The document discusses several key tax changes and impacts of the Affordable Care Act taking effect in 2013. This includes a new 3.8% Medicare surtax on investment and some earned income above $200,000/$250,000 adjusted gross income thresholds. The medical expense deduction is also increased to 10% of income. Employers must now report the cost of employees' health insurance on W-2 forms. The top capital gains tax rate rises to 20% from 15%. The temporary 2% reduction in Social Security taxes expires, increasing taxes. Overall, most individuals and those with higher incomes will face higher taxes in 2013.