Transcript 2010: A November Surprise

Washington Update
Western Reserve Chapter, AAHAM
NE Ohio HFMA Chapter
February 21, 2013
How Government Really Works
Throw out all preconceived notions you have about
government and how it is “supposed” to work.
In reality, it works nothing like what you learned in
school or read about in books.
Welcome to Washington
“One doesn’t have to spend much
time in DC to understand why the
streets are designed in circles.”
–Ronald Reagan
“The Problem with political jokes is
they have a habit of getting
elected.”
-Henry Cate
1357
622
Can anyone tell me what these numbers represent?
1357 Days Until the 2016
Presidential Elections
622 Days Until the 2014
Congressional Elections
Before We Look Forward We Have to Do A Painful look
Back At 2012
Where Republicans Started
You will see some of these faces again as they once again
run for President in 2016
This is where we Ended
2012 Presidential Election Votes by Demographic
2012 Congressional Elections
51 Seats Needed For Majority
Senate: New Make-up
•
•
Democrats: 53
Republicans: 45
Independents: 2
•
Quick Takeaways
While GOP remains the
minority, retains
filibuster power
Expect GOP soulsearching after failure to
knock down 2006 Dem
Senators
Sens.-elect Joe Donnelly
of IN, Ted Cruz of TX,
and Elizabeth Warren of
MA may be brightest
stars in new Senate
(Really Democratic Seats – Sen. Angus King (ME) and Sen. Bernie Sanders (VT))
2014: Democrats have to defend 20 seats
Republicans have to defend 13
2012 Congressional Elections
House of Representatives: New Make-up
Democrats: 201
Republicans: 231
2013 A Look Forward
2013 A Look Forward
60 Minutes Interview
President Obama suggests joint appearance on 60 Minutes with
outgoing Secretary of State Hilary Clinton.
Looks like 2016 endorsement to me.
Biden can’t catch a break.
Then Obama supporters pay-off Clinton remaining debt from 2008 campaign
2013: A look Forward
The Filibuster
political delaying tactic: a tactic used to delay or prevent the passage of
legislation, e.g. a long irrelevant speech
Crisis averted when, shocking, Senate overwhelmingly approved new Filibuster
rules, which look like the old one’s.
2013: A look Forward
Gun Control
- President pushes for new reforms
- Democrats uneasy about Presidents plans
- Republicans opposed to Presidents plans
- Public open to reform
- NRA likely to prevail yet again
- Best gun control advocates can hope for is universal background checks and
closing gun show loophole and maybe limiting magazine size
Just when you think you get Congress to focus on fiscal issues
shooting takes them off focus
2013: A look Forward
Presidents 2nd Term Agenda
- Climate change
- gun control
- Immigration reform
- Equal pay for women
- Voting Reform
- Gay rights
- Debt (the one issue not addressed in the President’s inaugural
address)
2013: A look Forward
Had we gone off the fiscal cliff we would have defaulted on our
debt loans and would have likely seen another downgrade of our
overall debt making the US on par with other third world nation’s
2013: A look Forward
Fiscal Cliff
- There are some who say going over the “fiscal cliff” would have
had serious consequences
- Others say it wouldn’t have done much since this was a self
imposed “cliff”
- Both political parties spent a lot of time calculating the political
ups and downs to going over the cliff
- "Crisis" ultimately avoided (temporarily)
Fiscal Cliff "Deal"
-- Income tax rates: Extends decade-old tax cuts on incomes up to $400,000 for individuals, $450,000
for couples. Earnings above those amounts would be taxed at a rate of 39.6 percent, up from the
current 35 percent. Extends Clinton-era caps on itemized deductions and the phase-out of the
personal exemption for individuals making more than $250,000 and couples earning more than
$300,000.
-- Estate tax: Estates would be taxed at a top rate of 40 percent, with the first $5 million in value
exempted for individual estates and $10 million for family estates. In 2012, such estates were subject
to a top rate of 35 percent.
-- Capital gains, dividends: Taxes on capital gains and dividend income exceeding $400,000 for
individuals and $450,000 for families would increase from 15 percent to 20 percent.
