Those eligible to shop at the exchanges will include people whose employers don't offer affordable health coverage, and others who need to buy insurance on their own for some reason (such as, they're self-employed, or they're retired and not yet eligible for Medicare).
States are supposed to tell Washington by Dec. 14 whether they'll run their own exchanges, partner with the federal government, or not get involved, in which case Uncle Sam will set up and run insurance stores for them.
Whoever controls them, there's a lot of work to get ready for October 2013. That's when exchanges are supposed to open their (presumably online) doors and allow potential customers to check out their products and begin the selection process. Between now and then, exchange officials will have to sort and certify offerings from insurance providers, while building the information systems and electronic customer interfaces they'll need to conduct business.
Coverage purchased through exchanges is slated to take effect at the beginning of 2014.
Tax hikes. Whatever the outcome of current budget negotiations, taxes on the wealthy are certain to rise in at least one area. To help pay for the Affordable Care Act's expansion of coverage, the tax on wages for Medicare Part A (hospital insurance) will rise by just under 1 percent for individuals who make more than $200,000 and for married couples who earn more than $250,000.
The increase will put this payroll tax at 2.35 percent for folks in those income levels. It's scheduled to take effect on Jan. 1, 2013.
The Affordable Care Act also mandates a new 2.3 percent tax on "medical devices," set to begin on the same date. The Internal Revenue Service hasn't yet issued final regulations setting the boundaries for what this levy will hit, however. Among the issues here is whether things often sold to consumers as well as health-care professionals, such as latex gloves, will be subject to the new tax.