Safer Roads in America (Part 2 of 2)

Since 1991, Congress has recognised that improving roadway safety hardware can significantly reduce fatalities and injuries on the nation’s roadways and contribute to safer roads in America. In addition, as early as 1994, the FHWA called for the replacement of old and obsolete roadway safety features such as blunt and guardrail terminals.

A comprehensive approach to updating and improving roadway safety hardware can be an effective method to accomplishing the goal of towards zero death and safer roads in America.

There are a number of devices that are specifically designed to alleviate the severity of and/or prevent roadway departures. For example:
Median barriers
Shoulder-applied guardrail hardware safety features
Crash cushions

Median barriers are longitudinal barriers most commonly used to separate opposing directions of traffic on a divided highway. While these systems may not reduce the frequency of crashes due to roadway departure, they can definitely help prevent a median crash from becoming a median crossover head-on collision.

Barrier design and placement needs to effectively protect motorists travelling in opposing lanes, while also considering the safety of the occupants of the offending vehicle. Among the factors involved in selection of a barrier system are the types of vehicles using the roadway, the roadway geometry, and the potential severity of a median crossover crash. Standard barriers capable of redirecting passenger cars, light vans and trucks are considered cost effective for most situations. However, at locations with adverse geometrics, high traffic volumes and speeds, significant amounts of heavy truck traffic, or special environmental considerations, a higher performance median barrier may be more appropriate.

There are three basic categories of midpoint barriers.
Rigid barrier system
Semi-rigid barrier system
Flexible barrier system

Rigid barriers: Concrete barriers are the most common type of rigid median barrier in use today contributing to safer roads in America. While the initial cost of installation can be relatively high, concrete barriers are known for their relatively low life-cycle cost, and effective safety performance.

Semi-rigid barriers: Commonly referred to as guardrail or guide rail, semi-rigid barriers typically consist of connected segments of metal railing supported by posts and blocks. The semi-rigid barrier system is most suitable for use in traversable medians having a little change in grade and cross-slope. In comparison to rigid barriers, semi-rigid barriers can be less costly, but can be more difficult to install in areas with slope and poor soil conditions.

Cable barriers: A typical cable barrier consists of multiple steel cables that are connected to a series of posts. These systems are considered the most versatile and forgiving barrier systems available for reducing the severity of median crossover crashes. Cable median barriers minimize the forces on the vehicle and its occupants and absorb most of the energy during a crash. Cable barrier systems have a lower installation cost.

While no barrier can eliminate the consequences for every driver who runs off the road, cable median barrier is expected to reduce the number of vehicles that cross a median and enter oncoming traffic.

Brightness and Visibility of Signage and Markings

Driving at night or in adverse weather increases the risk of roadway crashes. Crash data bear out the importance of safety improvements targeted toward nighttime driving. While only 25 percent of travel occurs at night, more than half of traffic fatalities occur during nighttime hours. Almost 60 percent of all highway fatalities involve vehicles running off the road. While nighttime crashes are attributable to a wide variety of causes such as impaired driving, drowsiness, speed, etc., pavement markings with adequately maintained retroreflectivity help drivers navigate more safely on unfamiliar roads and through unexpected hazards. In addition to properly maintaining roadway markings and traffic signs, it is important that the materials used to manufacture these products be environmentally friendly.

Study participants were able to read and
understand brighter signs substantially
faster.
This study suggests that brighter
signs require less eyes-off-the-road time,

According to the Federal Highway Administration (FHWA) the rate of traffic fatalities is three times higher at night than during the day. One of the most important factors contributing to this tragic difference is night time drivers simply lack the visual cues they receive during daylight hours. A number of significant changes taking place on the nation’s roadways could make this situation even worse in the years ahead.

Older Drivers

The percentages of person’s aged 65 and older who are licensed drivers has increased from 61 percent in 1980 to 72 percent in 1990 and 80 percent in 2003. By 2020, people in this age group will represent one of every five licensed drivers, and the proportion is expected to increase to one in four by 2030.

As a group, older drivers tend to be relatively safe drivers with a substantially lower rate of crashes per licensed driver compared to drivers aged 16-24. On the other hand, highway safety data indicate clearly that older drivers are at a significantly higher risk of being injured or killed when crashes do occur. Compared with an overall fatality rate of 2.00 per 1, 000 crashes, persons aged 65 – 74 have a fatality rate of 3.2. The rate climbs to 5.3 for those aged 75-84 and at 85 and above, the rate is 8.6.

