Health Insurance Industry Fair Competition Act

H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act H.R. 2112, Consolidated and Further Continuing Appropriations Act, 2012, including an amendment regarding pharmaceutical importation H.R. 3203, Novel Device Regulatory Relief Act of 2011 H.R. 3204, Guidance Accountability and Transparency Act of 2011 H.R. 3205, FDA Renewing Efficiency from Outside Reviewer Management Act of 2011 H.R. 3206, Cultivating Scientific Expertise to Foster Innovation Act of 2011 H.R. 3207, Modernizing Laboratory Test Standards for Patients Act of 2011 H.R. 3208, Patients Come First Act of 2011 H.R. 3209, Premarket Predictability Act of 2011 H.R. 3211, Humanitarian Device Reform Act of 2011 H.R. 3214, Food and Drug Administration Mission Reform Act of 2011 H.R. 3230, Keeping America Competitive through Harmonization Act of 2011 H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 2 / S. 192, Repealing the Job-Killing Health Care Law Act H.R. 605 / S. 312, Patients Freedom To Choose Act H.R. 1744 / S. 20, American Job Protection Act H.R. 2529 / S. 1368, Restoring Access to Medication Act S. 17, Medical Device Access and Innovation Protection Act H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 1744 / S.20, American Job Protection Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 1880, Jobs and Premium Protection Act S. 1886, Counterfeit Drug Penalty Enhancement Act of 2011 S. 2002, Online Pharmacy Safety Act S. 3501, American Job Protection Act S. 3673, Patients Freedom To Choose Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152). Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; National Quality Plan Request For Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment; Medical Loss Ratio; Rate Increase Disclosure and Review; Value Based Insurance Design; Consumer Operated and Oriented Plan Programs; Nondiscrimination in favor of Highly Compensated Individuals - second notice re: timing; DOL: Retrospective Review Under E.O. 13563; Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Electronic Disclosure by Employee Benefit Plan; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing. Summary of benefits and Coverage and the Uniform Glossary; Exchange Functions in the Individual market; Health Insurance Premium Tax Credit; Establishment of Exchanges and Qualified Health Plans; Health Coverage Affordability Safe Harbor for Employers. Comprehensive health reform (bills in the Senate and House) - all aspects relating to coverage, financing, and delivery reform, including: 1099 reporting; Grandfathering, HSA and FSA changes; CMS claims database; IPAB; CLASS Act; employer mandate; medical loss ratio; mandated insurance requirements; Exchanges; Medicare reform; regulatory reform; Essential Health Benefits Package; Health Insurance Tax; Medical Device Tax Various issues relating to implementation of P.L. 111-148 (111th Congress), Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business Jennifer Pierotti - Covered Official Positions: Intern, U.S. Senate Committee on Small Business and Entrepreneurship, Minority Staff - Olympia J. Snowe - January 2010 - April 2010

Client expense: $14,250,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605, Patients Freedom to Choose Act H.R. 1063, Strengthening Medicare and Repaying Taxpayers Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 1744, American Job Protection Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act of 2011 H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act S. 17, Medical Device Access and Innovation Protection Act S. 20, American Job Protection Act S. 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act S. 1098, Family and Retirement Health Investment Act of 2011 S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act P.L. 111-148 (111th Congress), Patient Protection and Affordable Care Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform. (P.L. 111-148 and P.L. 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; National Quality Plan Request For Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment, Medical Loss Ratio, Rate Increase Disclosure and Review; Value Based Insurance Design; Consumer Operated and Oriented Plan Programs; Nondiscrimination in favor of Highly Compensated Individuals - second notice re timing, DOL: Retrospective Review Under E.O. 13563, Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Electronic Disclosure by Employee Benefit Plan; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing Various issues relating to P.L. 111-148 (111th Congress) also known as the Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business; health care reform; employer mandate repeal Daniel Hillenbrand - Covered Official Positions: Intern - Office of Congressman John Kline

Client expense: $10,010,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Economic Analysis, Bureau of Labor Statistics (BLS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Library of Congress (LOC), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605, Patients Freedom to Choose Act H.R. 1173, Fiscal Responsibility and Retirement Security Act H.R. 1370, a bill to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 1744/S.20, American Job Protection Act P.L. 112-009 (Formerly H.R. 4), Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 Filed comments and met with relevant agencies on regulations implementing health care reform. (P.L. 111-148 and 111-152). Regulations commented on include: Medical Loss Ratio (MLR) Request for Information, Adult Child Coverage (Age 26) Interim Final Rule, Grandfathered Plan Status Interim Final Rule, Preexisting Condition Exclusion, Lifetime & Annual Limits, Rescissions, Patient Protections Interim Final Rule, Preventive Services Coverage Interim Final Rule, Internal Claims & Appeals and External Review Processes Interim Final Rule, Preexisting Condition Insurance Plan (PCIP) Interim Final Rule, 1099 Reporting Requirements Request for Comments, Planning and Establishment of State-level Exchanges Request for Comments, National Quality Plan Request For Comments, Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments, Essential Health Benefits (IOM Study), Amended Interim Final Rule for Grandfathered Plan Status, Guidance on OTC Medicine & Definition of Medical Expenses, Development of Health Risk Assessment, Medical Loss Ratio, Rate Increase Disclosure and Review, Value Based Insurance Design, Consumer Operated and Oriented Plan Programs, Nondiscrimination in favor of Highly Compensated Individuals - second notice re timing, DOL: Retrospective Review Under E.O. 13563, Treasury: Retrospective Review Under E.O. 13563, State Innovation Waivers, ACOs & Medicare Shared Savings Program, Electronic Disclosure by Employee Benefit Plan, Shared Responsibility for Employers Regarding Health Coverage (Section 4980H) Various issues related to P.L. 111-148 (111th Congress) also known as the Patient Protection and Affordable Care Act; these issues include anything being implemented during the 112th Congress or rulemaking, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; issues related to the regulatory process and legislative corrections to P.L. 111-148, Patient Protection and Affordable Care Act (coverage, financing, and delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio); regulatory process and legislative corrections to P.L. 111-152, Health Care and Education Affordability Reconciliation Act of 2010; ERISA preemption; impact on small business

Client expense: $9,040,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Accounting Standards Advisory Board (FASAB), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, Food & Drug Administration (FDA), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

