Despite Fight, New Year Brings Big Health Care Changes

New taxes on drug makers, lower prescription-drug costs for seniors and restrictions on tax-free medical spending accounts are among a slate of health-law provisions that kick in Saturday.

The changes show how the law will begin to reshape American health care, even as opponents try to overturn the measure in Congress and the courts.

Although House Republicans are threatening to starve the law of funding and stage a symbolic repeal vote, those actions aren't likely to block any significant pieces of the law aimed at consumers for 2011. That's because the changes generally involve new rules and don't require spending.

"The debate over defunding and repeal is going to be much more of a political story in 2011 than something that actually means something for consumers immediately," said Larry Levitt, vice president at the nonprofit Kaiser Family Foundation.

Over the longer term, however, Republicans could succeed in thwarting funding for staff and grants needed to put the law in place. The biggest changes, including new health-insurance exchanges and subsidies for lower earners, are set to happen in 2014.

Medicare recipients who fall into a prescription-drug coverage gap known as the "doughnut hole" may reap the biggest windfall of the law in 2011. Enrollees whose total drug costs for the year fall between $2,840 and $6,448 will get a 50% discount on branded prescriptions. That's compared with a $250 rebate the law gave them in 2010 to offset the cost of paying for those drugs entirely out of pocket. The seniors' group AARP estimates more than three million people fall into the doughnut hole each year.

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