Congestion Mitigation

Traffic congestion, particularly in urban areas, contributes to a degradation of air quality, jeopardises safety, impedes efforts to conserve energy, reduces productivity and results in delays that affect our standard of living and quality of life. Its adverse effects on our national economy are estimated to cost us over $75 billion annually.

TRIP, a non-profit organisation is backed by corporations involved in the engineering of freeways as well as obtaining financial assistance from insurance companies, the manufacturers of equipment, distributors and suppliers that provide information endorsing policies which lessen traffic jams and improve other conditions such as the state of roads and overpasses, and thereby contribute to the safety of road transportation, resulting in economic abundance and safer roads in America.

Safer Roads in America (Part 1 of 2)

A vision of safer roads in America with zero deaths brings multiple agencies and organizations together to create a “toolbox” to address safety issues using the concept of the “4 E’s” of safety. (engineering, education, enforcement and emergency medical services).

Over the years, The American Traffic Safety Services Association (ATSSA) has shown that the installation or upgrade of roadway safety features can provide immediate and substantial safety benefits which will contribute to safer roads in America.
Examples are:

  • In Mendocino County, California, the number of crashes plummeted 42 percent while fatalities fell 61 percent following aggressive sign installation programs. The total program cost $79,260 however accident cost savings were over $12 million.
  • The City of Redmond, Washington installed 13 in-street pedestrian crossing signs at crosswalks on roadways with speeds at or under 30 mph. Before the sign installation, driver-stopping compliance ranged from 19 – 67 percent. After installation, the conformity ratio ranged from 68 – 98 percent.

In 2005, Americans traveled almost 3 billion miles. People speed, talk on cell phones, eat and even read while driving. ATSSA worked closely with Congress and the Administration to make roadway safety a key feature in the legislation:

The issues are:

  1. Highway Safety Improvement (HSIP)
  2. Strategic Highway Safety Plans
  3. Work Zone Safety
  4. High-risk Rural Roads
  5. Roadway Hardware
  6. Brightness and visibility of signage and markings
  7. Older drivers
  8. Congestion mitigation
  9. Funding Roadway safety
  10. Funding the Highway Trust Fund

Additional recommendations from the study were:

Highway Safety Improvement Program (HSIP)

The focal point should be on effective low-cost roadway safety improvements:

  1. Intersection safety improvements.
  2. Providing it does not affect the safety or mobility of bicyclists, pedestrians and the disabled, rumble strips or other warning device should be installed.
  3. Safety devices which are for the benefit of pedestrians, bicyclists and the disabled.
  4. The elimination of hazards at railway-highway crossings.
  5. Construction of a traffic calming feature.
  6. Elimination of a roadside obstacle or the shielding thereof, if it cannot be removed.
  7. Improvement of highway signage and pavement markings.
  8. Installation of a priority control system for emergency vehicles at signalized intersections.
  9. Installation of a traffic control or other warning device at a location with high accident potential.
  10. Safety – conscious planning.
  11. Improvement in the collection and analysis of crash data.
  12. Operational or traffic enforcement activities relating to work zone safety.
  13. Installation of guardrails, barriers and crash attenuators
  14. Installation of barriers between construction work zones and traffic lanes for the safety of motorists and workers.
  15. The addition or retrofitting of structures to eliminate or reduce accidents involving vehicles and wildlife.
  16. Installation and maintenance of signs (including Fluorescent Yellow-Green signs) at pedestrian level crossings and in school zones.
  17. Projects and activities eligible for funding under the HRRR program (High Risk Rural Roads program)
  18. Installation of a skid-resistant surface at an intersection, horizontal curve, or other location with a high frequency of accidents.
  19. Roadway safety training for traffic control technicians, traffic control supervisors, pavement marking technicians and supervisors and inspectors and guardrail installation supervisors and inspectors.

Strategic Highway Safety Plans

The U. S. Road Assessment Program (usRAP) provides a new approach to organising highway safety information. The primary tool for the usRAP is the “Risk Map”. These maps illustrate the safety performance. usRAP has established a risk mapping protocol to help highway agencies understand variations in the level of crash risk across their road network. usRAP risk maps help users see which roads have the highest and lowest risk of fatal and serious injury crashes and can provide a useful tool to help highway agencies in setting safety improvement priorities.

