How is the ACA going to impact your small business and what can you do differently to avoid it having a negative hit to your bottom line?

1. The Affordable Care Act
and the
Impact on Practice
ACVIM – 2014 Forum

2. IRS Circular 230 Disclosure
In accordance with requirements imposed by the IRS, we inform you that, unless
expressly stated otherwise, any U.S. federal tax advice contained in this presentation
(including attachments) is not intended or written to be used, and cannot be used, for
the purpose of a) avoiding penalties under the Internal Revenue Code or b)
promoting, marketing or recommending to another party any transaction or matter
addressed herein.
Please consult your tax advisor before relying on any of the advice provided in this
presentation.

3. Quick Intro – Jason Deshayes, CPA
• Partner with Butler and Company
• My calling is to serve clients and help navigate
them through their finances, whether they are
an individual or a business
• I also believe it is hugely important to serve
the community

4. 2013 and 2014 are going to be
interesting years
• Provisions of the Affordable Care Act have
kicked in, with a lot on the horizon still
• The new American Taxpayer Relief Act was
passed, providing a level of certainty with
what the future of tax law has in store
• Are we finally going to accept this is the new
normal?

5. The Affordable Care Act
• Affectionately referred to as Obamacare
• Wide reaching legislation that has completely
morphed the idea of medical care and health
insurance for the entire country
• Focus on all of the additional health conditions that
will be covered now
– Nothing is free, it’s going to come out of
someone’s pocket
• We still don’t know what is going
to happen!

6. So, what does the ACA mean to me?

7. Benefits/Changes
• Extension of benefits to unmarried dependents
under the age of 26
• Cannot deny coverage based on pre-existing
conditions
• Individual mandate for coverage
• Creation of state health insurance exchanges
• Shared responsibility for employers of at least 50 FTE
• Additional Medicaid eligibility

8. Certain Requirements
• Health insurance has to be sold to anyone regardless of
health status
• People in the same age group will pay the same
premiums regardless of health status
• All companies with 50+ FTEs have to offer affordable
health care with essential health benefits

9. Rating Restrictions
• Age
– Older people won’t pay more than 3x the amount younger
people pay
• Premium Rating Area
– Higher cost of living = more expensive insurance
• Number of family members covered
– Each person counts
• Tobacco Use
– Premium can only be rated on a 1.5:1 ratio
• Used to be 10x!

10. Minimal Essential Coverage
• Defined as:
– Coverage under an “eligible employer-sponsored plan,” which the proposed
Treasury rule defines generally to mean coverage under a group health plan,
whether insured or self-insured, including coverage under a federal or non-
federal governmental plan;
– Coverage under an employer-sponsored retiree health plan;
– Coverage under certain government programs, such as Medicare, Medicaid,
the Children’s Health Insurance Program (CHIP) and TRICARE;
– Coverage in the individual insurance market, including a plan offered by an
Exchange; and
– Other coverage recognized by HHS, including self-funded student health
coverage and coverage under Medicare Advantage plans.
• You need to have minimal essential coverage to avoid
a penalty as an individual (more later)

11. Essential Health Benefits
• No annual/lifetime limits on:
– Ambulatory services
– Emergency services
– Hospitalization
– Maternity and Newborn care
– Mental Health and Substance Abuse
– Prescription drugs
– Rehabilitative services
– Laboratory services
– Pediatric services (oral and vision too)
– Preventative and wellness

12. New Mental Health Coverage
Individuals who will gain
mental health, substance
use disorder or both
benefits under ACA
Individuals with existing
mental health and
substance use disorder
benefits who will benefit
under federal parity
protections
Total individuals who
will benefit from parity
protections
Currently in
individual plans
3.9 million 7.1 million 11 million
Currently in small
group plans
1.2 million 23.3 million 24.5 million
Uninsured 27 million N/A 27 million
Total 32.1 million 30.4 million 62.5 million
Source ASPE Issue Brief Feb 20,2013

