1. Health Care Reform Update – The 28% Factor W. Stephen Love President and Chief Executive Officer Dallas-Fort Worth Hospital Council November 14, 2013

2. Patient Protection & Affordable Care Act History Modifications Legislation Became Law – March 23, 2010 Supreme Court – June 28, 2012 Implementation – Especially 2014 2

3. Current and Future Trends in Healthcare Delivery Fee for Service Coordinate Payment Prevention Wellness 3

4. Current and Future Trends in Healthcare Delivery Medical Homes Accountable Care Organizations Primary Care Networks Physicians – Retain Physician Payment 4

5. Coverage - Access Emergency Room Proper Primary Setting Piggly Wiggly Effect Primary Care Providers 5

6. Fiscal Cliffs Debt Ceiling – February 7, 2014 Appropriations Budget – December 13, 2013 Funding Government – through January 15, 2014 Physician Payment Fix – December 31, 2013 6

7. Reimbursement - Federal Budget Policy = Health Policy Provider Cuts = Beneficiary Impact $250 Billion = 10 Year Reduction 7

8. Reimbursement - State No Medicaid Expansion ◦ $85 Billion ◦ 1.4 Million People ◦ Reasons Against Medicaid 1115 Waiver 8

9. State of Texas 28 Percent Uninsured 6 Million People 1.2 Million Children 40 Percent of Women – Inappropriate pre-natal care Working Uninsured 9

10. Enroll in Health Coverage Navigators Non-Navigators Certified Application Counselors Agents and Brokers 10

11. Employers 2015 Employer Shared Responsibility Payment Greater than 50 FTE’s 50 or less FTE’s Less than 25 FTE’s 11

12. Employers 2014 and 2015 – Shop for 50 or less FTE’s 2016 – Shop less than 100 FTE’s Small Business Health Options Program 12

13. Individuals Adult Penalties ◦ 2014$ 95 ◦ 2015$325 ◦ 2016$695 ◦ 2017 and beyond – Increased based on cost- of-living adjustment 13

14. Questions

15. Health Care Reform Update – The 28% Factor W. Stephen Love President and Chief Executive Officer Dallas-Fort Worth Hospital Council November 14, 2013