Tomorrow (Dec. 14) is the deadline for whether states want to set up their own health exchanges in anticipation for 2014 enrollments. Which got us thinking about the Affordable Care Act in general…

• In late 2010, kids up to age 26 could stay on their parents’ healthcare plan.
• In 2011, insurers needed to adhere to a minimum medical loss ratio (MLR), which means at least 80% of premiums now have to go directly to care, not admin (85% for group plans).
• This year, there have been a number of more obscure provisions that have affected the provision of care and Medicare.
• In 2014, look out – just about everything else kicks in, including:
  • No medical underwriting
  • No denial of coverage for preexisting conditions
  • No gender-based pricing
  • Compressing the differences in rates between young and old
  • No penalty for smokers (if you can believe it).

But what about 2013? There’s some pretty heavy stuff in store that might be flying under the radar. Some good for Medicaid recipients. Some not so good for high earners and other taxpayers. We thought you might be interested

In 2013:

• High-income earners (defined as making more than $200,000 AGI, $250,000 for couples) will pay almost 1% more in Medicare payroll tax.
• They will also pay 3.8% more on their investment income.
• Employers will no longer be able to deduct Medicare Part D contributions (that’s for prescription drugs) to their Medicare-eligible retirees.
• There will be an excise tax on makers and importers of medical devices.
• The qualification for income tax deductions for medical expenses will rise from 7.5% of AGI to 10%.
• Medicaid gets richer: Increased reimbursement for primary care, and expanded coverage of preventive services.
• On the Medicare front, physician comparison data will be available to the public, and payments for certain hospital readmissions will be reduced.

There’s an awful lot to the Affordable Care Act. Some being talked about, some stealth. How will it affect you in 2013? We’d love to hear.