H.R. 1322, Earned Retiree Healthcare Benefits Protection Act of 2011 H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 4 / S. 72 / S. 18, Small Business Paperwork Mandate Elimination Act of 2011 S. 312 / H.R. 605, Patients Freedom to Choose Act S. 20, American Job Protection Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the McConnell and Stabenow amendments to repeal P.L. 111-148, Patient Protection and Affordable Care Act S. 493, SBIR/STTR Reauthorization Act of 2011, including the Johanns and Hutchinson amendments Potential legislation similar to the following: P.L. 111-148, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), specifically issues related to the regulatory process and legislative corrections S. 510 FDA Food Safety Modernization Act, including issues related to 1099 reporting H.R. 4853 Middle Class Tax Act of 2010 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 4626, Health Insurance Fair Competition Act Education Affordability Reconciliation Act of 2010 Anticipated legislation not yet introduced: Comprehensive health reform and all aspects relating to coverage, financing, delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information, see 75 Fed. Reg. 19,297(April 14, 2010) Adult Child Coverage (Age 26) Interim Final Rule, see 75 Fed. Reg. 34,538 (May 13, 2010) Grandfathered Plan Status Interim Final Rule, see 75 Fed. Reg. 34,538-70 (June 17, 2010) Preexisting Condition Exclusion, Lifetime & Annual Limits, Rescissions, Patient Protections Interim Final Rule, see 75 Fed. Reg. 37,18837,241 (June 28, 2010) Preventive Services Coverage Interim Final Rule, see 75 Fed. Reg. 41,72660 (July 19, 2010) Internal Claims & Appeals and External Review Processes Interim Final Rule, see 75 Fed. Reg. 43,330-64 (July 23, 2010) Preexisting Condition Insurance Plan (PCIP) Interim Final Rule, see 75 Fed. Reg. 37,18837,241 (June 28, 2010) 1099 Reporting Requirements Request for Comments, see 75 Fed. Reg. at 49,828 (August 16, 2010) Planning and Establishment of State-level Exchanges Request for Comments, see 75 Fed. Reg. 45,584-90 (August 3, 2010) National Quality Plan Request For Comments, see 75 Fed. Reg. 63478 (October 15, 2010) Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments, see 75 Fed. Reg. 67,975 (November 4, 2010) Essential Health Benefits (IOM Study) Amended Interim Final Rule for Grandfathered Plan Status, see 75 Fed. Reg. 34,53870 (June 17, 2010) Guidance on OTC Medicine & Definition of Medical Expenses, see 75 Fed. Reg. 80,501 (December 22, 2010) Development of Health Risk Assessment, see 75 Fed. Reg. 82400-82402 (December 30, 2010) Medical Loss Ratio, see 75 Fed. Reg. 74,864-74,934 (December 1, 2010) Rate Increase Disclosure and Review, see 75 Fed. Reg. 81,004-81,029 (December 23, 2010) Value Based Insurance Design, see 75 Fed. Reg. 81,544-81,547 (December 28, 2010) Consumer Operated and Oriented Plan Programs, see 76 Fed. Reg. 5,774-5,777 (February 2, 2011) Non-discrimination in favor of Highly Compensated Individuals (second notice), see 75 Fed. Reg. 67,975 (November 4, 2010) Various issues including: ERISA preemption, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts (specific legislation not yet introduced)

Client expense: $10,890,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Mediation Board, Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

H.R. 1020 - Arbitration Fairness Act of 2009 S. 931 - Arbitration Fairness Act of 2009 Asbestos Related Legislation Bankruptcy Transparency Issues S. 3305 - Big Oil Bailout Prevention Liability Act of 2010 Climate Change/Global Warming Coastal Wind Zone Proposal H.R. 3644 - Commission on Natural Catastrophe Risk Management and Insurance Act of 2007 Credit Scoring and the Use of Credit as Underwriting Tool Emergency Economic Stabilization Act of 2008 and TARP Related Issues H.R. 1409 - Employee Free Choice Act of 2009 S. 560 - Employee Free Choice Act of 2009 H.R. 1788 - False Claims Act Correction Act of 2009 Federal Resolution Authority Financial Services Systemic Risk Proposals Obama Administrations White Paper on Financial Services Modernization H.R. 5114 - Flood Insurance Reform Priorities Act of 2010 Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152) H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 4626 - Health Insurance Industry Fair Competition Act S. 1681 - Health Insurance Industry Antitrust Enforcement Act of 2009 H.R. 2555 - Homeowners Defense Act of 2009 S. 505 - Homeowners Defense Act of 2009 H.R. 83 - Homeowners Insurance Protection Act of 2009 H.R. 2609 - Insurance Information Act of 2009 Legal Reform Low Income Tax Recapture Bonds H.R. 3424 - To amend the Internal Revenue Code of 1986 to disallow the deduction for excess non-taxed reinsurance premiums with respect to United States risks paid to affiliates. McCarran-Ferguson Reform and Modernization Medicare Secondary Payer and Workers' Compensation Settlement Agreements H.R. 635 - National Commission on State Workers Compensation Laws Act of 2009 H.R. 1264 - Multiple Peril Insurance Act of 2009 H.R. 2554 - National Association of Registered Agents and Brokers Reform Act of 2010 H.R. 1880 - National Insurance Consumer Protection Act H.R. 2571 - Non-admitted and Reinsurance Reform Act of 2009 S. 1363 - Non-admitted and Reinsurance Reform Act of 2009 H.R. 1260 - Patent Reform Act of 2009 S. 515 - Patent Reform Act of 2009 S. 610 - Patent Reform Act of 2009 H.R. 3590 - Patient Protection and Affordable Care Act S. 2478 - Remuneration for Ecological and Societal Tolls Occasioned by Reckless Errors Act H.R. 4173 - Restoring American Financial Stability Act of 2010 S. 1071 - Shareholders Bill of Rights Sunshine in Litigation Act of 2009 H.R. 2761 - Terrorism Risk Insurance Program Reauthorization Act of 2007, Continue to Monitor Legislation Passed December, 2007. H.R. 5297 - The Small Business Lending Fund Act of 2010 (Surety Bond Issues) H.R. 847 - James Zadroga 9/11 Health and Compensation Act of 2010

Client expense: $740,000 · Firm income: Not reported

Government targets: Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of, White House Office

- HR 3590, "Patient Protection and Affordable Care Act", provisions regarding health care reform. - HR 4872, "The Health Care and Education Affordability Reconciliation Act of 2010", regarding health care reform; reasonable effective dates for compliance with insurance reforms; affordable premiums; federal health insurance rate authority; national insurance exchange; grandfathering. Health Care Reform; Pathway to Covering America; Employer Based Health Care System; Uninsured/Expanding Coverage; Health Care Reform Modeling; Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Health Care; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; Medical Loss Ratios; MEWAs; Government-run health insurance Plan; Government Plan Trigger; negotiated rates; state opt-out; Co-Ops; Medicare Payment Rates; Provider Underpayments; Level Playing Field; Affordable Private Health Care; proposed insurer fees; excise taxes on high value Plans; premium caps; 5 to 1 Age Rating Bands; Realistic Minimum Benefit Values; Effective Individual Mandate; Sherlock Report; Health Care Delivery System Reforms; malpractice reform; Oliver Wyman actuarial analysis "Impact of the Patient Protection and Affordable Care Act on the Costs in the Individual and Small-Employer Health Insurance Markets"; CBO premium impact analysis; New federal regulatory functions; existing state regulatory functions; Federal Exchanges; Federal Connectors; Virtual Connectors; State Insurance Marts (SIMs); Pooling; Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; evidence based care; Health Care Delivery System Reforms; Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; Antitrust and Health Insurance Reform; McCarran-Ferguson antitrust exemption repeal legislation: HR 4626, "Health Insurance Industry Fair Competition Act"; Scope of FEHBP preemption.

