Election and Legislative Update for Healthcare Providers 2012 Southeast Healthcare Provider Conference September 25, 2012

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Election and Legislative Update for Healthcare Providers 2012 Southeast Healthcare Provider Conference September 25, 2012 Mary Moore Hamrick Grant Thornton LLP Stephanie Kennan McGuireWoods Consulting LLC

Campaign story: Referendum or choice?

Obama's overall job approval rating February 2009 September 2012 Source: http://www.gallup.com. Each result is based on a three-day rolling average.

Obama: Right direction, wrong track February 2009 September 2012 Source: Rasmussen Reports, Sep. 2012

The unemployment effect on incumbent elections Lost Won *In the two years before Reagan's re-election, unemployment had dropped 3.4%. Source: U.S. Bureau of Labor Statistics Unemployment % 8.1% Obama most recent (Sep. 2012) 8.3% Obama took office (Feb. 2009) 7.5% Carter 7.4% Reagan* 7.3% GHW Bush 6.8% Ford 5.5% GW Bush 5.2% Clinton 3.9% Eisenhower 3.7% Johnson 3.7% Truman

It's "the economy, stupid." -James Carville

Economic landscape unemployment rate - 8.1% federal budget deficit - $1.1 trillion national debt close to $16 trillion debt ceiling - $16.4 trillion real GDP - 1.5% 2Q2012 consumer spending - 2.0% 2H2012

Threats to the U.S. economy Taxmageddon Eurogeddon slow growth China, Brazil, India oil shock October surprise

The path to victory Each state's area is proportional to its number of electoral votes. Source: The Cook Political Report Graphic by Peter Bell

Congressional election

Control of the Senate Either party could win a majority Source: The Cook Political Report, 2012.

Control of the House Even if Democrats win every toss-up, it's not enough Source: Cook Political Report, 2012.

Expect high turnover: lots of new freshmen in 2013 Number of Freshmen in Congress 2005 2013 Distribution of Congress by Tenure NJ Research Forecast: Jan 2013 113 Served more than 6 years Served 2-6 years 49 65 70? Projected Retirements 46% 34% Open Seats to Date Served 0-2 years 2005 (109 th ) 2007 (110 th ) 2009 (111 th ) 2011 (112 th ) 2013 (113 th ) * 2013 figures are NJ Research forecast based on open seats to date (includes announced retirements), projected retirements, and projected incumbent losses (based on a re-election rate of 90%). Source: National Journal Research, 2012.

Changes in health care committees House Energy and Commerce all up; five retiring or running for another office Senate Health, Education, Labor and Pensions (HELP) four up; one retiring

More polarization / less incentive to compromise Senate vote ratings *National Journal s Vote Ratings scores members of Congress on selected roll-call votes from the previous year *Members are compared to each other on an ideological scale, from liberal to conservative Source: National Journal, February 26, 2011, Pulling Apart, Ron Brownstein; New York Times, January 14, 2012, Boehner Faces a Restive G.O.P. and New White House Attacks, Jennifer Steinhauer.

Fewer outliers, more polarization in House: GOPs voting more liberally than the most conservative Dem (outliers) and vice versa 1993-2011 DEM Outliers GOP Outliers Source: National Journal Vote Ratings.

Lame duck session

Immense pressure for action in a six-week window Source: National Journal, July 2, 2012, Field Guide to the Lame Duck, Nancy Cook.

The fiscal cliff Sources: Congressional Budget Office; Bipartisan Policy Center; Eurasia Group.

Rates increase during difficult economic times Income 10% 15% 15% 15% 25% 28% 28% 31% 33% 36% 35% 39.6% Estate, gift and GST $5.12M $1M exemption 35% 55% rate Capital gains top rate 15% 23.8%* Dividend top rate 15% 43.4%* * Includes 3.8% Medicare tax