What Wonders Have They Wrought?

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What Wonders Have They Wrought?

• The Patient Protection and
• Affordable Care Act

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The Affordable Care and Patient Protection Act

• 2,409 pages
• 477,520 words
• Reconciliation Package
• 153 pages
• 34,000 words
• 13,000 Pages of Regulations

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Prepared by the Joint Economic Committee
Republicans
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Health Care After Reform
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5 Key Components

• Individual Mandate
• Employer Mandate
• Insurance Regulation
• Subsidies Medicaid Expansion
• Insurance Exchange

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How Much Will It Cost?
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Paying for PPACA

• New Taxes 1 Trillion
• Debt 1.48 Trillion

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1 Trillion in Taxes Under PPACA
The Law Imposes 19 New Taxes

1. Excise Tax on Charitable Hospitals
2. Black liquor tax hike, a tax on a type of
   biofuel
3. Tax on Innovator Drug Companies
4. Blue Cross/Blue Shield Tax Hike
5. Tax on Indoor Tanning Services
6. Codification of the economic substance doctrine
   This provision allows the IRS to disallow
   completely-legal tax deductions and other legal
   tax-minimizing plans
7. Medicine Cabinet Tax HSAs, FSAs and HRAs taxed
   when buying over the counter medicine
8. HSA Withdrawal Tax Hike
9. Surtax on Investment Income
10. Hike in Medicare Payroll Tax

1. Tax on Medical Device Manufacturers
2. High Medical Bills Tax
3. Flexible Spending Account Cap aka Special
   Needs Kids Tax
4. Elimination of tax deduction for
   employer-provided retirement Rx drug coverage in
   coordination with Medicare Part D
5. 500,000 Annual Executive Compensation Limit for
   Health Insurance Executives
6. Individual Mandate Excise Tax
7. Employer Mandate Tax
8. Tax on Health Insurers
9. Excise Tax on Comprehensive Health Insurance Plan

Source Americans for Tax Reform
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My Insurance Premium?

• Premiums Will Double in Next 6-10 Years
• Change as Result of PPACA
• Big Business No Change to 3 Savings
• Small Business No change to 1 Savings
• Individual Policy 10-13 Increase
• Young Healthy 17-95 Increase

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Does PPACA Ration Care?No Direct Rationing
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Independent Payment Advisory Board (IPAB)

• Starting in 2017
• Not a death panel
• Base Closing-Style Panel
• If Medicare spending exceeds GDP 1, IPAB must
  recommend cuts.
• Congress can reject recommendations in total. If
  Congress does not act, recommendations are
  implemented
• Cannot recommend cuts in benefits, increase
  out-of-pocket expenses or premiums, or restrict
  eligibility. Cannot cut hospital payments until
  2020. Whats left?

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Potential Problems

• No Judicial Review
• Physicians may stop accepting Medicare patients
• 15 percent of hospitals and nursing homes that
  provide Medicare services could become
  unprofitable over a decade, according to CMS

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Universal Coverage?
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Some PPACA Benefits

• Donut Hole closing
• Improved coverage for screening and preventive
  care
• Experiments in cost reduction ACOs, Medical
  Homes, P4P
• for community health centers

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Issues for North Carolina

• Should North Carolina Establish an Exchange?
• Should North Carolina Expand Medicaid?

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Status of Health Insurance Exchanges
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Status of Medicaid Expansion Decisions
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Medicaid Expansion in North Carolina
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PPACA Timeline
Enacted
2013
Begins Phasing in Subsidies to Close Medicare Part D 'Donut Hole'
Establishes Flexible Spending Account Limits
Medicare Part A Tax Increase
Tax on Medical Devices
Cuts in Medicare DSH Payments


2014
Expanded Medicaid Coverage
Health Insurance Exchanges
Individual Mandate
Employer Mandate
No Annual Limits on Coverage
Essential Health Benefits
New Fees on Health Insurance Sector
2017
IPAB
2018
New Tax on Comprehensive Insurance Plans
2010
Medicare Beneficiary Drug Rebate Medicare Beneficiary Drug Rebate Medicare Beneficiary Drug Rebate Medicare Beneficiary Drug Rebate
Dependent Coverage Extended to Age 26 Dependent Coverage Extended to Age 26 Dependent Coverage Extended to Age 26 Dependent Coverage Extended to Age 26
Health Plans Required to Cover Preventive Benefits Health Plans Required to Cover Preventive Benefits Health Plans Required to Cover Preventive Benefits Health Plans Required to Cover Preventive Benefits Health Plans Required to Cover Preventive Benefits Health Plans Required to Cover Preventive Benefits
2011
Minimum Medical Loss Ratio for Insurers Minimum Medical Loss Ratio for Insurers Minimum Medical Loss Ratio for Insurers Minimum Medical Loss Ratio for Insurers

Medicare Advantage Payment Reductions Medicare Advantage Payment Reductions Medicare Advantage Payment Reductions Medicare Advantage Payment Reductions Medicare Advantage Payment Reductions
Increased Medicare Premiums for High-Income Beneficiaries Increased Medicare Premiums for High-Income Beneficiaries Increased Medicare Premiums for High-Income Beneficiaries Increased Medicare Premiums for High-Income Beneficiaries Increased Medicare Premiums for High-Income Beneficiaries Increased Medicare Premiums for High-Income Beneficiaries
2012
New annual fees on pharmaceutical industry New annual fees on pharmaceutical industry New annual fees on pharmaceutical industry New annual fees on pharmaceutical industry New annual fees on pharmaceutical industry New annual fees on pharmaceutical industry
Medicare Value-Based Purchasing Medicare Value-Based Purchasing Medicare Value-Based Purchasing Medicare Value-Based Purchasing
Reduced Medicare Payments for Hospital Readmissions Reduced Medicare Payments for Hospital Readmissions Reduced Medicare Payments for Hospital Readmissions Reduced Medicare Payments for Hospital Readmissions Reduced Medicare Payments for Hospital Readmissions Reduced Medicare Payments for Hospital Readmissions
Pending