Health Care Law's First Anniversary: Why Haven't Americans Seen Changes Yet?

March 22, 2011— -- It was a year ago that President Obama, after months of heated rhetoric, fiery debates and partisan wrangling, signed the historic health care bill into law.

"The bill I'm signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see," the president said, as he swiftly turned the contentious bill into the law of the land.

The Affordable Care Act -- dubbed "Obamacare" by critics -- includes a number of significant changes to be rolled out piecemeal by 2014. Many have already been implemented, including those that benefit small businesses and Americans with pre-existing conditions. But many of these are targeted to a narrow group of people, such as the poor, those under the age of 26 and senior citizens. The major provisions in the law don't take effect until 2014, until which time Americans may not see a significant change in their coverage.

Under the "grandfather provision," the law also allows those Americans who like their plan to keep it so many in that group may not see any major changes either.

With insurance premiums rising rapidly, most Americans still don't know what the health care law means for them. A poll conducted by the Kaiser Family Foundation this month found that 52 percent of Americans don't feel they have enough information about the health reform law to understand how it will affect them personally, compared to 47 percent who think they do. The numbers are very similar to those of a year ago, when 56 percent said they did not have adequate information.

Overall, 13 percent say their family has benefited from health reform over the past year, while 20 percent report having suffered a negative effect.

"I think part of the reason why there seems to be skepticism among the public or confusion among the public as to how they will be affected by the law is that the major provisions of the law, particularly around coverage and the expansion of coverage don't go into effect until 2014," said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation.

"Because of that most people have yet not seen a major change in their coverage or in the cost of their coverage and so they are somewhat concerned about what might come and not sure of what they can expect to see from them, from the law," she added.

Here is a brief snapshot of the provisions that have already been rolled out under the health care law and what they mean to you:

Eliminating the "doughnut hole:" Senior citizens on Medicare plans who spend more than the allotted amount on medicine are being given a 50 percent discount on prescription drugs. The bill aims to close the "doughnut hole" -- the out-of-pocket expenses seniors have to incur once their costs for medication reach $2,830 -- completely by 2020, but older Americans will still have to pay for 25 percent of their drugs. Last year, the administration mailed out $250 rebates to seniors who fell in this gap.

More Medicare Benefits: There will be a 10 percent Medicare bonus payment for primary care services, and a 10 percent Medicare bonus payment to some surgeons in specialties with fewer doctors. That component of the health care bill lasts until Dec. 31, 2015.

The new law eliminates any cost-sharing Medicare beneficiaries need to pay for preventive care and waives the deductible for colorectal cancer screening tests.

Focus on preventative care: The law eliminates co-payments for preventative screenings such as mammograms and cancer screenings, and makes bonus payments to professionals who have high-quality ratings.

Young Americans' benefits: Young adults can now stay on their parents' insurance plans until the age of 26. The provision, one of the first to be implemented, was designed to help graduates who may be having trouble finding full-time employment with benefits.

Tighter restrictions on insurance providers: Insurers can no longer cancel coverage of patients who get sick, except in cases where the policy holder commits fraud. This provision applies primarily to the individual insurance market. Insurance companies are also barred from imposing a lifetime limit on co-payments.

Small business benefits: Small businesses that establish wellness programs are eligible for federal grants.

Help for states: The Obama administration has given millions to help create and strengthen state insurance rate review processes. These systems vary widely all over the country, and only a handful of states have the authority to deny rate increases. While the new law aims to strengthen rate reviews, it doesn't give states the power to reject rates.

Tanning tax: Indoor tanning salons are now subject to a 10 percent tax that took effect last year.

Help for sick children: Health insurance companies are prohibited from dropping children with pre-existing conditions. Similar measures for adults with pre-existing conditions will be rolled out in the coming years.

Medical Loss Ratio for Insurers: Under the new law, insurance companies serving the large group market will have to devote 85 percent of every dollar to patient care and improving quality of care, and not to such expenses as overhead costs, executive salaries or dividends for shareholders. For those serving small business and individuals, that has to amount to 80 percent of every dollar.

If insurance companies fail to meet these standards, they will have to provide rebates to consumers.

The medical loss ratio -- the ratio of medical expenses to administrative spending -- came under fire last year when some companies, such as McDonald's, reportedly threatened to drop limited coverage plans because of the new standards.

Medicaid Expansion: A new program will go into effect that will provide matching federal funds for long-term care services under Medicaid. The federal government will also provide funds for home health care and attending services for people with disabilities.

The Medicaid expansion under the new health care law has met with resistance from many state governments that say it puts additional burdens on them at a time when they're struggling with budget deficits.

High risk pools: Programs have already been established in some states to provide temporary insurance to those people who have been denied insurance because of pre-existing conditions for at least six months. The high risk pools and premiums differ from state to state.

Premiums can range anywhere from $140 to $900, HHS said in July, with older people having to pay more. The premiums are linked to individual health insurance costs in each state.

Changes Still to Come

Here is what Americans can expect this year and in the coming years:

2011: Individuals who make $85,000 or more, or couples with incomes of at least $170,000, would have to pay higher premiums, starting in 2011. And the federal premium subsidy will be cut to 74.5 percent, depending on a person's income.

2011: Starting this tax season, small businesses that qualify can start applying for tax credits under the new health care law for 2010 and beyond.

2011: Louisiana specifically will receive an expansion of $300 million in Medicare funding from the federal government.

2014: Most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans. Small businesses, high-risk patients and the uninsured would have the option of shopping for coverage in health insurance exchanges, a marketplace in which people could shop for and compare insurance plans.

2014: Those who are at 133 percent of the federal poverty level, or $29,327 for a family of four, would be eligible for Medicaid, starting in 2014. Also in 2014, adults who don't have children would be eligible for such benefits that have traditionally only been given to households with children.

2014: Employers would also be required to provide coverage to their workers, or pay a fine of $2,000 per worker. Companies with fewer than 50 employees, however, are exempt from this rule.

ABC News' Karen Travers contributed to this report.