Client expense: $250,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- HR 3590, "Patient Protection and Affordable Care Act", provisions regarding health care reform. - HR 4872, "The Health Care and Education Affordability Reconciliation Act of 2010", regarding health care reform; reasonable effective dates for compliance with insurance reforms; affordable premiums; federal health insurance rate authority; national insurance exchange; grandfathering. Health Care Reform; Pathway to Covering America; Employer Based Health Care System; Uninsured/Expanding Coverage; Health Care Reform Modeling; Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Health Care; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; Medical Loss Ratios; MEWAs; Government-run health insurance Plan; Government Plan Trigger; negotiated rates; state opt-out; Co-Ops; Medicare Payment Rates; Provider Underpayments; Level Playing Field; Affordable Private Health Care; proposed insurer fees; excise taxes on high value Plans; premium caps; 5 to 1 Age Rating Bands; Realistic Minimum Benefit Values; Effective Individual Mandate; Sherlock Report; Health Care Delivery System Reforms; malpractice reform; Oliver Wyman actuarial analysis "Impact of the Patient Protection and Affordable Care Act on the Costs in the Individual and Small-Employer Health Insurance Markets"; CBO premium impact analysis; New federal regulatory functions; existing state regulatory functions; Federal Exchanges; Federal Connectors; Virtual Connectors; State Insurance Marts (SIMs); Pooling; Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; evidence based care; Health Care Delivery System Reforms; Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; Antitrust and Health Insurance Reform; McCarran-Ferguson antitrust exemption repeal legislation: HR 4626, "Health Insurance Industry Fair Competition Act"; Scope of FEHBP preemption.

Client expense: $250,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General issues on comprehensive health reform, including all aspects relating to coverage, financing, and delivery reform (no specific legislation introduced) H.R. 3590, Patient Protection and Affordable Care Act, provisions on Coverage, Delivery Reform and Financing H.R. 4872, Health Care and Education Reconciliation Act, provisions on Coverage, Delivery Reform and Financing H.R. 850, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 1346/S.540, Medical Device Safety Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 3200, America's Affordable Health Choices Act of 2009 Ongoing legislative issues related to health care reform in Senate HELP & Finance Committees, and House Education & Labor, Energy & Commerce, and Ways & Means (legislation not yet introduced) General issues related to medical liability reform and ERISA preemption (specific legislation not yet introduced) H. Res. 1203, a resolution providing for consideration of the Senate amendments to the bill (H.R. 3590) to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes, and providing for consideration of the bill (H.R. 4872) to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010, provisions on health care

Client expense: $25,120,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Security Council (NSC), Office of Management & Budget (OMB), Pipeline & Hazardous Materials Safety Administration, SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

S 2 Middle Class Opportunity Act, Card Check provisions; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241, a bill to amend title 10, United States Code to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, a bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill to amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self-employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse- Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socio-economic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs; S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comment letter expressing concerns taht ONC's certification criteria for EHR eliminates flexibility CMS established in rule for achieving meaningful use; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services; HR 6095 to amend title XVIII of the Social Security Act to preserve integrated care for durable medical equipment under the competitive bidding program for qualified hospital-related DME entities; S 3653 Healthcare Bureacrats Elimination Act, A bill to remove unelected, unaccountable bureaucrats from seniors' personal health decisions by repealing the IPAB.

Client expense: $5,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

HR 3596/S 1681: HEALTH INSURANCE INDUSTRY ANTITRUST ENFORCEMENT ACT OF 2009; PROVISIONS RELATED TO PROPERTY-CASUALTY AND LIFE INSURANCE HR 4626: HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT; PROVISIONS RELATED TO PROPERTY-CASUALTY AND LIFE INSURANCE

Client expense: $290,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; (cont.) H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3590, Patient Protection and Affordable Care Act (Reid) health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, federal rate review process, restrictions on rescissions, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit; and S. 3958, Empowering States to Innovate Act, (Wyden-Brown) state innovation waivers. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $1,980,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R. 4626, Health Insurance Industry Fair Competition Act, McCarran Ferguson repeal for health insurance

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE INFORMATION CLEARINGHOUSE H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED ANNUITIES REGULATION H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO TAX INCENTIVES FOR ANNUITIES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS AND ANNUITIES SALES H.R. 3590: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH REFORM, AND MEDICARE TAX ON NONQUALIFIED ANNUITY INCOME H.R. 4126: RETIREMENT FAIRNESS ACT OF 2009; PROVISIONS RELATED TO MODIFICATION OF 401(K) PLAN RULES H.R. 4173: DODD-FRANK WALL STREET REFORM AND CONSUMER PROTECTION ACT (FKA: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010); ALL PROVISIONS OF THE BILL H.R. 4213: UNEMPLOYMENT COMPENSATION EXTENSION ACT OF 2010 (FKA: AMERICAN JOBS AND CLOSING TAX LOOPHOLES ACT OF 2010); PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 4626: HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT; PROVISIONS RELATED TO INSURANCE ANTI-TRUST REGULATIONS (MCCARRON-FERGUSON) H.R. 4742: SMALL BUSINESSES ADD VALUE FOR EMPLOYEES (SAVE) ACT OF 2009; PROVISIONS RELATED TO SIMPLIFICATION OF SIMPLE IRAS, AND VOLUNTARY AUTO IRAS H.R. 4872: HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH CARE REFORM, AND UNEARNED INCOME TAXATION H.R. 5297: SMALL BUSINESS JOBS AND CREDIT ACT OF 2010; PROVISIONS RELATED TO PARTIAL ANNUITIZATION AND ROTH CONVERSIONS OF 401(K) SAVINGS S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE S. 1177: CONFIDENCE IN LONG-TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION IN LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES TAX INCENTIVES S. 1626: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S.1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS S. 2832: LIFETIME INCOME DISCLOSURE ACT; PROVISIONS RELATED TO ANNUITY ILLUSTRATION ON BENEFIT STATEMENTS S. 3217: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010; PROVISIONS RELATED TO REGULATORY REFORM

Client expense: $380,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3590: the Patient Protection and Affordable Care Act H.R. 4872: Health Care and Education Reconciliation Act H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stablization, for fiscal year ending Sept. 30. 2009 and other purposes. S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title for certain non-instutionalized full benefit dual eligible individuals. S. 631: A bill to amend the Internal Revenue Code of 1986 to allow long-term insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. S. 245: A bill to expand, train and support all sectors of the health care workforce to care for the growing population of older individuals in the United States. H.R. 1642: Fire safety legislation that would assist all of our nation's nursing facilities in becoming fully sprinklered. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 468: To expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States. H.R. 2536: To provide relief for the shortage of nurses in the United States, and for other purposes. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S.1796: America's Healthy Future Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 2043: To amend the Public Health Service Act to authorize capitation grants to increase the number of nursing facilities and students, and for other purposes. S. 795: A bill to amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. H.R. 3590: The Patient Protection and Affordable Care Act. H.R. 4626: Health Insurance Industry Fair Competition Act. H.Res.1291: Expressing support for designation of the week beginning May 9, 2010, as National Nursing Home Week. S.Res. 518: Senate support for National Nursing Home Week. H.R. 5457: Nursing Home Patient and Medicaid Assistance Act of 2010. S. 2871: Rosa's Law. Child Labor Law final rule, 29 CFR parts 570 and 579 H.R. 4994: Medicare and Medicaid Extenders Act of 2010. H.R. 2520: The Patient's Choice Act. H.R. 5712: Veterans, Seniors and Children's Health Technical Corrections Act of 2010.

