To amend the Internal Revenue Code of 1986 to make the child credit refundable for 5 years.

Legislation to fix or affecting the Medicare Physician Fee problem and Graduate Medical Education. Support S. 668 and H.R. 452 to repeal IPAB. Regulations implementing HIT, ACO's, Physician Fee Schedule, Medicare fraud and abuse, electronic records Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10. Regulations stemming from HR 3590, the Patient Protection & Affordable Care Act.

Client expense: Not reported · Firm income: $30,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Health care reform implementation-P.L 111-148, Patient Protection and Affordable Care Act and P.L. 111-152 S. 915, American Health Security Act of 2011 - single payer health plan H.R. 1200, American Health Security Act of 2011- single payer health plan H.R. 1206, Access to Professional Health Insurance Advisors Act of 2011 - insurance brokers S. 73, State Leadership in Health Care Act - state exchanges H.R. 2187, Nurse Staffing Standards for Patient Safety and Quality Care of 2011 S. 992, Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 S. 1088, Retiree Health Coverage Protection Act - early retirement reinsurance program S. 688, Puerto Rico Hospital HITECH Amendments of 2011 H.R. 21, Reclaiming Individual Liberty Act - individual mandate H.R. 452, Medicare Decisions Accoutability Act of 2010 PEO legislation Employer tax exclusion, employer provided health plans H.R. 2077, MLR Repeal Act of 2011

Client expense: $940,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), Employment Standards Administration, Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR)

Legislation to fix or affecting the Medicare Physician Fee problem and Graduate Medical Education. Support S. 668 and H.R. 452 to repeal IPAB. Regulations implementing HIT, ACO's, Physician Fee Schedule, Medicare fraud and abuse, electronic records Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10.

Client expense: Not reported · Firm income: $30,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

U.S. HOUSE OF REPRESENTATIVES Contacts in support of repealing The Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, (continued) 2) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 3) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, 5) eliminate the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment, and 6) eliminate the authority of the Center for Medicare and Medicaid Services to use the Star Rating System to incentivize health insurers to stay within the quality measures to get high-star ratings and to get bonus payments which can have the effect of limiting the circumstances in which treatments can be given to their patients. Contacts in support of H.R. 452, Medicare Decisions Accountability Act of 2011, which would repeal the provisions of Public Law 111-148 regarding the Independent Payment Advisory Boards, including eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts in regard to potential health reform legislation (not introduced) over concerns related to 1) the authority of any sort of health care commissions ability to restrict access to life-saving care, 2) premium price controls that might reduce the ability of insurance to cover expensive life-saving care, and 3) malpractice limits being made applicable to intentional denial of treatment for discriminatory reasons. Contacts relating to H.R.1179, Respect for Rights of Conscience Act of 2011, providing assurances that its current language contained safeguards that would prevent the bill from authorizing discriminatory denial of life-saving treatment, or of medically assisted provision of food and fluids, to vulnerable patients, such as those with disabilities. U.S. SENATE Contacts in support of repealing The Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 2) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 3) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, 5) eliminate the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment and 6) eliminate the authority of the Center for Medicare and Medicaid Services to use the Star Rating System to incentivize health insurers to stay within the quality measures to get high-star ratings and to get bonus payments which can have the effect of limiting the circumstances in which treatments can be given to their patients. (continued) U.S. SENATE (continued) Contacts in support of H.R. 452, Medicare Decisions Accountability Act of 2011, which would repeal the provisions of Public Law 111-148 regarding the Independent Payment Advisory Boards, including eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments.

Health care reform implementation-P.L 111-148, Patient Protection and Affordable Care Act and P.L. 111-152 Health Care and Education Reconciliation Act of 2010 (individual mandate, state exchanges, medical loss ratio) HR 1683, State Flexibility Act - Medicare funding S. 915, American Health Security Act of 2011 - single payer health plan HR 1200, American Health Security Act of 2011- single payer health plan HR 1206, Access to Professional Health Insurance Advisors Act of 2011 - insurance brokers HR 2341, Direct Care Job Quality Improvement Act S. 73, State Leadership in Health Care Act - state exchanges HR 2187, Nurse Staffing Standards for Patient Safety and Quality Care of 2011 S. 992, Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 S. 1088, Retiree Health Coverage Protection Act - early retirement reinsurance program S. 688, Puerto Rico Hospital HITECH Amendments of 2011 HR 21, Reclaiming Individual Liberty Act - individual mandate HR 452, Medicare Decisions Accoutability Act of 2010 S. 1416, Medigap Medical Loss Ratio Improvement Act of 2011 HR 2465, Medigap Medical Loss Ratio Improvement Act of 2011

Client expense: $920,000 · Firm income: Not reported

Government targets: Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR)

U.S. HOUSE OF REPRESENTATIVES Contacts in support of repealing The Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 2) eliminate the authority (continued) of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 3) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, and 5) repeal the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment. Contacts in support of H.R. 452, Medicare Decisions Accountability Act of 2011, which would repeal the provisions of Public Law 111-148 regarding the Independent Payment Advisory Boards, including eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts in regard to potential health reform legislation (not introduced) over concerns related to 1) the authority of any sort of health care commissions ability to restrict access to life-saving care, 2) premium price controls that might reduce the ability of insurance to cover expensive life-saving care, and 3) malpractice limits being made applicable to intentional denial of treatment for discriminatory reasons. Contacts relating to H.R.1179, Respect for Rights of Conscience Act of 2011, providing assurances that its current language contained safeguards that would prevent the bill from authorizing discriminatory denial of life-saving treatment, or of medically assisted provision of food and fluids, to vulnerable patients, such as those with disabilities. U.S. SENATE Contacts in support of repealing The Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 2) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 3) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, and 5) repeal the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment. Contacts in support of H.R. 452, Medicare Decisions Accountability Act of 2011, which would repeal the provisions of Public Law 111-148 regarding the Independent Payment Advisory Boards, including eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. (continued) U.S. SENATE (continued) Contacts in regard to potential health reform legislation (not introduced) over concerns related to 1) the authority of any sort of health care commissions ability to restrict access to life-saving care, 2) premium price controls that might reduce the ability of insurance to cover expensive life-saving care, and 3) malpractice limits being made applicable to intentional denial of treatment for discriminatory reasons.

