2016 Election mpact on business, jobs and lives
2016 Election
Impact on business, jobs and lives
Problems and Solutions
US & Intl Economic Situation
2016 Presidential Race
Future Growth
Medical Devices: Tinkerers are now using things like 3-D printers to make artificial hands for children; clothing that will monitor health in real time; and
incredibly cheap genetic tests that indicate what’s going wrong now, what is likely to go wrong in the near future and how to avoid the latter. But, again,
virtually every single invention – or even slight modifications to improve those inventions – has to
go through the maze of regulatory approval and spend thousands of dollars supporting the “mother
may I” rules of the FDA. Richard Williams Mercatus Center
US Dollar +25%
3yr Oil and Nat Gas
Rate Dilemma
“There are limits to what monetary policy can and, indeed, should, do. The burden
must also fall on fiscal and other policies to do their part to help create conditions
conducive to economic stability.”
SF Fed President John Williams
Productivity=Growth
Policy solutions for growth
Free Trade=lower tariffs
Reg. Relief=reduced costs
Tax reform=capital formation w/incentives
Infrastructure=efficiency
Energy Production
The 10yr Debt Time Bomb
Trump Econ/Tax PlanCut Corp& Pass thru
to 15%Carried interest as
ordinary1x 10% Repat Tax
Ag TPP and NAFTAImpose tariffs on imported goods
Big Drop in InterestDeductibility
New $500B infrastructure Full expensing!
100 Day Reg & Energy Plan
Energy Platform:Save coal industry,
Pass Keystone, Lift moratorium for energy on
Fed landsCancel Paris Climate Agreement
Rescind and Reform: Obama executive actions,
Climate Action Plan, WOTUS,
Obamacare, Dodd-Frank
Trump HC Plan
Allow health insurance to cross state linesFull individual deduction of HC premiums
Repeal Obamacare: no individual mandate,Repeal of medical device tax
HSA: tax free and allowed to accumulatePrice Transparency
Medicaid Block GrantsAllow access to imported drugs
Trump HC Contradictions
2/18 “I like the mandate.”
3/1: Repeal mandate and ACA
Repeal Obamacare: no individual mandate
Feb. CNN: he wants to “take care of” poor people “through maybe concepts
of Medicare”
Next day, tweets his proposal would use “private plans”
Trump plans help/hurt
Help: big tech & big pharma
Hurt: debt heavy balance sheets
Help: industrials & manufacturers
Hurt: free trade
Hurt: ACA managed care, hospitals, Medicaid HMOs
Help: Medical Device industry
The Good and the Bad
Source: Tax Foundation
CLINTON PLAN
Fair share C tax
No Free Trade
Exit Tax
$275B Infrastructure plan
Extend/expand Obama regulation
programs
Big Change to Cap Gains
Fin Reg & Energy Plan
500mln solar panels by 2021Implement Clean Power Plan &
Paris Agreements$60B Clean energy challenge
Risk fee on the largest financial institutionsNo hedge fund investing
Hold senior bankers accountable for lossesNo financial firm is ever too big or too risky
HFT tax, close carried interest
Clinton HC PlanDefend the Affordable Care Act
Crack down on rising prescription drug prices
100% 3yr match for states joining expanded Medicaid coverage
$5,000 tax credit per family for excessive out-of-pocket and premium costs above 5% of their income.
Transform HC to reward value and qualityvia bundled payments and ACOs
Clinton’s Comments“We have to go after price gougingand monopolistic practices and get
Medicare the authority to negotiate.”
“…I’ll defend ACA, build on its successes,and go further to reduce costs.”
“What we have to do, I think, is defend ACA and fix it.”
“I will direct the government to reevaluateMedicare and Medicaid payment practices to remove
obstacles to reimbursement and helpintegrate care for addictions into standard practice.”
Clinton plans help/hurt
Hurt: MNCs competitiveness
Hurt: raises taxes on top earners/capital formation
Help:ACA managed care,hospitals, Medicaid HMOs
Help: energy/alternativesHurt: energy/hydrocarbon production
Hurt: banking
Good, Bad and Complicated
Source: Tax Foundation
2016 RecapClinton:
biz tax hikesBuild ACA
Public option build on regscap gains taxno free trade
big alternativesbig infra
create pathway
Trump: biz tax cuts
Cut ACAMedicaid block
reduce regs cap gains cutno free trade
big hydro carbon big infra
build a wall
2016 HC Similarity Recap
Increased price transparency
Allow Medicare to negotiatedrug prices directly with pharma
Source: PIIE
Major LP Issues
Regulatory overload
Politics/Election fat tail
Slow growth & low rates
Policy solution summary
Future Growth Solutions
Artificial intelligence
PMI
Chronic Care
“…we have seen how the great acceleration is being driven forward by a powerful alliance between hardware and
software – between technology and ideology. Day by day, year by year, this
process is reaching further into our lives, as the billionaires and would-be billionaires
of Silicon Valley widen their ambitions. Space travel, education, energy,
agriculture, transportation – all these sectors and more are in their sights. In
their quest to disrupt the world, they and their cousins around the world are aided
and abetted by the availability of raw computing power on a scale unimaginable
a few decades ago. Robert Colvile in “The Great Acceleration: How the World is Getting Faster, Faster”
Chronic Care Focus
CMS recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as
reduced spending. BeginningJanuary 1, 2015 Medicare pays separately under the
Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology
(CPT) code 99490, for non-face-to-face carecoordination services furnished to Medicare
beneficiaries with multiple chronic conditions.
Pressure on PriceOver the period from 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. CBO and JCT expect them to grow at similar rates over the next decade—by about 5
percent per year, on average, or about 2 percentage points faster than income per capita. As a result of that growth, average premiums for employment-
based coverage are projected to be about $10,000 for single coverage and about $24,500 for family coverage in 2025, nearly 60 percent higher than
they were in 2016.CBO Feb 2016
HC Pricing TransparencyCastlight: mission is to empower people to make
the best choices for their health, and help companies make the most of their health benefits.
MD Insider: we analyze doctor performanceusing big data
Guroo: At guroo.com, you'll find data on health care costs and quality. We have national, state,
and local prices.
Strata Decision: Our passion and our mission is to help hospitals and health systems drive margin to fuel their mission.
Precision Medicine Initiative
Final Thoughts…