Client expense: $500,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), SENATE

Insurance regulation reform issues including optional federal charter, creation of a Federal Insurance Office, McCarran-Ferguson, retained assets accounts, long-term disability issues and underwriting issues. S.1583 - Insurance Industry Competition Act of 2009 - all provisions H.R.1880 - National Insurance Consumer Protection Act - all provisions H.R.2609 Insurance Information Act of 2009 / Federal Insurance Office Act of 2009 all provisions H.R.2554 National Association of Registered Agents and Brokers Reform Act of 2009 - licensing issues H.R.2571 / S.1363 Nonadmitted and Reinsurance Reform Act of 2009 surplus lines issues H.R.3059 / S.1386 - Access to Repair Parts all provisions H.R.2057 Motor Vehicles Owners Right to Repair Act of 2009 all provisions S.1681 / H.R.3596 - Health Insurance Industry Anti-Trust Enforcement Act of 2009 definitions of insurance: liability and health H.R.4626 Health Insurance Industry Fair Competition Act Lines of insurance included and FTC study of insurance H.R.5993 / S.3718 Securing Americas Veterans Insurance Needs and Goals (SAVINGS) Act of 2010 all provisions S.3683 Insurance Competition and Transparency Act of 2010 FTC Oversight Provisions Natural catastrophe issues including proposals regarding government backstops for insurance losses from large-scale natural catastrophes. H.R.1264 - Multiple Peril Insurance Act of 2009 all provisions H.R.83 Homeowners Insurance Protection Act of 2009 all provisions H.R.998 - Policyholder Disaster Protection Act of 2009 all provisions S.866 Catastrophe Obligation Guarantee Act all provisions H.R.2555 / S.505 Homeowners Defense Act all provisions S.1486 / H.R.998 Policyholder Disaster Protection Act of 2009 all provisions S.1487 Commission on Catastrophic Disaster Risk and Insurance Act of 2009 all provisions H.R.2555 Homeowners Defense Act of 2009 all provisions S.3672 Coordination of Wind and Flood Perils Act of 2010 all provisions Flood insurance issues including reauthorization of the National Flood Insurance Program (NFIP) H.R.1105 Omnibus Appropriations Act, 2009 extend the National Flood Insurance Program (NFIP) to September 30, 2009 and privacy provisions H.R.3139 National Flood Insurance Program Extension Act of 2009 Extend the NFIP program H.R.2918 Legislative Branch Appropriations Act 2010 Temporary extension of the NFIP H.R.2996 the Interior Environment Appropriations Act Temporary extension of the NFIP H.R.3326 The Department of Defense Appropriations Act 2010 Temporary extension of the NFIP H.R.4691 Temporary Extension Act of 2010 Temporary extension of the NFIP H.R.2701 Intelligence Authorization Act of 2010 Temporary extension of the NFIP & COBRA Hiring Incentives to Restore Employment Act Draft bill Temporary extension of the NFIP H.R.4851 Continuing Extension Act of 2010 Temporary extension of the NFIP H.R.5114 Flood Insurance Reform Priorities Act of 2010 all provisions H.R.5255 Stable Flood Insurance Authorization Act of 2010 all provisions H.R.4778 National Flood Insurance Program Extension Act of 2010 all provisions S.3347 - a bill to extend the National Flood Insurance Program through December 31, 2010 all provisions H.R.5569 National Flood Insurance Program Extension Act of 2010 all provisions H.R.4213 - American Jobs and Closing Tax Loopholes Act of 2010 - Temporary extension of the NFIP S.3814 National Flood Insurance Program Reextension Act of 2010 - all provisions Workers compensation issues including: H.R.635 National Commission on State Workers Compensation Laws Act of 2009 all provisions H.R.2641 Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2009 all provisions Clarification of Medicare Secondary Payer reporting requirements Health care reform issues, including revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation. H.R.3200 - Americas Affordable Health Choices Act of 2009 S.1679 - Affordable Health Choices Act including the CLASS Act and the Universal 24-Hour Coverage amendment S. 1796 - Americas Healthy Future Act of 2009 - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation) H.R.3590 Patient Protection and Affordable Care Act (House and Senate versions) - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation H.R.3962 the Affordable Health Care for America Act - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation H.R.4872 Health Care and Education Reconciliation Act of 2010 - revenue offsets

Client expense: $710,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R. 83. Homeowners Insurance Protection Act (entire bill) H.R. 308/ S. 1364. Hurricane and Tornado Mitigation Investment Act (entire bills) H.R. 1583. To further competition in the insurance industry (Repeals McCarran-Furguson Act) (entire bills) H.R 327/ S. 1485. National Hurricane Research Initiative Act (entire bill) H.R. 988/ S. 1486. Policyholder Disaster Protection Act (entire bill) H.R. 1239. Property Mitigation Assistance Act (entire bill) H.R. 1264. Multi Peril Insurance Act (entire bill) S. 505. Homeowners Defense Act (entire bill) H.R. 1880. National Insurance Consumer Protection Act (entire bill) H.R. 1754/ S.664. Financial System Stabilization and Reform Act of 2009 (entire bill) S. 886. Catastrophe Obligation Guarantee Act (entire bill) H.R. 2555. Homeowners Defense Act of 2009 (entire bill) H.R. 2554. National Association of Registered Agents and Brokers Reform Act (entire bill) H.R. 2571/ S. 1363. Non-admitted and Reinsurance Reform Act H.R. 2609. Insurance Information Act (entire bill) H.R. 3596/ S. 1681. Health Insurance Industry Antitrust Enforcement Act (entire bill) S.1484. Catastrophe Savings Account Act (entire bill) S. 1487. Commission on Catastrophic Disaster Risk and Insurance Act (entire bill) H.R. 3139. National Flood Insurance Program Extension Act (entire bill) H.R. 3126/ H.R. 3639. Consumer Financial Protection Agency Act S. 1540. Resolution Reform Act of 2009 H.R. 4173. Wall Street Reform and Consumer Protection Act of 2009. (entire bill) H.R. 3817. Investor Protections Act of 2009. (entire bill) H.R. 3818. Private Fund Investment Advisors Registration Act of 2009. (entire bill) H.R. 3996. Financial Stability Improvement Act. (entire bill) S. 3217. Restoring America's Financial Stability Act (entire bill) H.R. 4778. National Flood Insurance Program Extension Act (entire bill) H.R. 4802. Risk Retention Modernization Act (entire bill) H.R. 4626. Health Insurance Industry Fair Competition Act (entire bill) H.R. 5114. Flood Insurance Reform Priorities Act (entire bill) H.R. 5255. Stable Flood Insurance Authorization Act (entire bill) S. 3347. To extend the NFIP though December 31, 2010 (entire bill) S. 3814. National Flood Insurance Program Re-extension Act (entire bill) S. 3685. Insurance Competition and Transparency Act (entire bill) S. 3546. Cheaper Car Insurance Act (entire bill)