Legislation to fix or affecting the Medicare Physician Fee problem and Graduate Medical Education. Support S. 668 and H.R. 452 to repeal IPAB. Regulations implementing HIT, ACO's, Physician Fee Schedule, Medicare fraud and abuse, electronic records Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10.

Client expense: Not reported · Firm income: $20,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Legislation to fix or affecting the Medicare Physician Fee problem and Graduate Medical Education. Support S. 668 and H.R. 452 to repeal IPAB. Regulations implementing HIT, ACO's, Physician Fee Schedule, Medicare fraud and abuse, electronic records Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10.

Client expense: Not reported · Firm income: $20,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Legislation to fix the the Medicare Physician Fee problem. Support S. 668 and H.R. 452 to repeal IPAB. Regulations implementing HIT, ACO's Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10.

Client expense: Not reported · Firm income: $20,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

U.S. HOUSE OF REPRESENTATIVES Contacts in support of H.R.2, titled Repealing the Job-Killing Health Care Law Act, because it would 1) eliminate the Independent Payment Advisory Boards directive to make recommendations designed to limit the ability of Americans to spend enough of their private funds on health care to keep up with the rate of medical inflation, (continued) 2) eliminate the authority of the Secretary of Health and Human Services and other Federal agencies to impose quality and efficiency measures on health care providers that would limit their ability to provide life-saving medical treatment , based upon the recommendations of the Independent Payment Advisory Board, 3) eliminate the authority of the Center for Medicare and Medicaid Services to limit Medicare participants choice of private-fee-for-service plans that allow senior citizens voluntarily to add their own funds on top of the government contribution in order to obtain insurance less likely to deny care, 4) eliminate the requirement that state health insurance exchanges administrators exclude plans offered by insurers that they deem permit their customers to spend an unjustified and excessive amount on their health care, and 5) repeal the provision related to shared decisionmaking. Contacts in support of H.R. 452, Medicare Decisions Accountability Act of 2011, which would repeal the provision of Public Law 111-148 directing the Independent Payment Advisory Board to make recommendations designed to limit the ability of Americans to spend enough of their private funds on health care to keep up with the rate of medical inflation. Contacts in support of encouraging the House Committee on Oversight and Government Reform to hold hearings regarding the components of Public Law 111-148 relating to the Independent Payment Advisory Board and the authority of the Secretary of Health and Human Services and other Federal agencies to impose quality and efficiency measures on health care providers that would limit their ability to provide life-saving medical treatment , based upon the recommendations of the Independent Payment Advisory Board. Contacts in support of encouraging the House Committee on Oversight and Government Reform to hold hearings regarding uses of monies granted for comparative effectiveness research under the Public law 111-5. Contacts regarding uses of monies granted for comparative effectiveness research under the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5). Contacts in response to inquiries regarding implementation of elements of Public Law 111-148 related to the denial of life-saving medical treatments. Contacts in response to inquiries regarding Medicare regulation CMS-2010-0205-1983, which would provide for advance care planning counseling during annual visits. Contacts in regards to legislation (not introduced) over concerns related to 1) the authority of a Health Care Services Commission to restrict access to life-saving care, 2)premium price controls that might reduce the ability of insurance to cover expensive life-saving care, and 3) malpractice limits being made applicable to intentional discriminatory denial of treatment. (continued) U.S. SENATE Contacts in support of S.AMDT.13 to S.223 because it would 1) eliminate the Independent Payment Advisory Boards authority to make recommendations designed to limit the ability of Americans to spend enough of their private funds on health care to keep up with the rate of medical inflation, 2) eliminate the authority of the Secretary of Health and Human Services and other Federal agencies to impose quality and efficiency measures on health care providers that would limit their ability to provide life-saving medical treatment , based upon the recommendations of the Independent Payment Advisory Board, 3) eliminate the authority of the Center for Medicare and Medicaid Services to limit Medicare participants choice of private-fee-for-service plans that allow senior citizens voluntarily to add their own funds on top of the government contribution in order to obtain insurance less likely to deny care, 4) eliminate the requirement that state health insurance exchanges administrators exclude plans offered by insurers that they deem permit their customers to spend an unjustified and excessive amount on their health care, and 5) repeal the provision related to shared decisionmaking. Contacts in regards to legislation (not introduced) over concerns related to 1) the authority of a Health Care Services Commission to restrict access to life-saving care, 2)premium price controls that might reduce the ability of insurance to cover expensive life-saving care, and 3) malpractice limits being made applicable to intentional denial of treatment, denied for discriminatory reasons. Contacts in opposition to confirming Donald Berwick as the Director of Center for Medicare and Medicaid Services. Contacts in response to inquiries regarding implementation of certain elements of Public Law 111-148 related to the denial of life-saving medical treatments.

Health reform and its effect on the self-employed. Pooling mechanisms for access to health coverage . Implementation and improvement of the Patient Protection and Affordable Care Act. Expanding and preserving Health Savings Accounts and Health Reimbursement Arrangements. Legislation:Repealing the Job-Killing Health Care Law Act(H.R.2). Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act(H.R.5). Medicare Decisions Accountability Act(H.R. 452).

Client expense: $223,842 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Small Business Administration (SBA), Treasury, Dept of