Work Zone Safety

With many highways and bridges at or near end of their useful life, system preservation (resurfacing, restoration, rehabilitation, reconstruction) has become critical and roadway work zones are likely to be more prevalent in the future. Work zones impact the safety and mobility of the travelling public, businesses, highway workers and transportation agencies. Unsafe work zones can result in the loss of life, the loss of productivity and a growing frustration on the part of the motoring public.

Maintenance and reconstruction activities on our nation’s highways are increasingly taking place while traffic is being maintained and at night. This results in an increased risk of injury or death for highway workers who already suffer a fatality rate that is more than double that of other construction workers.

Whether it is dealing with hazards as common as working within inches of motorists travelling at high speeds or as rare as finding what could be a pipe bomb, perhaps no occupational setting has more diverse and complex set of perilous situations than highway work zones.

High Risk Rural Roads

Rural roads are the most dangerous roads in America. NHTSA reports that nationwide, for the years 2000 through 2007, rural traffic fatality rates were more than twice that of urban areas. According to the FHWA, crashes on rural roads tend to be more severe for a number of reasons:

Rural collectors and local roads tend to lack features such as paved shoulders, clear zones and divided directions of travel. Rural roads tend to have higher average vehicle speeds, partially due to relatively low volumes. Data indicates there is typically more alcohol involvement in fatal crashes, and, in addition, rural areas have lower safety belt usage. When a crash does occur, medical facilities tend to be at greater distances and, as a result, crash victims have longer wait times for medical treatment.

NHTSA reported that in 2009, among all crashes that occurred on rural roadways, 80.6% of them were run-off-the-road crashes. Contributing factors include curved roads, high speed limit roads, fewer lanes, young drivers, speeding, alcohol use, driver performance related factors (sleepiness, inattentiveness, over-correction, crash-avoiding), and adverse weather conditions.

Edge drop-offs on High Risk Rural Roads

An estimated 11,000 Americans suffer injuries and 160 die each year in crashes related to unsafe pavement edges, at a cost of $1.2 billion. An edge drop-off of four or more inches is considered unsafe if the roadway is at a 90 degree angle to the shoulder surface. Near vertical edge drop-offs of less than four inches are still considered a safety hazard to the driving public and may cause difficulty upon re-entry to the paved surface. A low cost countermeasure to improve edge drop-offs is high visibility striping with raised profile that give audible alerts to errant drivers while also improving wet and/or night visibility which will contribute to safer roads in America.

Highway Safety Part 2

Large Trucks:

About 1 in 10 highway deaths occur in a crash involving a large truck. Large trucks often weigh 20-30 times as much as passenger vehicles. They are taller and have greater ground clearance than cars, which means that lower-riding vehicles can slide beneath truck trailers, with deadly consequences.

Rear underride guards are supposed to stop this from happening but the Insurance Institute for Highway Safety research shows that guards meeting federal safety standards can fail in relatively low-speed crashes. IIHS has petitioned regulators to require underride guards that are strong enough to remain in place during a crash and to broaden rules to mandate guards for more large trucks and trailers.

Low – and medium-speed vehicles:

Low-speed vehicles are not designed to protect their occupants in crashes. Although LSVs must be equipped with basic features like lights, mirrors and safety belts, they are exempt from most federal motor vehicle safety standards, and they do not have to meet any criteria for vehicle crashworthiness. They are not required to have airbags or other safety features beyond belts, since they are intended for short trips in residential neighbourhoods and other low risk driving situations.

Most states allows LSVs on certain roads, usually those with 35 mph or lower speed limits. The National Highway Traffic Safety Administration (NHTSA) defines appropriate performance and safety standards for LSVs but has no say in where LSVs are driven. The same goes for mini trucks, which are legal to operate on some roads in 16 states, even though they were not designed to meet U. S. Safety or Emission Standards.

The federal government does not recognize medium-speed vehicles as a vehicle class. NHTSA in 2008 denied petitions to create a new medium-speed vehicle (MSV) class. The agency said that unlike LSVs, MSVs travel in higher-risk traffic situations and should comply with all of the safety standards set for passenger cars. Despite the agency’s decision not to recognize MSVs, nine states allow them on certain roads with 35-55 mph or lower speed limits.

Motorcycles:

Riding a motorcycle is inherently riskier than driving a car. Maintaining control is harder on two wheels than on four and when crashes occur, motorcyclists are at a greater risk of serious injury or death because they do not have an enclosed vehicle to protect them. Although motorcyclist deaths have fallen from the 2008 peak of more than 5, 000, the 4, 667 that occurred in 2012 were still more than double the number from 1997.