Client expense: $310,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT), Treasury, Dept of

Implementation of healthcare reform laws - Executive Branch actions re PL 111-148 and PL 111-152. Repeal Patient Protection and Affordable Health Care Acts (PL 111-148/PL 111-152) - HR 4901, To repeal the Patient Protection and Affordable Care Act; HR 4903, To repeal the Patient Protection and Affordable Care Act; HR 4910, To repeal the Patient Protection and Affordable Care Act and enact the Empowering Patients First Act in order to provide incentives to encourage health insurance coverage; HR 4919, To repeal the Patient Protection and Affordable Care Act; HR 4972, To repeal the Patient Protection and Affordable Care Act; HR 5005, To repeal the Patient Protection and Affordable Care Act; HR 5073, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and enact the OPTION Act of 2009; HR 5216, To repeal the Patient Protection and Affordable Care Act; HR 5421, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, repeal the 7.5 percent threshold on the deduction for medical expenses, provide for increased funding for high-risk pools, allow acquiring health insurance across State lines, and allow for the creation of association health plans; HR 5424, Reform Americans Can Afford Act of 2010 ; HR 5444, Private Option Health Care Act; HR 6355, STAT Act of 2010; S 3147, Patient Choice Restoration Act; S 3152, A bill to repeal the Patient Protection and Affordable Care Act. *High risk pools - HR 5664, High-Risk Pool Fairness Act. *Effective date for prohibitionon rescissions - HR 5761, To amend the Patient Protection and Affordable Care Act to expedite the application of the provision prohibiting rescissions of health insurance coverage. *Government-run plan - HR 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. *Guarantee-issue and open enrollment for Medigap policies - HR 5844, Fairness in Medigap Options Act of 2010. *Regulations of LTC insurance - HR 5890, Long-Term Care Insurance Reform Act of 2010. *Third-party review of LTC insurance disputed claims - S 1626, A bill to require issuers of long term care insurance to establish third party review processes for disputed claims. *Model disclosure forms for LTC insurance - S 1636, A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance. *Model Disclosure form for long-term care insurance - HR 4078, To require the Secretary of Health and Human Services to develop a national model disclosure form to assist consumers in purchasing long-term care insurance. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010. *Changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms - HR 4872, Health Care and Education Reconciliation Act of 2010. *Requirements for dental coverage - HR 5000, Dental Coverage Value and Transparency Act of 2010. *Requirements for private disability insurers - HR 6066, Preventing Social Security Fraud Act of 2010. *Supplemental disability insurance for Federal employees - HR 6368, Federal Employee Disability Insurance Act of 2010. *FTC authority - S 3685, Insurance Competition and Transparency Act of 2010. *Health coverage tax credit - S 3793, Job Creation and Tax Cuts Act of 2010. *State innovation waivers - S 3958, Empowering States to Innovate Act. *Disclosure of coverage exclusions - HR 1253, To require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry; S 1681, Health Insurance Industry Antitrust Enforcement Act of 2009. *Recissions, hospital stays for breast cancer patients - HR 1691, To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; S 688, A bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations. *Coverage requirement for cancer screening - HR 4563, Cancer Screening Coverage Act of 2009. *MCCarran-Ferguson antitrust exemption - HR 4626, Health Insurance Industry Fair Competition Act. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *National marketplace - HR 3217, Health Care Choice Act of 2009; S 1459, A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. *Reinstatement of coverage upon payment of overdue premiums - HR 3584, To amend the Public Health Service Act to require reinstatement upon payment of all premiums due of group or individual health insurance coverage terminated by reason of nonpayment of premiums. *Changes to McCarran-Ferguson Act - HR 3596, To ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers; S 1681, A bill to ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Agriculture/food-related provisions of: H.R.4626, to restore federal antitrust law application to health insurance business. Issues other than legislation: Expansion and strengthening of antitrust enforcement. Merger review. Merger moratorium on large agribusiness consolidations. Impact of concentration in the banking industry. Impact of concentration in the agricultural chemical industry. Pricing practices of the agricultural chemical industry. Limitations on packer market power.

Client expense: $110,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Bureau of Indian Affairs (BIA), Commodity Futures Trading Commission (CFTC), Council of Economic Advisers (CEA), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Farm Credit Administration, Federal Emergency Management Agency (FEMA), Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Aeronautics & Space Administration (NASA), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Surface Transportation Board (STB), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Immigration & Customs Enforcement (ICE), U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR)

H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 3590, Patient Protection and Affordable Care Act (P.L. 111-148), specifically issues related to the regulatory process and legislative corrections H.R. 4872, Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), specifically issues related to the regulatory process and legislative corrections H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act S. 3501, American Job Protection Act S. 3673, Patients' Freedom to Choose Act S. 510, FDA Food Safety Modernization Act, provisions related to 1099 reporting and amendments offered by Senator Mike Johanns and Senator Max Baucus which would repeal Section 9006 of H.R. 3590, Patient Protection and Affordable Care Act S. 3924, Public Accountability in Health Care Implementation Act Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information Adult Child Coverage (Age 26) Interim Final Rule Grandfathered Plan Status Interim Final Rule Preexisting Condition Exclusion, Lifetime & Annual Limits Rescissions, and Patient Protections Interim Final Rule Preventive Services Coverage Interim Final Rule Internal Claims & Appeals and External Review Processes Interim Final Rule Preexisting Condition Insurance Plan (PCIP) Interim Final Rule 1099 Reporting Requirements Request for Comments Planning and Establishment of State-level Exchanges Request for Comments National Quality Plan Request For Comments Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments Essential Health Benefits (IOM Study) Issues related to ERISA preemption (specific legislation not yet introduced) Various ongoing issues related to Section 9006 of of H.R. 3590, Patient Protection and Affordable Care Act, usually referred to as the 1099 reporting mandate Comprehensive health reform and all aspects relating to coverage, financing, delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate

Client expense: $36,360,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Election Commission (FEC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR), White House Office