13. Women’s Health Coverage
Additional benefits provided for women’s health Number of women impacted and when
Maternity coverage under individual plans 8.7 million starting in 2014
Preventive care services 20.4 million starting late 2010
Expanded insurance coverage 1.1 million starting late 2010
Expanded benefit coverage 13.5 million starting 2014
Source ASPE Research Brief March 20,2012

14. What is Affordable?
• If the employee portion of the employer-coverage exceeds
9.5% of the employee’s household income, then the coverage
is deemed not to be affordable
– Different ways to determine this:
• W-2 method for employee only
• Federal Poverty Line
• Rate of Pay Method (9.5% of 130 hours x rate of pay)
• Employees disclose all personal financial information to determine true household
income
• If there are multiple cost options (ex: multiple levels of
deductibles or coverage benefits), then the affordability test
is based on the lowest-cost option

15. Insurance Issues
• The new coverage standards apply only to policies that renew
on or after January 1, 2014.
– This means if you have a renewal cycle of September 1, then your
policy doesn’t kick in until September 1, 2014
– May make a whole lot of sense to get into a group plan while the
getting is good
– The majority of individual policies are adopting a January 1 start
• No idea of what the cost of coverage is looking like in the long
term
– Some places, very little increase
– Personally speaking, I saw an increase of 60%

16. So, what does the ACA mean to me?
• Depending on your circumstances, you will
see a tax hike starting in 2013
– 3.8% Medicare tax on net investment income if
you have more than $200,000 (single) or $250,000
(married) of income
• Interest, dividends, annuities, royalties and rents
(unless derived from a trade or business)
• Gains from the disposition of property – buildings,
stocks, mutual funds, capital gain distributions

17. So, what does the ACA mean to me?
– 0.9% additional Medicare tax withholding on
wages over $200,000 (single) or $250,000
(married)
• This is only on the employee side – employers do not
match this additional tax
– Not subject to additional Medicare
• Activities that aren’t trade or business (Executor)
• S-corporation income for active owner
• Covenant-not-to-compete
• Retirement income
• These items may trigger higher AGI

18. So, what does the ACA mean to me?
• Lots of reporting requirements – tax reporting is the
key mechanism for enforcement
– Income tax returns
• Corporate
• Individual
– Payroll tax reports
• If you aren’t using a payroll service, I would recommend you look
into it – they know what reporting is necessary

19. So, what does the ACA mean to me?
– Once the individual mandate goes into effect in 2014, you will
be required to have health insurance or pay a penalty…errr….I
mean, tax. The $$$ is low compared to cost of coverage
– Individual Shared Responsibility penalty
• The greater of a flat fee or % of income
– Fee in 2014 = $95, $325 in 2015, $695 in 2016
– Maximum fee is $2,085 (3x the fee; indexed for inflation)
– % of taxable income = 1% in 2014, 2% in 2015, 2.5% in 2016
• Doesn’t apply if:
– You can’t afford coverage (premiums > 8% of income)
– Undocumented immigrants
– People who only don’t have insurance for less than 3 months
– People whose income is below tax filing
requirements
• Cannot exceed the cost of a bronze (cheapest) plan
• Applies for each month without coverage
• No liens or levies from the IRS
– IRS can only extract the penalty from a refund

20. Penalty Calculation
Single, healthy, young taxpayer has applicable
income (for penalty) of $60,000 a year
–Penalty in 2014 = greater of $95 or 1% of $60,000
($600)
–Cost of coverage = est $150/month = $1,800
If this individual doesn’t see the doctor ever, why
not pay the penalty and get the insurance whenever
you need it

21. Penalty Calculation
Family of 4 with applicable income of $150,000
–Penalty in 2016 = greater of $2,085 or 2.5% of
$150,000 ($3,750)
–Cost of coverage = est $450/month = $5,400
Still cheaper to just pay the penalty – may not be
smarter, but the penalty isn’t large enough to force
compliance

22. Employer Responsibility
– Employer Mandated Coverage – if you own a
business and meet certain qualifications, you may
be subject to penalties if you don’t offer “minimal
essential coverage” - $2,000 per employee
• Kicks in now in 2015 (pushed back a year)
• 30 person threshold – penalty kicks in after that
• Let’s say you have 100 employees and you do provide
health insurance, but 2 of your employees use the
exchange - $140,000 penalty (70 employees x $2,000)