A crash helmet of an approved design is obligatory for all motorcycle riders and passengers in some 20 states. In most other states, helmets must be worn by riders under 18 or 19. Three states currently have no helmet laws in place (Colorado, Illinois and Iowa), although this is subject to change. In Delaware, all riders must carry helmets, but only those under 19 are required to wear them.

Rhode Island requires only passengers to wear a helmet. Moped riders must wear helmets in around 20 states, half of which require only those of a certain age to them, e. g. 16 to 19.

Many bikers are vehemently opposed to wearing helmets and argue that they have a right to kill themselves, although when they are injured it is often the state that has to pick up the bill. In many states, you are also required to wear goggles if a windscreen (windshield) is not fitted to your bike.
In general, motorcycles registered for use on public highways must meet the equipment requirements in the state in which they are registered, in addition to federal safety standards. Only bikes over 50cc are permitted to use interstate or limited access highways. In many states, motorcyclists are required to use headlights at all times.

Riding between lanes of traffic is prohibited in all states and riding two (or more) abreast is also prohibited in some states.

Pedestrians and Cyclists:

Traffic engineering improvements can reduce pedestrian crashes. Separating vehicles and pedestrians by installing sidewalks, overpasses and underpasses can help reduce conflicts. Other solutions include building median refuge islands and adjusting traffic signals to create an exclusive pedestrian phase or to give pedestrians a head start before vehicles get a green light.

Red Light Running:

Camera enforcement works to curb this dangerous behaviour. Red light cameras are an effective way to discourage red light running. Enforcement is the best way to get people to comply with any law, but it is impossible for police to be at every intersection. Cameras can fill the void. An institute study comparing large cities with red light cameras to those without, found the devices reduced the fatal red light running crash rate by 24 percent and the rate of all types of fatal crashes at signalized intersections by 17 percent.

A 2005 study by the U. S. Federal Highway Administration (FHWA) suggests red light cameras reduce dangerous right-angle crashes. This study also found there can be an increase in the number of rear-end collisions, leading to the total number of collisions remaining unchanged.

There are various groups and individuals, such as the National Motorists Association, who oppose red light cameras on the grounds that the use of these devices raises legal issues and violates the privacy of citizens. They also argue that the use of red light cameras does not increase safety.

Roundabouts:

Roundabouts are a safer alternative to traffic signals and stop signs. The tight circle of a roundabout forces drivers to slow down, and the most severe types of intersection crashes, namely right-angle, left-turn and head-on collisions are unlikely. Roundabouts improve traffic flow and are better for the environment. Research shows that traffic flow improves following conversion of traditional intersections to roundabouts. Less idling, in turn, reduces vehicle emissions and fuel consumption.

Roundabouts generally are safer for pedestrians. Pedestrians walk on sidewalks around the perimeter and cross only one direction of traffic at a time. Crossing distances are relatively short, and traffic speeds are lower than at traditional intersections.

Surveys have shown that the damage incurred in roundabout crashes was significantly reduced. The increased safety levels in roundabouts can be attributed to:

Yield-at-entry operation.
Fewer conflict points. Standard four-way intersections have 32 conflict points versus 8 in a roundabout.
Central and splitter islands reduce the number of conflict points.

Highway Safety Part 1

The number of people killed in motor vehicle crashes has been falling, according to a report by The National Highway Safety Administration in the United States. The annual tolls for 2010, 2011 and 2012 were the lowest recorded since 1975, when the U. S. Department of Transportation began collecting detailed fatality data.

Airbags:

Airbags are one of the most important safety innovations of recent decades. The devices are normally hidden from view but inflate instantly when a crash begins. Thanks to the advocacy of IIHS and others, frontal airbags have been required in all new passenger vehicles since the 1999 model year. Side airbags are not specifically mandated, but nearly all manufacturers include them as standard equipment in order to meet federal side protection requirements.

Frontal airbags reduce driver fatalities in frontal crashes by 29 percent and fatalities of front-seat passengers age 13 and older by 32 percent. Side airbags that protect the head reduce a car driver’s risk of death in driver-side crashes by 37 percent and an SUV driver’s risk by 52 percent.

Some vehicles now have rear-window curtain airbags to protect people in back seats or front-center airbags to keep drivers and front-seat passengers from hitting each other in a crash. There are also inflatable safety belts aimed at reducing rear-seat injuries.