H.R. 1020 - Arbitration Fairness Act of 2009 S. 931 - Arbitration Fairness Act of 2009 Asbestos Related Legislation Bankruptcy Transparency Issues S. 3305 - Big Oil Bailout Prevention Liability Act of 2010 Climate Change/Global Warming Coastal Wind Zone Proposal H.R. 3644 - Commission on Natural Catastrophe Risk Management and Insurance Act of 2007 Credit Scoring and the Use of Credit as Underwriting Tool Emergency Economic Stabilization Act of 2008 and TARP Related Issues H.R. 1409 - Employee Free Choice Act of 2009 S. 560 - Employee Free Choice Act of 2009 H.R. 1788 - False Claims Act Correction Act of 2009 Federal Resolution Authority Financial Services Systemic Risk Proposals Obama Administrations White Paper on Financial Services Modernization H.R. 5114 - Flood Insurance Reform Priorities Act of 2010 Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152) H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 4626 - Health Insurance Industry Fair Competition Act S. 1681 - Health Insurance Industry Antitrust Enforcement Act of 2009 H.R. 2555 - Homeowners Defense Act of 2009 S. 505 - Homeowners Defense Act of 2009 H.R. 83 - Homeowners Insurance Protection Act of 2009 H.R. 2609 - Insurance Information Act of 2009 Legal Reform Low Income Tax Recapture Bonds H.R. 3424 - To amend the Internal Revenue Code of 1986 to disallow the deduction for excess non-taxed reinsurance premiums with respect to United States risks paid to affiliates. McCarran-Ferguson Reform and Modernization Medicare Secondary Payer and Workers' Compensation Settlement Agreements H.R. 635 - National Commission on State Workers Compensation Laws Act of 2009 H.R. 1264 - Multiple Peril Insurance Act of 2009 H.R. 2554 - National Association of Registered Agents and Brokers Reform Act of 2010 H.R. 1880 - National Insurance Consumer Protection Act H.R. 2571 - Non-admitted and Reinsurance Reform Act of 2009 S. 1363 - Non-admitted and Reinsurance Reform Act of 2009 H.R. 1260 - Patent Reform Act of 2009 S. 515 - Patent Reform Act of 2009 S. 610 - Patent Reform Act of 2009 H.R. 3590 - Patient Protection and Affordable Care Act S. 2478 - Remuneration for Ecological and Societal Tolls Occasioned by Reckless Errors Act H.R. 4173 - Restoring American Financial Stability Act of 2010 S. 1071 - Shareholders Bill of Rights Sunshine in Litigation Act of 2009 H.R. 2761 - Terrorism Risk Insurance Program Reauthorization Act of 2007, Continue to Monitor Legislation Passed December, 2007. H.R. 5297 - The Small Business Lending Fund Act of 2010 (Surety Bond Issues) H.R. 847 - James Zadroga 9/11 Health and Compensation Act of 2010

Client expense: $1,570,000 · Firm income: Not reported

Government targets: Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of, White House Office

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation, health care reform H.R. 4626 - Health Insurance Industry Fair Competition Act, Anti-trust exemption ***, no specific bill(s), Health Savings Accounts/Medical Saving Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Government Plan Option, Uninsured, Employer Based Health System, Health Care Reform, small group market reform, exchanges, health care reform implementation

Client expense: Not reported · Firm income: $100,000

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

Provide counsel regarding Health Industry Fair Competition Act (H.R. 4626) and Health Insurance Industry Antitrust Enforcement Act of 2009 (S. 1681)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853: Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 3829- Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage.

Client expense: $1,631,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issues Area: HCR-Healthcare Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act" parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care & Education Affordability Reconciliation Act of 2010" parts pertaining to health care reform; reasonable effective dates for compliance with insurance reforms; affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority; national insurance exchange; grandfathering Health Care Reform; Pathway to Covering America; Employer Based Healthcare System; Uninsured/Expanding Coverage; Healthcare Reform Modeling; Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Saving Accounts; Individual Mandate; Medical Loss Ratios; MEWAs; Government-run health insurance plan; Government Plan Trigger; negotiated rates; state opt-out; Co-Ops; Medicare Payment Rates; Provider Underpayments; Level Playing Field Affordable Private Health Care; proposed insurers fees; excise taxes on high value plans; premium caps; 5 to 1 Age Rating Bands; Realistic Minimum Benefit Values; Effective Individual Mandate; Sherlock Report; Healthcare Delivery System Reforms; malpractice reform; Oliver Syman actuarial analysis "Impact of the Patient Protection and Affordable Care Act on the Costs in the Individual and Small-Employer Health Insurance Markets"; CBO premium impact analysis New federal regulatory functions; existing state regulatory functions; Federal Exchanges; Federal Connectors; Virtual Connectors; State Insurance Marts (SIMs); Pooling Health Care Quality: Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; evidence based care; Healthcare Delivery System Reforms; Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification Antitrust and Health Insurance Reform; McCarran-Ferguson antitrust exemption repeal legislation: HR 4626 "Health Insurance Industry Fair Competition Act" Scope of FEHBP preemption

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance Industry Competition Act of 2009 - H.R. 1583, all provisions Financial System Stabilization and Reform Act of 2009 - H.R. 1754/S. 664, all provisions National Insurance Consumer Protection Act - H.R. 1880, all provisions Community Reinvestment Modernization Act of 2009 - H.R. 1479, all provisions Nonadmitted and Reinsurance Reform Act of 2009 - H.R. 2571/S. 1363, all provisions National Association of Registered Agents and Brokers Reform Act of 2009 - H.R. 2554, all provisions Insurance Information Act of 2009 - H.R. 2609, all provisions Health Insurance Industry Antitrust Enforcement Act - H.R. 3596/ S. 1681, all provisions Americas Health Future Act Legislation to reform the healthcare system - H.R. 3962/ H.R. 3590, all provisions Drywall Victims Insurance Protection Act of 2009 - H.R. 4094, all provisions Medicare Secondary Payer Enhancement Act of 2010 - H.R. 4796, all provisions Health Insurance Industry Fair Competition Act - H.R. 4626, all provisions

Client expense: $204,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal legislation that could impact state laws governing medical professional liability; Healthcare Reform (H.R. 3590); Arbitration Fairness Act (H.R. 1020); McCarran-Ferguson repeal (H.R. 4626).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal legislation that could impact state laws governing medical professional liability; Medicare and Medicaid payment rules that impact medical professional liability; McCarran-Ferguson repeal (H.R. 4626); Healthcare Reform (H.R. 3590).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attachment. RET Fourth Quarter Report 2010 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853 - Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. S. 3829 - Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage.