23. Employer Responsibility
– Inadequate/Unaffordable Insurance Penalty
• You offer insurance to 95% of your FTEs, but the
insurance is either unaffordable or lacks minimum
value
• At least one employee utilizes a health exchange
• $3,000 penalty assessed monthly (1/12 of $3,000 per
month) per employee who uses exchange
• Penalty capped at the “no coverage” penalty

24. So, what does the ACA mean to me?
– Flexible Spending Accounts – capped at $2,500
starting in 2013
– Itemized deduction of medical expenses requires
10% of AGI (up from 7.5%)
• If your AGI is $100,000, you need $10,000 of
unreimbursed medical before you get a $1 of
deduction
– Over-the-Counter Drugs are not longer allowable
for FSA, HAS, HRA and MSAs
• Nonqualified distributions have increased
tax for 20%

25. So, what does the ACA mean to me?
– 2.3% medical device manufacturer tax
• Intended to cover only devices used on humans
– Problem is that some of this technology can be used on
animals too…so if your vet bills get higher, you know why
• Tax paid by the manufacturers, who then pass on that
cost to the device users
– Required disclosure of nutritional content at fast
food restaurants and vending machines
– Grants for small employers who set up
wellness programs
– Free preventative care

26. So, what does the ACA mean to me?
– 2.3% medical device manufacturer tax
• Intended to cover only devices used on humans
– Problem is that some of this technology can be used on
animals too…so if your vet bills get higher, you know why
• Tax paid by the manufacturers, who then pass on that
cost to the device users
• For example, you use a human pediatric endoscope to
use on a small animal or some other exotic pet – since
it can be used on humans, it would be subject to this
tax
• AVMA has been working hard on this

27. Eegads – that’s enough of that!

28. American Taxpayer Relief Act
• Our government’s way of avoiding the country
going over the “fiscal cliff” – the result of
automatic tax increases and spending cuts

29. American Taxpayer Relief Act
• We went over the cliff…for a little bit and
came out with a degree of certainty about tax
law
– I am certain a number of our clients will be taxed
a lot more
– I am certain that at least I won’t be stressing
about the Alternative Minimum Tax nearly as
much
– I am certain estate planning will require far less
use of a crystal ball

30. American Taxpayer Relief Act
• Tax rate changes
– The rates general stay the same, until which you
hit $400,000 (single) or $450,000 (married) of
taxable income - new rate of 39.6%
– Qualified Dividends and Long-Term Capital Gains
stay at 15%, unless you are in the 39.6% tax
bracket – then you pay 20%
• Still have the 0% rate if you are in 10% or 15% bracket

31. American Taxpayer Relief Act
• Itemized Deductions and Personal Exemptions
– The more you make, the less benefit you receive
for your personal exemptions and itemized
deductions (kicks in with incomes over $250k/
$300k)
• Alternative Minimum Tax
– Finally…no more patching, the AMT Exemption is
indexed for inflation
• Social Security 2% cut is gone for
employee portion

32. American Taxpayer Relief Act
• Extension of the Qualified Charitable
Distribution
– Allows you to make a donation direct from the IRA
to a charity
– Meets requirement for RMD; good through 2013
• American Opportunity Tax Credit extended

33. Business Structure and
Compensation
Being a business owner requires a lot of financial know-how
–Business organization/entity selection
–Accounting for revenue/expenses
–Human resources
–Marketing
Worth it to consult with an attorney and accountant to make
sure you’ve got your bases covered
It’s far easier to do things right from the get-go
Organizational structure can change down the
road if the structure you have isn’t appropriate

34. Sole Proprietorship
• Really easy to set up - you put your sign on a door.
• No protection of personal assets
• Self-employment tax issues
• Included on personal return as a Schedule C
• Can only have one owner

35. Sole Proprietorship
You
&
Your Practice
One Tax Bill

36. Partnership
• Requires more work for set up, must have a partnership
agreement.
• Very little protection of personal assets
• Self-employment tax issues
• Files a separate return with the income being taxed at the
individual partner's level based on their ownership
• Have to have at least two partners
• Lots of flexibility, presuming you allow it in
your partnership agreement