-- Alternative minimum tax: Permanently addresses the alternative minimum tax and indexes it for
inflation to prevent nearly 30 million middle- and upper-middle-income taxpayers from being hit with
higher tax bills averaging almost $3,000. The tax was originally designed to ensure that the wealthy
did not avoid owing taxes by using loopholes.
Fiscal Cliff "Deal"
-- Other tax changes: Extends for five years Obama-sought expansions of the child tax credit, the
earned income tax credit, and an up-to-$2,500 tax credit for college tuition. Also extends for one year
accelerated "bonus" depreciation of business investments in new property and equipment, a tax
credit for research and development costs and a tax credit for renewable energy such as windgenerated electricity.
-- Unemployment benefits: Extends jobless benefits for the long-term unemployed for one year.
-- Cuts in Medicare reimbursements to doctors: Blocks a 27 percent cut in Medicare payments to
doctors for one year. The cut is the product of an obsolete 1997 budget formula.
-- Social Security payroll tax cut: Allows a 2-percentage-point cut in the payroll tax first enacted two
years ago to lapse, which restores the payroll tax to 6.2 percent.
-- Across-the-board cuts: Delays for two months $109 billion worth of across-the-board spending
cuts set to start striking the Pentagon and domestic agencies this week. Cost of $24 billion is divided
between spending cuts and new revenues from rule changes on converting traditional individual
retirement accounts into Roth IRAs.
Debt Ceiling
- The maximum amount of monies the United States can borrow. The debt ceiling was created under
the Second Liberty Bond Act of 1917, putting a "ceiling" on the amount of bonds the United States
can issue. As of the end of July, 2011 the debt ceiling was set at $14.3 trillion.
- Funny or not so funny thing with the debt ceiling is no one is sure what would actually happen
should we default.
- A three month deal was struck in Congress.
- Also includes provision suspending lawmakers pay if they don’t pass a budget by April (nice add, but
unconstitutional).
- 27th Amendment, which states: "No law, varying the compensation for the services of the Senators
and Representatives, shall take effect, until an election of Representatives shall have intervened."
- This was Republican’s efforts to force Senate Democrats to put forward a budget. Senate has not
passed a budget in 4-years.
2013: A look Forward
Sequestration
* The debt limit deal enacted on August 2 calls for about $900 billion in cuts in
discretionary programs over the next decade and would impose further automatic,
across-the-board spending cuts in many programs if Congress fails to enact an additional
$1.2 trillion in deficit-reduction measures by January 15, 2012.
* Those across-the-board cuts would first take effect in January 2013, a year later than
many people have mistakenly believed, and would represent approximately a 9 percent
annual cut in affected non-defense programs, along with roughly a 9 percent cut in
defense programs in 2013.
SEQUESTRATION
- On Aug. 2, President Obama signed into law the Budget Control Act of 2011 (BCA).
- The bill allows the president to increase the debt ceiling by up to $2.8 trillion, but it will
reduce the deficit by $2.3 trillion over 10 years, with at least $840 billion coming from
discretionary spending cuts over the next decade. In the first year of enactment, fiscal
year 2012, discretionary programs will see a cut of $44 billion (4 percent).
- There are two ways the federal deficit can be cut – through automatic “caps” on
categories of spending or through a proposed budget hammered out by a “Super
Committee” of 12 members of Congress.
- The automatic caps exempt some mandatory programs like Social Security, food stamps,
and Medicare. However, no revenues would be raised to help retire the deficit. The Super
Committee could cut any program or raise revenues.
2013: A look Forward
Sequestration
- President would like to do away with Sequestration
- Other Democrats would like to push Sequestration
back another 3-months
- Republicans now re-thinking letting Sequestration go into effect
- Speaker Boehner looking for a way out
2013: A look Forward
What Does This Mean for Healthcare?
* Repealing "Obama Care" not realistic from the beginning and not
now that the President has been re-elected.
* What is possible and likely are changes, tweaks, and
modifications to the law.
* All sides have signaled the need to make "modifications."
Healthcare: Still a lot of provisions from the Patient Protection & Affordable Care Act
kick in in 2014.
* Guidelines for Federally mandated exchange officially out Feb 1 Federal Register Notice.
