President Barack Obama signed into law on Tuesday the most sweeping overhaul in decades to the $2.5 trillion U.S. healthcare system.
The measure, which marked a major political victory for Obama, will bring tighter regulations to insurers and other players as well as some payment cuts -- but the industry could also see more than 30 million new customers.
Here are the winners and losers in both the legislation passed by Congress and signed by Obama on Tuesday and in a bill passed by the House of Representatives and pending in the Senate that would make some changes to bill signed by the president.
WINNERS
BRAND-NAME DRUGMAKERS
* The pharmaceutical industry keeps its $80 billion agreement to provide savings and rebates. Its fees, to be divided among companies such as Pfizer and Merck & Co, would be delayed from 2010 to 2011, starting at $2.5 billion next year and increasing to more than $4 billion by 2018. After 2019, the industry would pay $2.8 billion a year.
* Overall, wider insurance coverage could help offset the costs by providing more potential customers.
* Drugmakers warded off deeper price cuts in the Medicare government health insurance program for the elderly and disabled. The House had sought to fully close the so-called "doughnut hole" in which coverage drops temporarily after reaching a certain limit, but the bill maintains the industry's 50-percent discount. The government will pay for another 25-percent discount.
* Lawmakers rejected Obama's plan to end lucrative "pay-for-delay" settlements with brand-name drugmakers, a win for both generic and brand-name companies.
* It creates a stronger Independent Medicare Advisory Board to recommend payment changes that could impact medicine usage.
* The bill also discards an earlier provision that would have extended a hospital drug discount program.
BRAND BIOLOGIC DRUGMAKERS
* While the bill sets up a regulatory path for generic versions of expensive biologic drugs, Amgen and Roche's Genentech unit and other biological drugmakers won a 12-year period of exclusive sales for brand-name drugs before facing competition from generic rivals.
DEVICE MAKERS
* Fees for medical device makers, such as Boston Scientific and Medtronic, would be delayed to 2013 after initial bills called for 2010. The sector earlier won a reduced industry tax of $20 billion, down from $40 billion.
* Rather than an overall industry fee, last-minute changes to the bill converted it to a 2.3 percent sales tax except for certain retail products sold for individual use.
HOSPITALS
* Hospitals, which include companies such as Universal Health Services and Tenet Healthcare, say they kept a $155 billion, 10-year deal to accept lower government payments from Medicare and Medicaid in exchange for an expected boost in insured customers.
* A provision that could have helped certain hospitals with an expanded drug discount program was dropped.
* Hospitals are also exempted from the Independent Medicare Advisory Board, insulating them from future recommended payment cuts from the panel.
PHARMACY BENEFIT MANAGERS
* Analysts say increased Medicare drug coverage could boost pharmacy benefit managers (PBM) that administer prescription drug benefits as companies, such as Express Scripts and Medco Health Solutions, could see increased volumes.
* PBMs still face more disclosures but not new taxes. Companies must give the Department of Health and Human Services information about rebates from drugmakers for certain drugs.
HOSPICE
* Maintained its exemption from the Medicare board's oversight, a win for companies that provide care for the terminally ill such as Odyssey Healthcare.
OTHERS
* Earlier in the process, cosmetic product makers such as Allergan and Johnson & Johnson along with Coca-Cola, Pepsico and other makers of sugary drinks avoided taxes that could have curbed product use.
* Laboratory companies such as Quest Diagnostics and Laboratory Corporation of America Holdings also earlier avoided annual fees.
LOSERS
HEALTH INSURERS
* While health insurers overall still face tighter regulation, companies such as Aetna Inc, Cigna Corp, UnitedHealth Group Inc and WellPoint Inc saw their $67 billion, 10-year tax delayed until 2014.
* Private Medicare plans called Medicare Advantage would see their payments frozen in 2011, then lowered in 2012. The plans, which can offer more benefits than traditional Medicare coverage, would also have to spend at least 85 cents out of every dollar on medical costs -- leaving 15 cents toward overhead and salaries, among other things.
* Consumer protection rules would change the way companies do business, banning denial of coverage for preexisting medical conditions and ending lifetime coverage limits. Some curbs would be expanded to all health insurance plans six months after the bill passes, while others take effect in 2014.
* Insurance plans for large groups would have to spend at least 85 cents out of every dollar on medical costs -- leaving 15 cents toward overhead and salaries. Small group or individual plans would have to spend at least 80 cents per dollar on care. That proportion of spending, known as a "medical loss ratio," has varied widely and is closely watched by Wall Street due to its impact on profits.
* The bill changes penalties for individuals who do not buy health insurance as mandated. The fine is lowered from $495 to $325 in 2015 and from $750 to $695 in 2016, but the alternative method of fining people using a percentage of income increased slightly to 2.5 percent by 2016.
* The bill does not include President Barack Obama's call for federal oversight of health insurance rates. It also expands tax credits and other financing to help more people afford insurance.
* Lawmakers have said roughly 30 million Americans who currently have no health insurance could get it with the reform.
GENERIC DRUGMAKERS
* The 12-year period of exclusive brand-name sales of biologic drugs surpasses the 5-7 years proponents had sought.
* Overall, companies that make generic versions of brand-name drugs see little direct help, although increasing insurance access may help more people buy medicine.
* But the bill includes a 75-percent discount on generic drugs in Medicare, the same as on brand-name drugs. Companies were concerned that closing the Medicare "doughnut hole" would turn people away from cheaper, generic medicines.
TANNING BED MAKERS
* The bill keeps a 10-percent tax on consumers who use indoor tanning salons, seeking to raise $2.7 billion by 2019 while discouraging a practice that can cause skin cancer.