37. Partnership
Practice
Guaranteed payments
& draws
Provider
#1
Provider
#2
Tax on profits paid by
Individual owners

38. S-Corporation
• Much more formal organization
• Protection of personal assets
• Get paid a W-2 as part of compensation; distributions represent
the rest
• Files a separate return with the income being taxed at the
individual partner's level based on their ownership
• May have 1 - 100 unrelated owners
• Not as good for fringe benefits
• Flexibility with tax planning

39. S-Corporation
Practice
W-2 Compensation
& distributions
Owner/
Employee Tax on profits paid by
Individual owner

40. Corporation
• Much more formal organization
• Protection of personal assets
• Get paid via W-2 as compensation
• Corporation files own tax return and pays own tax, but at
maximum tax rate as a Personal Service Corp
• May have unlimited owners
• Better fringe benefits for owners
• Flexibility with tax planning

41. Corporation
Practice
W-2 Compensation
Provider
#1
Provider
#2
Tax on profits paid by
the corporation
Tax on wages paid
by shareholders

42. Limited
Liability Company
• Has a lot of flexibility as it can be any and all of the entities
mentioned here – can be a LLC for legal purposes, but can be a
corporation, sole proprietorship, partnership or S-corporation for
tax purposes
• Advised to help shield legal liability - but still have insurance!

43. Keeping the books
•Keeping track of the books means recording revenue &
expenses, reconciling bank accounts, balancing bank loans, etc…
•If you are not the type to do this work yourself, it’s best to bring
in an outside party – bookkeeper, accountant, CPA, etc…
•It is far less expensive to do things the right way the first go
around
•Your bookkeeping and accounting needs will (and should)
evolve as the practice evolves

44. Accounting Systems
• QuickBooks is one of the most common accounting systems
available - both a desktop and online version
• CBS – Client Bookkeeping Solution
• Xero
• FreshBooks
• Good ol’ spreadsheets
• Other cloud based programs

45. Accounting Systems
• A few things to think about:
–Is this a program you can understand?
–What is a good interface with your CPA?
–Can you get the data you want from the system easily?
–Cost vs. benefit
–Do you want/need the remote access?

46. Retirement Plans
• When was the last time you looked at the plan?
• What type of match is the business on the hook for?
• Is the plan appropriate for the employee base?
• Does it fit the owners’ needs?
• Are your employees even using it?
• Save on some payroll taxes by increasing the retirement
benefits – higher match/lower salary

47. Retirement Plans
• Various types of retirement plans – SIMPLE, 401k, SEP are
examples
• Limits range from $11,500 to $50,000
• SIMPLE plans have the smallest limit, but least cost to the
employer and easiest to manage
• SEPs can put the most money into retirement, but at the cost of
the employer having to front the entire cost
• 401k plans have a mix of employer and employee contributions, as
well as Roth/traditional components, but higher administrative
cost
• Catch up contributions allowed if over 50
• IRAs outside of employer plans

48. Employees and Payroll
• Whatever you are paying an individual, add approximately 10%
for taxes and at least 15% - 20% for benefits (if you offer them)
• Quarterly reporting and other deposit requirements for payroll
taxes
• Documentation requirements for each employee
• Payroll outsourcing is a very easy way to take care of this at a
pretty low cost
• The employer pays for 1/2 of each employee's social security
and Medicare (7.65% of gross pay up to $109,000, 1.45% after
that) plus unemployment taxes
• Safe assumption is each employee will cost you
about twice as much as their hourly rate

49. Cost of Employees
• You hire an assistant at $35,000 – the compensation package
also includes health insurance and a retirement match
Your cost:
Salary $35,000
Payroll Taxes 3,500
Health insurance 3,600 ($300/month)
Retirement match 1,050 (3% match)
Other costs 2,500
Total cost $45,620 (130% of salary)

50. Questions?

51. Contact Info
Jason Deshayes, CPA
Butler and Company
505-821-0893
Jason@butlercpa.com
Skype – taxguyjase
Twitter - @taxguyjase