* Exchanges need to be implemented by states. As of today fewer than 15 states have
built or implemented their own plans. 25 States declined to set-up and 18 that will and 7 pursuing
partnership exchange.
Employer Requirements:
The U.S. Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) released on January 30, 2013, two
proposed rules and a final rule relating to the Affordable Care Act's (ACA) requirement that individuals maintain "minimum essential
coverage" (MEC) or be subject to a "shared responsibility" payment.
IRS Final Rule: The IRS issued final regulations in May 2012 addressing eligibility for the health insurance premium tax credit, which is
available to certain low-income individuals purchasing a qualified health plan on a health insurance exchange. The January 30, 2013
final rule supplements these regulations by finalizing the requirement that "affordability" of coverage available for the employee under
an employer-sponsored group health plan is determined based on self-only coverage (and not family coverage).
http://www.mwe.com/files/Uploads/Documents/Pubs/IRS-FR-02-01-2013.pdf
IRS Proposed Rule: The proposed rule addresses (1) the obligation each taxpayer has to make a "shared responsibility payment" for
himself, herself and any dependents who, for a calendar month, do not have MEC, and (2) exemptions to this payment obligation. The
limited exceptions for this payment obligation include individuals who lack access to affordable MEC. The proposed rule addresses the
difference in determining affordable MEC for an employee eligible for coverage under a group health plan (as described above) versus
affordability for a "related individual." A "related individual" is one for whom an Internal Revenue Code Section 151 deduction can be
claimed. http://www.mwe.com/files/Uploads/Documents/Pubs/IRS-PR-02-01-2013.pdf
HHS Proposed Rule: The HHS proposed rule sets forth standards and processes by which a health insurance exchange will make
eligibility determinations and grant exemptions from the shared responsibility payment. This proposed rule also (1) identifies certain
types of coverage deemed to be MEC , and (2) sets forth standards by which HHS may designate certain health benefits coverage as
MEC. http://www.mwe.com/files/Uploads/Documents/Pubs/HHS-PR-02-01-2013.pdf
Medicaid Expansion:
Just how expensive would this expansion be, and who would pay?
* For the first three years starting in 2014, the federal government will cover 100 percent
of the cost for states’ Medicaid expansion, while dwindling down that percentage to 90
percent within the decade, leaving states accountable for 10 percent of the cost.
* Through 2022, the expansion will increase states’ spending by 2.8 percent compared to
what they would be spending without it.
* Governor John Kasich (R) has agreed to expand Medicaid in Ohio
* A lot of Republican Governor’s came out against expansion, but now have come out in
support. (Funny how 2013-2014 elections have that affect on people).
*Medicaid rules on expansion and provider payments just released:
http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html
DOC FIX:
* Always been a dance we do in Washington – temporarily fix it each year
* This year be different. Efforts to permanently address this issue
* This year may be opportunity to finally fix this issue
* Rep. Allyson Schwartz (D-PA) and Rep. Joe Heck (R-NV) introduce bi-partisan legislation
to address permanent fix
* This is only possible due to recent Congressional Budget Office cutting the original cost
of this issue ($243.7 billion) in half ($138.3 billion)
* Other bills being floated so Schwartz-Heck legislation may not be final vehicle, but with
new scoring number for the first time a real discussion about permanently addressing
this issue
2013: A look Forward
* Independent Payment Advisory Board: Top priority to be on the chopping block –
concern this will lead to "rationing" of healthcare and undermine congressional authority over
Medicare payment policy.
* CLASS ACT: Created a federally administered long-term care insurance plan. HHS
declined to implement in 2012 ruling that it was impossible to create a program in a
manner that would be actuarially sound. (OFFICIALLY DEAD – REPUBLICANS CLAIM VICTORY)
* Individual Mandate: Republicans believe pushing to continue to repeal has political
benefit, but numbers have shown it does save government money. Supreme Court did
rule it constitutional.
* Medical Device Tax: This is a revenue tax on device Mfgs. Critics on both sides say this
is an assault on small businesses.
* FSA & HSA Limits: Law placed caps on how much money can be set aside pretax in 2
kinds of health accounts. Opponents believe this cap discourages people from putting
away as much money for out-of-pocket medical expenses.