Researchers have determined that the risk zone for driver airbags is the first 2 to 3 inches of inflation. So, placing yourself 10 inches from your driver airbag gives you a clear margin of safety. Measure this distance from the center of the steering wheel to your breastbone. The rules for children are different. An airbag can seriously injure an unbuckled child who is sitting too close to it or is thrown toward the dash during emergency braking.

Alcohol-impaired driving:

About a third of all drivers who die in road accidents in the U. S. have blood alcohol levels of 0.08 percent or more. Approximately 7, 000 deaths could have been prevented in 2012 if all drivers were below the legal limit. The key to reducing alcohol related driving and therefore promoting highway safety is disincentive. Preventative steps include:

Administrative licence suspension: In most states, this allows the police to deprive a person of his/her licence who fails or refuses to be tested for alcohol levels.

Sobriety checkpoints: Checkpoints which have been upheld by the U. S. Supreme Court, although not always resulting in arrests, do serve as a deterrent to driving under the influence of alcohol.

Minimum drinking age of 21: Setting 21 as the minimum legal age for buying alcohol has helped to reduce drunk driving among teenagers.

Alcohol interlocks: An ignition interlock device is a mechanism installed on a motor vehicle’s dashboard. Should the driver’s breath sample not meet minimum alcohol guidelines, there is an interruption in the signal from the ignition to the starter. Many states require these devices for people with previous records of dui convictions.

Bumpers:

Bumpers are supposed to limit damage in minor collisions, but many are ineffective. The Insurance Institute for Highway Safety has a bumper test evaluation program to assess how well bumpers resist damage in fender benders. Better bumpers mean less out-of-pocket costs for consumers and lower insurance costs.

Child Safety:

Children are much safer in vehicle accidents than they used to be. Appropriate child safety seats provide significantly more protection in an auto accident than safety belts alone.
All infants and toddlers should ride rear-facing until they are 2 years old or until they reach the height and weight limit of their child restraints.
Once they outgrow rear-facing restraints, children should ride in harness-equipped forward-facing restraints for as long as possible, up to the height and weight limit of the child restraint. Top tethers should be used whenever a child restraint is installed forward-facing.
When children outgrow child restraints, they should use belt-positioning booster seats until adult safety belts fit properly.

U.S. Regulators plan to require automakers to equip new cars and trucks with technology that allows vehicles to communicate with each other to avoid crashes. Transportation Secretary Anthony Foxx sent a signal to the auto industry that the Obama administration is intent on pushing ahead with so-called vehicle-to-vehicle crash avoidance systems.

Currently many new vehicles offer advanced crash avoidance features. These include front crash prevention, lane departure warning, blind spot detection, adaptive headlights and park assist and backover prevention.

Distracted driving:

Regulatory laws in the United States have placed numerous restrictions on cell phone use by drivers. Individual States have jurisdictional discretion over the use of cell phones and other hand-held devices used by drivers on their roads.

The laws regulating driving may be subject to primary enforcement or secondary enforcement by state, country or local authorities. All state-level cell phone use laws in the United States are of the primary enforcement type, meaning an officer may cite a driver for a cell phone use violation if the driver has committed another primary violation (such as speeding, failure to stop, etc.,) at the same time.

A federal transportation funding law passed in July 2012 known as the Moving Ahead for Progress in the 21st Century Act provided $17.5 million in grants during fiscal year 2013 for states with primary enforcement laws against distracted driving, including laws prohibiting cell phone use while driving. States with secondary enforcement laws or no laws at all are ineligible to receive this grant funding.

Event Data Recorders:

An event data recorder, or EDR, collects information from a vehicle just before and during most serious crashes. Crash investigators can download data from the EDR’s memory to help them better understand what happened to the vehicle and how the safety systems performed, and in some cases, help determine who’s at fault in the crash. Most EDRs are built into a vehicle’s airbag control module and record information about airbags deployment, vehicle speed, engine throttle and driver safety belt use.

EDRs are not required by law, but many vehicles have them. In December of 2012, the National Highway Safety Administration proposed a rule requiring the devices in all 2015 and later models. An estimated 92 percent of new passenger vehicles already have them. Under an earlier rule, EDRs in 2013 and later models must record specific data in a standard format to make the retrieving of information easier.

ObamaCare

ObamaCare, officially called the Protection and Affordable Care Act, is a health care reform law signed in 2010 By President Barack Obama. Many of the law’s provisions are already in effect and rest continue to roll out until 2022. Important provisions include a mandate for most Americans to have insurance by 2014 and the opening of health insurance marketplaces for subsidized insurance.

