2012 Election: Results Snapshot

1. 2012 Election: Results Snapshot • President • Obama over Romney • U.S. Senate (1 seat) • Stabenow over Hoekstra • New breakdown: 55 Democrats (2 independents) - 45 Republicans • U.S. of House Representatives (14 seats) • Two new members to Michigan Delegation (Dan Kildee and Kerry Bentivolio) • House remains controlled by Rs (234-201), MI Delegation 9R,5D)

2. Federal Funding - Fiscal Cliff Deal The American Taxpayer Relief Act of 2012 • Payroll tax cut and “Obama/Bush tax cuts” expire • Rich pay more in taxes; capital gains and dividends ($400k singles, $450k married couples) • No increase on debt limit ($16.394t) • 1 year UI extension • 1 year “Farm Bill” fix

3. Fiscal Cliff Deal – Health Care • 1 yr. Medicare physician payment fix ($25b) • Paid for (in part) by hospitals • Documentation and coding offset ($10.5b) • Medicaid DSH reductions ($4.2b) • Other Hospital-related extensions ($5b) • Ambulance add-on payments, low-volume adjustment add-on, Medicare-dependent hospital program • 2 month delay on sequester contained in previous debt ceiling deal • Including 2% cut to Medicare

4. Fiscal Cliff Deal – Conclusion

5. Looking Ahead – U.S. • America is a deeply divided country • Grid-lock will continue • The Senate will be controlled by the Democrats and the House by the Republicans • As is the case in Michigan, the only way to accomplish anything is to elect a House. Senate, and executive (president or governor) of the same party. • Impact on the Affordable Care Act (Obamacare) • Will now be fully implemented with the re-election of President Obama • Debt issues will continue to dominate

6. 2012 Election: Results Snapshot • State House of Representatives (110 seats) • Republicans maintain majority (59-51) • Five incumbents defeated (all Republican) • MI Supreme Court: maintains 4-3 conservative majority • Justice Stephen Markman (R), Justice Brian Zahra (R) & Dean Bridget Mary McCormack (D) elected • This just in: Justice Diane Hathaway (D) to step down Jan. 21. • Gov. will appoint her replacement • Six ballot proposals

7. Six Statewide Ballot Questions • Proposal 1 - Emergency Manager Law Repeal • Repealed 48% Yes/ 52% No; Re-done by during Lame Duck Constitutional Amendments(All Defeated) • Proposal 2 - Collective Bargaining – prohibit regulations • 58% Yes/ 42% No • Proposal 3 - 25% Renewable Energy sources by 2025 • 37% Yes/ 63% No • Proposal 4 - Collective Bargaining - home health care • 43% Yes/ 57% No • Proposal 5 - Two-thirds Supermajority Vote for Taxes • 31% Yes/ 69% No • Proposal 6 - International Bridge • 40% Yes/ 60% No

8. Conclusions - Michigan • Big winners: • Debbie Stabenow • Governor Snyder • Wins big by defeating all the proposals • Wins big by helping Republicans retain majority in House • Wins big by helping Republicans retain majority on the Michigan Supreme Court • Big losers: • Bob King and labor • MattyMaroun and his bridge

9. Lame Duck Highlights - Michigan • Right to Work complicates everything • Michigan becomes 24th RTW state; over 10K people rally against • Fastest time I’ve ever seen a bill become law • Emergency Manager Law Repeal Redo • Personal Property Tax Reform • Election Recall Reform • Detroit Lighting Authority • Regional Transit Authority

10. Lame Duck Highlights – Health Care • Governor shows veto “muscle” • Blue Cross Blue Shield mutualization (abortion language inserted by House) • CCW Exemption (no options for public venues, including hospitals) • Medical liability reform (2 bills, mainly technical) • Right to Life • Strengthen laws against coercive abortions • Strengthen regulations on facilities who perform abortions • Regulation on the disposition of fetal remains • Health Insurance Exchange goes down in flames • State-based exchange and planning grant funding • Gov. to move forward with state-fed partnership • No activity on Auto No-Fault, Certificate of Need or Conscientious Objection

11. Key Players in the 97th Legislature • Governor Snyder • Senate • Majority Leader Randy Richardville (R-Monroe) • Majority Floor Leader ArlanMeekhof (R-West Olive) • Appropriations Chair Sen. Roger Kahn (R-Saginaw Twp.) • DCH Subcommittee Chair Sen. John Moolenaar (R-Midland) • Senate Health Policy Chair Sen. Jim Marleau (R-Lake Orion) • Senate Minority Leader Gretchen Whitmer (D-East Lansing)

12. Key Players in the 97th Legislature • House • Speaker Jase Bolger (R-Marshall) • Majority Floor Leader Rep. Jim Stamas (R-Midland) • Appropriations Chair Rep. Joe Haveman (R-Holland) • DCH Subcommittee Chair* Rep. Matt Lori (R-Constantine) • Health Policy Chair* Rep. Gail Haines (R-Lake Angelus) • Minority Leader Tim Greimel (D-Auburn Hills) • Minority Floor Leader Rudy Hobbs (D-Southfield)

13. Looking Ahead to the Upcoming Session • Governor will begin to shape the discussion during SOS • Blue Cross Blue Shield mutualization redo • Road funding • Educational Achievement Authority • State budget discussion begin quickly • Affordable Care Act • It will be implemented in Michigan • Conservative Republicans are still likely to fight it at every turn now that they view themselves as the last defense • Other Health Care Issues • Auto No-fault • Nursing Issues; Scope of Practice and CRNA Opt-out • CCW, Conscientious objection likely back in some form • Certificate of Need; Fee increases, potential end-runs

14. FY 2014 - Preliminary MHA Medicaid Priorities • Support state Medicaid expansion • Increase Medicaid rates to Medicare level • Maintain GME at FY 2013 level. • Maintain outpatient funding at cost for small and rural hospitals • Increase DSH funding • Limit state retention from provider taxes • Claims tax—expires 12/31/13