2013: A look Forward
* ACA allows insurance carriers to charge seniors 3 times more than young people for
premiums.
* New House bill HR 544 (The LIBERTY Act) allows insurance carriers to charge 5 times as
much.
http://gingrey.house.gov/news/documentsingle.aspx?DocumentID=319048
ACA Timeline - 2013
* Additional CHIP Funding: Under the new law, states will receive two more years of funding to
continue coverage for children not eligible for Medicaid.
*Improve Preventive Health Coverage: To expand the number of Americans receiving preventive
care, the law provides new funding to state Medicaid programs that choose to cover preventive
services for patients at little or no cost.
* Increase Medicaid payments to primary care doctors: As Medicaid programs and providers
prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less
than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is
fully funded by the federal government.
* Expand authority to bundle payments: The law establishes a national pilot program to encourage
hospitals, doctors, and other providers to work together to improve the coordination and quality of
patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an
episode of care rather than the current fragmented system where each service or test or bundles of
items or services are billed separately to Medicare.
ACA Timeline – 2014
* Establishing health insurance marketplace: Starting in 2014 if your employer doesn’t offer
insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and
small businesses can buy affordable and qualified health benefit plans in this new transparent and
competitive insurance marketplace.
* Promote Personal Responsibility: Under the new law, most individuals who can afford it will be
required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for
uninsured Americans.
* Increased access to Medicaid: States will receive 100% federal funding for the first three years to
support this expanded coverage, phasing to 90% federal funding in subsequent years.
* Makes care more affordable: Tax credits to help the middle class afford insurance will become
available for those with income between 100% and 400% of the poverty line who are not eligible for
other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an
individual or $88,000 for a family of four.)
ACA Timeline – 2014
* Eliminates limits on coverage: The law prohibits new plans and existing group plans from imposing
annual dollar limits on the amount of coverage an individual may receive.
* No discrimination over pre-existing conditions: The law implements strong reforms that prohibit
insurance companies from refusing to sell coverage or renew policies because of an individual’s preexisting conditions. Also, in the individual and small group market, it eliminates the ability of
insurance companies to charge higher rates due to gender or health status.
* Tax credit for small business: The law implements the second phase of the small business tax credit
for qualified small businesses and small non-profit organizations. In this phase, the credit is up to
50% of the employer’s contribution to provide health insurance for employees. There is also up to a
35% credit for small non-profit organizations.
ACA Timeline – 2015
* Doctor pay based on value not volume: A new provision will tie physician payments to
the quality of care they provide. Physicians will see their payments modified so that those
who provide higher value care will receive higher payments than those who provide
lower quality care.
Expect delays on some of these issues. Would expect all phases to be in place by 20172018.
Telephone Consumer Protection Act (TCPA)
Issue: More than one-third of Americans use a wireless device as their primary or only means of
communication, and that number continues to grow. As a result, the ability to make contact via
mobile phone is becoming increasingly crucial for businesses and the consumers they serve.
Unfortunately, the outdated Telephone Consumer Protection Act (TCPA) hinders informational calls
(about drug and other product recalls, fraud alerts, data breaches, flight delays, and other important
and time-sensitive information) from being made to mobile devices.
In the 112th Congress, an ad-hoc multi-industry coalition worked with Representatives Lee Terry (RNE) and Ed Towns (D-NY) to introduce the Mobile Informational Call Act, legislation that would have
modernized TCPA regulations regarding informational calls to mobile devices. Unfortunately, the
numerous negative news stories misrepresenting the bill's goals tainted the public's perception of the
Act and created such a toxic legislative environment that the bill's co-sponsors requested that their
legislation not move forward.
Telephone Consumer Protection Act (TCPA)
* LEGISLATIVE DAY IS CRITICAL
* April 3-4, 2013 in Washington, DC
* AN EVENT YOU CANNOT AFFORD TO MISS!!!!
* Contact Rep. Bob Latta (R-OH) – Vice Chairman of the Energy & Commerce Committee
We need your help and want to ask you to call or write Rep. Latta and ask him to take
the lead on modernizing the TCPA
Paul A. Miller
(703) 930-7790
[email protected]
www.mwcapitol.com