Client expense: $760,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for CARES Act (H.R. 1339/S. 1235) & National Facial Protection Month resolution (H. Res. 193) Support for Health Insurance Industry Fair Competition Act (H.R. 4626) & Dental Coverage Value and Transparency Act (H.R. 5000) Support for designation of September 2010 as National Craniofacial Acceptance Month (H. Res 1603) Support for increasing awareness of craniofacial anomalies (H. Res. 1418)

Client expense: $12,515 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Health Insurance Reform (generally) H.R. 3200 America's Affordable Health Choices Act of 2009 (all provisions) H.R. 15 National Health Insurance Act of 2009 (all provisions) S. 1681 & H.R. 3596-Health Insurance Antitrust Enforcement Act (all provisions) H.R. 3962- Affordable Health Care for America Act (all provisions) H.R. 3590- Patient Protection and Affordable Care Act (all provisions) H.R. 4892- Health Care & Education Reconciliation Act of 2010 (health provisions) H.R. 4626 Health Insurance Industry Fair Competition Act of 2010 (all provisions) PPACA Implementation (generally) H.R. 5808-Amends PPACA to add a public option (all provisions)

Client expense: $290,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

P.L. 111-148 - Patient Protection and Affordable Care Act H.R. 4626 - Health Insurance Industry Fair Competition Act H.R. 2847 - Hiring Incentives to Restore Employment Act P.L. 111-147 - Hiring Incentives to Restore Employment Act H.R. 4213 - Unemployment Compensation Extension Act of 2010 P.L. 111-205 - Unemployment Compensation Extension Act of 2010 Diabetes Prevention; Health Care Reform

Client expense: $550,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

P.L. 111-148 - Patient Protection and Affordable Care Act H.R. 4626 - Health Insurance Industry Fair Competition Act H.R. 2847 - Hiring Incentives to Restore Employment Act P.L. 111-147 - Hiring Incentives to Restore Employment Act H.R. 4213 - Unemployment Compensation Extension Act of 2010 P.L. 111-205 - Unemployment Compensation Extension Act of 2010 Health Care Reform

Client expense: $550,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE INFORMATION CLEARINGHOUSE H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED ANNUITIES REGULATION H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO TAX INCENTIVES FOR ANNUITIES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS AND ANNUITIES SALES H.R. 3590: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH REFORM, AND MEDICARE TAX ON NONQUALIFIED ANNUITY INCOME H.R. 4126: RETIREMENT FAIRNESS ACT OF 2009; PROVISIONS RELATED TO MODIFICATION OF 401(K) PLAN RULES H.R. 4173: DODD-FRANK WALL STREET REFORM AND CONSUMER PROTECTION ACT (FKA: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010); ALL PROVISIONS OF THE BILL H.R. 4213: AMERICAN JOBS AND CLOSING TAX LOOPHOLES ACT OF 2010; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 4626: HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT; PROVISIONS RELATED TO INSURANCE ANTI-TRUST REGULATIONS (MCCARRON-FERGUSON) H.R. 4742: SMALL BUSINESSES ADD VALUE FOR EMPLOYEES (SAVE) ACT OF 2009; PROVISIONS RELATED TO SIMPLIFICATION OF SIMPLE IRAS, AND VOLUNTARY AUTO IRAS H.R. 4872: HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH CARE REFORM, AND UNEARNED INCOME TAXATION H.R. 5297: SMALL BUSINESS JOBS AND CREDIT ACT OF 2010; PROVISIONS RELATED TO PARTIAL ANNUITIZATION AND ROTH CONVERSIONS OF 401(K) SAVINGS S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE S. 1177: CONFIDENCE IN LONG-TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION IN LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES TAX INCENTIVES S. 1626: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S.1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS S. 2832: LIFETIME INCOME DISCLOSURE ACT; PROVISIONS RELATED TO ANNUITY ILLUSTRATION ON BENEFIT STATEMENTS S. 3217: RESTORING AMERICAN FINANCIAL STABILITY ACT OF 2010; PROVISIONS RELATED TO REGULATORY REFORM

Client expense: $590,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance regulation reform issues including optional federal charter, creation of a Federal Insurance Office, McCarran-Ferguson, retained assets accounts, long-term disability issues and underwriting issues. S.1583 - Insurance Industry Competition Act of 2009 - all provisions H.R.1880 - National Insurance Consumer Protection Act - all provisions H.R.2609 Insurance Information Act of 2009 / Federal Insurance Office Act of 2009 all provisions H.R.2554 National Association of Registered Agents and Brokers Reform Act of 2009 - licensing issues H.R.2571 / S.1363 Nonadmitted and Reinsurance Reform Act of 2009 surplus lines issues H.R.3059 / S.1386 - Access to Repair Parts all provisions H.R.2057 Motor Vehicles Owners Right to Repair Act of 2009 all provisions S.1681 / H.R.3596 - Health Insurance Industry Anti-Trust Enforcement Act of 2009 definitions of insurance: liability and health H.R.4626 Health Insurance Industry Fair Competition Act Lines of insurance included and FTC study of insurance H.R.5993 / S.3718 Securing Americas Veterans Insurance Needs and Goals (SAVINGS) Act of 2010 all provisions S.3683 Insurance Competition and Transparency Act of 2010 FTC Oversight Provisions Natural catastrophe issues including proposals regarding government backstops for insurance losses from large-scale natural catastrophes. H.R.1264 - Multiple Peril Insurance Act of 2009 all provisions H.R.83 Homeowners Insurance Protection Act of 2009 all provisions H.R.998 - Policyholder Disaster Protection Act of 2009 all provisions S.866 Catastrophe Obligation Guarantee Act all provisions H.R.2555 / S.505 Homeowners Defense Act all provisions S.1486 / H.R.998 Policyholder Disaster Protection Act of 2009 all provisions S.1487 Commission on Catastrophic Disaster Risk and Insurance Act of 2009 all provisions H.R.2555 Homeowners Defense Act of 2009 all provisions S.3672 Coordination of Wind and Flood Perils Act of 2010 all provisions Flood insurance issues Reauthorization of the National Flood Insurance Program (NFIP) H.R.1105 Omnibus Appropriations Act, 2009 extend the National Flood Insurance Program (NFIP) to September 30, 2009 and privacy provisions H.R.3139 National Flood Insurance Program Extension Act of 2009 Extend the NFIP program H.R.2918 Legislative Branch Appropriations Act 2010 Temporary extension of the NFIP H.R.2996 the Interior Environment Appropriations Act Temporary extension of the NFIP H.R.3326 The Department of Defense Appropriations Act 2010 Temporary extension of the NFIP H.R.4691 Temporary Extension Act of 2010 Temporary extension of the NFIP H.R.2701 Intelligence Authorization Act of 2010 Temporary extension of the NFIP & COBRA Hiring Incentives to Restore Employment Act Draft bill Temporary extension of the NFIP H.R.4851 Continuing Extension Act of 2010 Temporary extension of the NFIP H.R.5114 Flood Insurance Reform Priorities Act of 2010 all provisions H.R.5255 Stable Flood Insurance Authorization Act of 2010 all provisions H.R.4778 National Flood Insurance Program Extension Act of 2010 all provisions S.3347 - a bill to extend the National Flood Insurance Program through December 31, 2010 all provisions H.R.5569 National Flood Insurance Program Extension Act of 2010 all provisions H.R.4213 - American Jobs and Closing Tax Loopholes Act of 2010 - Temporary extension of the NFIP S.3814 National Flood Insurance Program Reextension Act of 2010 - all provisions Workers Compensation issues including: H.R.635 National Commission on State Workers Compensation Laws Act of 2009 all provisions H.R.2641 Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2009 all provisions Health care reform issues, including revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation. H.R.3200 - Americas Affordable Health Choices Act of 2009 S.1679 - Affordable Health Choices Act including the CLASS Act and the Universal 24-Hour Coverage amendment S. 1796 - Americas Healthy Future Act of 2009 - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation H.R.3590 Patient Protection and Affordable Care Act (House and Senate versions) - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation H.R.3962 the Affordable Health Care for America Act - revenue offsets, expansion of the Medicare Secondary Payer Act, definition of health insurer, CLASS Act and workers compensation H.R.4872 Health Care and Education Reconciliation Act of 2010 - revenue offsets

