1. Health Reform Bracketology
2010 Congressional Election Madness
Standings as of October 25, 2010
Overview
As the 2010 election approaches, Leavitt Partners has engaged a collection of our policy
experts and senior advisors to identify provisions within the recently passed health reform
legislation that are subject to potential disruption. Health reform continues to be an important
topic with voters, and our firm believes that certain scenarios regarding the future
congressional makeup could have a material impact on the timing and nature of the
implementation of PPACA and related health care reform efforts.
HOUSE SENATE
Democrat
Republican
Democrat
Republican
Democrat
Republican
Democrat
Republican
Democrat
Republican
Democrat
Republican
Democrat
Republican
Democrat
Republican
? ?
Current Public Polls Suggest*
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Democrats Republicans
Toss Up
Democrats Republicans
Toss Up
179 33 223 48 7 45
Republicans
House
Democrats
Senate
© Leavitt Partners 2010

2. Methodology and Focus
Our analysis utilizes polling data from RealClearPolitics.com to project the likelihood of various election
outcome scenarios in the House of Representatives and the Senate. Based upon these scenarios, publicly
reported information, and other proprietary sources, Leavitt Partners has identified several PPACA provisions
that could be targets for disruption. We have queried several health care experts for their opinion on a)
the likelihood of disruption of these targets given certain election outcome scenarios, b) potential
congressional tools/channels to facilitate the disruption, and c) potential outcomes. The data is aggregated and
presented below.
Health Reform Bracketology
2010 Congressional Election Madness
Standings as of October 25, 2010
Republicans DemocratsRepublicansRepublicans Democrats Democrats
Election 2010 Scenarios
Target
• Individual Mandate
• Employer Penalty:
• Premium Subsidies:
• Medicaid Expansion:
• Medical Loss Ratio:
• Medicare Funding Cuts:
Likelihood
85%
78%
63%
53%
78%
85%
Likelihood
73%
50%
43%
38%
63%
68%
Likelihood
28%
30%
33%
20%
33%
53%
Target
• Individual Mandate
• Employer Penalty:
• Premium Subsidies:
• Medicaid Expansion:
• Medical Loss Ratio:
• Medicare Funding Cuts:
Target
• Individual Mandate
• Employer Penalty:
• Premium Subsidies:
• Medicaid Expansion:
• Medical Loss Ratio:
• Medicare Funding Cuts:
House Senate House Senate House Senate
© Leavitt Partners 2010

3. Individual Mandate
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
73%
(+5% Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 58%
Stall 35%
Repeal 8%
85%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: The Individual Mandate has become the leading symbol for conservatives and moderates in opposition of health reform.
As the election draws near look for heightened rhetoric around this provision as it is arguably on the top of the list for congressional disruption.
The Judicial path can also still affect this provision with Attorneys General from 20 states challenging the constitutionality of this mandate. The
slow court progression continues to make headlines and is staying top of mind for voters.
Republicans
Modify 78%
Stall 20%
Repeal 3%
28%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
53%Stall, 43%
Repeal,
5%
© Leavitt Partners 2010
Disruption Analysis
Likely modifications include
raising the income threshold of
those exempt from the
requirement, or denying funding
to the IRS to hire new staff to
enforce the provision. If
repealed, one discussed
substitute is an auto-enrollment
process with an opt-out
provision.

4. Employer Penalty
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
50%
(+2% Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 55%
Stall 33%
Repeal 15%
78%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: Our coaches have increased the chance of disruption slightly due to the appearance of a stronger than previously
expected Republican presence in the Senate. This issue will need to fit into an overall plan for getting the economy moving and restoring trust
among employers. However, the penalty will be linked to other issues to maintain employer coverage. Our coaches also believe that Democrats
are more likely to work with Republicans on modifications for the Employer Penalty than they would be on other PPACA issues.
Republicans
Modify 68%
Stall 30%
Repeal 3%
30%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
63%
Stall, 35%
Repeal,
3%
, 0%
© Leavitt Partners 2010
Disruption Analysis
We believe that any potential
modifications will be focused on
additional exceptions for
businesses or a reduction in the
penalties.

5. Premium Subsidies
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
43%
(No Change Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 80%
Stall 18%
Repeal 3%
63%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: No significant market developments have transpired in the last week causing our coaches to change their predictions.
Republicans
Modify 85%
Stall 13%
Repeal 3%
33%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
78%
Stall, 23%
, 0%
© Leavitt Partners 2010
Disruption Analysis
Potential compromises could
involve lowering the amount of
subsidy to the target population
(below 400% of the Federal
Poverty Level), or changing the
eligibility criteria to reduce the
number of eligible individuals
who qualify based upon
household income.

6. Medicaid Expansion
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
38%
(No Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 53%
Stall 40%
Repeal 8%
53%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: No significant market developments have transpired in the last week causing our coaches to change their predictions.
Republicans
Modify 65%
Stall 10%
Repeal 0%
20%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
50%
Stall, 48%
© Leavitt Partners 2010
Disruption Analysis
Possible modifications could
include offering Medicaid
eligible populations the option
of receiving a voucher for use in
purchasing insurance through
state exchanges.

7. Medical Loss Ratio
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
63%
(+5% Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 63%
Stall 18%
Repeal 20%
78%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: Our coaches increased this provision’s likelihood of disruption as tighter margins in managed care plans may warrant
additional compromise. As states and companies have come forward citing the need for waivers politicians are becoming increasingly sensitive
that the MLR could reduce the quantity of health plans.
Republicans
Modify 78%
Stall 23%
Repeal 0%
33%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
78%
Stall, 18%
Repeal,
5%
, 0%
© Leavitt Partners 2010
Disruption Analysis
Possible modifications could
include the granting of waivers
to carriers, businesses, or states
that show evidence of market
destabilization.

8. Medicare Funding Cuts
Standings as of October 25, 2010
Current Public Polls Suggest*
LP Coaches Poll Prediction
Democrats
Republicans
Republicans
Democrats
Republicans Democrats
HOUSE SENATE
68%
(No Change From Last Week)
Chance of Disruption if Republicans take the House and
Democrats retain the Senate. See below for type of disruption.Modify 63%
Stall 28%
Repeal 10%
85%
Chance of
Disruption
Republicans
House Senate
Alternative Scenario
Commentary: No significant market developments have transpired in the last week causing our coaches to change their predictions.
Republicans
Modify 70%
Stall 28%
Repeal 10%
53%
Chance of
Disruption
Democrats
House Senate
Democrats
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010
Modify
Stall
Repeal
Modify,
63%
Stall, 28%
Repeal,
10%
© Leavitt Partners 2010
Disruption Analysis
Early legislative action in the
112th congress could result in an
executive branch invitation to a
‘Budget Summit’, a forum for
negotiating a budget that both
Congress and the President can
tolerate. Such a summit would
be high stakes political theater
that could create “winners” or
“losers” out of the new
congress.

9. Republicans Take House,
Democrats Retain Senate
Historical Coaches Polling
*Prediction based on analysis using data from www.RealClearPolitics.com, October 25 2010 © Leavitt Partners 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
10/4/2010 10/11/2010 10/18/2010 10/25/2010
LikelihoodofDisruption
Medicare Funding Cuts
Medical Loss Ratio
Medicaid Expansion
Premium Subsidies
Employer Penalty

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