained if you are in doubt as to your or your client’s responsibilities under PPACA.