The Affordable Care Act (ObamaCare) increases the quality, accessibility and affordabiity of health insurance. In exchange most people, who can afford to, must obtain health coverage by 2014 or pay a per month fee. The law eliminates pre-existing conditions, stops insurance companies from dropping you when you are sick, protects against gender discrimination, expands free preventative services and health benefits, expands Medicaid and CHIP, improves Medicare, mandates larger employers insure employees, creates a marketplace for subsidised insurance providing tens of million individuals, families and small businesses with free or low cost health insurance, and decreases healthcare spending and the deficit.
This is what is in effect now:-

ObamaCare does not create health insurance, it regulates the health insurance industry and helps to increase quality, affordability and availability of private insurance.

Most people who currently have health insurance can keep it.

Young adults can stay on their parent’s plan until the age of 26.

If you do not have coverage, you can use the new Health Insurance Marketplace to buy a private insurance plan.

If you do not have coverage, you can use the new Health Insurance Marketplace to buy a private insurance plan.

Open enrollment in the Health Insurance Marketplace goes from October 1st 2013 to March 2014.

If you do not obtain coverage or an exemption by January 1st 2014, you must pay a per-month fee on your federal income tax return for every month you are without health insurance……….however,

Due to a coverage gap exemption that applies to all Americans (you can go without insurance for up to 3 months in a row in 2014) you will need to have insurance by April 1st 2014 to avoid the per-month fee.

Insurance purchased by the 15th of each month will start on the first of the next month. In other words, you will need to enroll in an marketplace plan before March 15th, 2014.

In 2014 the fee is $95 per adult ($47.50 per child) or 1% of income, whichever is the higher. The family maximum is $285.

The cost of your marketplace health insurance works on a sliding scale. Those who make less, pay less.

Americans making less than $45, 960 as individuals, or $94, 200 as a family of 4 may be eligible for premium tax credits through the marketplace. Tax credits subsidize insurance premium costs.

If you are able to get qualified health insurance through your employer you will not be able to receive marketplace tax credits unless the employer does not cover at least 60% of your premium cost, does not provide quality insurance or provides insurance that exceeds 9.5% of your family income.
Up to 82% of nearly 16 million uninsured young U. S. adults will qualify for federal subsidies or Medicaid through the marketplace.

You do not have to use the marketplace to buy insurance, but you should fill out an application to see if you qualify for assistance before shopping for insurance outside of the marketplace.

The ACA does away with pre-existing conditions and gender discrimination so these factors will no longer affect the cost of your insurance on or off the marketplace.

You cannot be denied health coverage based on health states.

You cannot be dropped from coverage when you are sick.

Health insurers cannot place lifetime limits on your coverage. As of 2014 annual limits are eliminated as well.

All new plans sold on an off the marketplace must include a wide range of new benefits including wellness visits and preventative tests and treatments at no additional out-of-pocket cost.

All full-time workers who work for companies with over 50 employees must be offered job based health coverage by 2015. Employers who do not offer coverage will pay a per-employee fee.

Small businesses with under 50 full-time employees can use a part of the marketplace called the SHOP (small business health options program) to purchase group health plans for their employees.

Small businesses with under 25 full-time employees can use the marketplace to purchase subsidised insurance for their employees.

Medicare is not part of the marketplace. If you have Medicare, keep it.

When you apply for the marketplace you will find out if you qualify for free or low cost coverage from Medicaid or the Childrens’ Health Insurance Program (CHIP). You will be made aware if you qualify for Medicare.

As from 1/1/2015

Doctors’ pay will be determined by the quality of their care, not how many people they treat.

As from 1/1/2017

If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers.)

2018

All health care plans must now cover preventative care (not just the new ones).

A new tax on “Cadillac” health care plans (more expensive plans for rich people who want fancier coverage).

2020

The elimination of the “Medicare gap”.

Among the people who will remain uninsured: –

Illegal immigrants (about 8 million). They will also be exempt from the health insurance mandate but will remain eligible for emergency services under provisions in the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA).

Citizens not enrolled in Medicaid despite being eligible.

Citizens not otherwise covered and opting to pay the annual penalty instead of purchasing insurance, mostly younger and single Americans.

Citizens whose insurance coverage would cost more than 8% of household income and are exempt from paying the annual penalty.

Citizens who live in states that opt out of the Medicaid expansion and who qualify for neither existing Medicaid coverage nor subsidised coverage through the states’ new insurance exchange.