Here's some more of what we're in for

2009 • Medicare cuts to hospitals begin (long‐term care (7/1/09) and inpatient and rehabilitation facilities (FY10))
2010 • Provide income exclusion for specified Indian tribe health benefits provided after 3/23/10• Temporary high‐risk pool and high‐cost union retiree reinsurance ($5 B each for 3.5 years) (6/23/10)• Impose 10% tax on indoor UV tanning (7/1/10)• Medicare cuts to inpatient psych hospitals (7/1/10)• Prohibits lifetime and annual benefit for private insurers spending limits (plan years beginning 9/23/10)• Prohibits non‐group private insurance plans from canceling coverage (rescissions) (plan years beginning 9/23/10)• Requires private insurance plans to cover, at no charge, most preventive care (plan years beginning 9/23/10)• Requires private insurance plans to allow dependents to stay on parents’ policies through age 26 (plan yearsbeginning 9/23/10)• Hospitals in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare payments (FY11)
2011 • Hospitals in “low‐cost” areas receive higher Medicare payments for 2 yrs ($400 million, FY11)• Medicare Advantage cuts begin• No longer allowed to use FSA, HSA, HRA, Archer MSA distributions for over‐the-counter medicines• Medicare cuts to home health begin• Medicare cuts for wealthier seniors ($85k/$170k), who are forced to pay higher Part D premiums (not indexed for inflation in Parts B/D)• Medicare reimbursement cuts when seniors use diagnostic imaging like MRIs, CT scans, etc.• Medicare cuts begin to ambulance services, ASCs, diagnostic labs, and durablemedical equipment• Impose new annual tax on brand name pharmaceutical companies• Americans begin paying premiums for federal long‐term care insurance (the CLASS Act, which analysis indicates is a ticking fiscal time-bomb)• Private insurance plans required to spend a minimum of 80% of premiums on medical claims (where 65% is considered the maximum "safe" amount to cover claims). Prior experience at the state level will indisputably harm private health insurance business.• Physicians in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare payments• Prohibition on Medicare payments to new physician‐owned hospitals (which will dramatically reduce access to senior care)• Penalties for non‐qualified HSA and Archer MSA distributions double (to 20%)• Seniors prohibited from purchasing power wheelchairs unless they first rent for 13 months• New Medicare cuts to long‐term care hospitals begin (7/1/11)• Additional Medicare cuts to hospitals and cuts to nursing homes and inpatient rehab facilities begin (FY12)• New taxes on all private health insurance policies to pay for comparative effectivness research (planyears beginning FY12)
2012 • Medicare cuts to dialysis treatment begins• Medicare to cut spending by using an HMO‐like coordinated care model (Accountable Care Organizations)• New Medicare cuts to inpatient psych hospitals (7/1/12)• Medicare cuts to hospitals with high readmission rates begin (FY13)• Medicare cuts to hospice begin (FY13)
2013 • Impose $2,500 annual cap on FSA contributions (indexed to CPI)• Increase Medicare wage tax by 0.9% and impose a new 3.8% tax on unearned , nonactivebusiness income for those earning over $200k/$250k (not indexed to inflation)• Generally increases (7.5% to 10%) threshold at which medical expenses, as a % of income, can be deductible• Eliminate deduction for Part D retiree drug subsidy employers receive• Impose 2.3% excise tax on medical devices• Medicare cuts to hospitals who treat low‐income seniors begin• $500,000 deduction cap on compensation paid to insurance company employees and officers
2014 • Unconstitutional personal mandate begins: Individuals without government‐approved coverage are subject to a tax of the greater of $695 or 2.5% of income• Employers who fail to offer "affordable" coverage would pay a $3,000 penalty for every employee that receives a subsidy through the Exchange• Employers who do not offer insurance must pay a tax penalty of $2,000 for every fulltime employee• More Medicare cuts to home health begin• All non‐grandfathered and Exchange health plans required to meet federally mandated levels of coverage• States must cover parents /childless adults up to 138% of poverty on Medicaid, receive increased FMAP• Tax credits available for Exchange‐based coverage, amount varies by income up to 400% of poverty• Private insurers cannot impose any coverage restrictions on pre‐existing conditions (guaranteed issue/renewability, which will bankrupt insurance providers)• Private insurers must offer coverage to anyone wanting a policy and every policy has to be renewed (which will bankrupt insurance providers)• Insurance plans must include government‐defined "essential benefits " and coverage levels• Government board (IPAB) begins submitting proposals to cut Medicare• Impose tax on nearly all private health insurance plans• Medicare payment cuts for hospital‐acquired infections begin (FY15)
2015 • More Medicare cuts to home health begin 2016 • Impose "Cadillac tax on “high cost” plans, 40% tax on the benefit value above a certain threshold: ($10,200 individual coverage, $27,500 family or self‐only union multiemployer coverage)