Client expense: $440,000 · Firm income: Not reported

Government targets: Commodity Futures Trading Commission (CFTC), HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms (cont.) H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5297, Small Business Jobs Act (Frank) amendments on employer reporting requirement and individual coverage requirement; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5853, Fiscal Responsibility and Retirement Security Act (Boustany) delaying implementation of the CLASS program; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 5982, Small Business Tax Relief Act (Levin) employer reporting requirements; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; and S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; issues related to COBRA subsidy requirements, issues related to genetic nondiscrimination; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; pre-existing condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $2,330,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

Implementation of healthcare reform legislation, health insurance cooperatives, multi-State plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, Federal rate review process restrictions on recissions, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program - Executive Branch actions re PL 111-148 and PL 111-152. *Disclosure of coverage exclusions - HR 1253, To require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry; S 1681, Health Insurance Industry Antitrust Enforcement Act of 2009. *Recissions, hospital stays for breast cancer patients - HR 1691, To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; S 688, A bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations. *Coverage requirement for cancer screening - HR 4563, Cancer Screening Coverage Act of 2009. *MCCarran-Ferguson antitrust exemption - HR 4626, Health Insurance Industry Fair Competition Act. *Regulatory reform - HR 1880, To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. *National marketplace - HR 3217, Health Care Choice Act of 2009; S 1459, A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. *Reinstatement of coverage upon payment of overdue premiums - HR 3584, To amend the Public Health Service Act to require reinstatement upon payment of all premiums due of group or individual health insurance coverage terminated by reason of nonpayment of premiums. *Changes to McCarran-Ferguson Act - HR 3596, To ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers; S 1681, A bill to ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers. *High risk pools - HR 5664, High-Risk Pool Fairness Act. *Effective date for prohibitionon rescissions - HR 5761, To amend the Patient Protection and Affordable Care Act to expedite the application of the provision prohibiting rescissions of health insurance coverage. *Government-run plan - HR 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. *Guarantee-issue and open enrollment for Medigap policies - HR 5844, Fairness in Medigap Options Act of 2010. *Delaying implementation of the CLASS program - HR 5853, Fiscal Responsibility and Retirement Security Act. *Regulations of LTC insurance - HR 5890, Long-Term Care Insurance Reform Act of 2010. *Third-party review of LTC insurance disputed claims - S 1626, A bill to require issuers of long term care insurance to establish third party review processes for disputed claims. *Model disclosure forms for LTC insurance - S 1636, A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance. *Model Disclosure form for long-term care insurance - HR 4078, To require the Secretary of Health and Human Services to develop a national model disclosure form to assist consumers in purchasing long-term care insurance. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010. *Changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms - HR 4872, Health Care and Education Reconciliation Act of 2010. *Requirements for dental coverage - HR 5000, Dental Coverage Value and Transparency Act of 2010. *Employer reporting requirements - HR 5982, Small Business Tax Relief Act of 2010. *Requirements for private disability insurers - HR 6066, Preventing Social Security Fraud Act of 2010. *Supplemental disability insurance for Federal employees - HR 6368, Federal Employee Disability Insurance Act of 2010. *FTC authority - S 3685, Insurance Competition and Transparency Act of 2010. *Health coverage tax credit - S 3793, Job Creation and Tax Cuts Act of 2010.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 2 Middle Class Opportunity Act, Card Check provisions; S 4 Comprehensive Health Reform Act of 2009, a bill to guarantee affordable, quality health coverage for all Americans, and for other purposes; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241a bill to amend title 10, United States Code, to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; S 179 Health Information Technology Act of 2009, a bill to improve quality in health care by providing incentives for adoption of modern information technology; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; HR 956 HealthCARE Act of 2009, a bill to expand the number of individuals and families with health insurance coverage, and for other purposes; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1085 Health Insurance Coverage Protection Act, a bill to impose a limitation on lifetime aggregate limits imposed by health plans; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; S 441 Quality Reform Expansion and Savings Act of 2009, a bill to encourage the development of coordinated quality reforms to improve health care delivery and reduce the cost of care in the health care system; S 444 National Health Information Technology and Privacy Advancement Act of 2009, a bill to provide for the establishment of a health information technology and privacy system; S 486 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1253 Health Insurance Restrictions and Limitations Clarification Act of 2009, a bill to require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, a bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 698 State-Based Health Care Reform Act, a bill to ensure the provision of high-quality health care coverage for uninsured individuals through State health care coverage pilot projects that expand coverage and access and improve quality and efficiency in the health care system; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill to amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self-employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; HR 2520 Patients' Choice Act, a bill to provide comprehensive solutions for the health care system of the United States; HR 2535 Blueprint for Health Act of 2009, a bill to establish a Blueprint for Health in order to create a comprehensive system of care incorporating medical homes to improve the delivery and affordability of health care through disease prevention, health promotion, and education about and better management of chronic conditions; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2778 Health Equity and Accountability through Research Act of 2009, a bill to amend the Public Health Service Act to redesignate the National Center on Minority Health and Health Disparities as the National Institute for Minority Health and Health Disparities; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S. 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S. 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socioeconomic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3158 Place Based Health Care Act of 2009, a bill to reform health care delivery by providing incentives for place-based health care, which seeks to bring health services to the patient by locating community health centers, federally qualified health centers, and community integrated health centers in or near settings that already serve a particular target population, such as schools, workplaces, and senior services facilities; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; S. 1479 NO TITLE, a bill to provide for the treatment of certain hospitals; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; H.R.3421 Medical Debt Relief Act of 2009, a bill to exclude from consumer credit reports medical debt that has been in collection and has been fully paid or settled; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs, and for other purposes S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; S 1679 Affordable Health Choices Act, an original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; Senate Finance Committee Americas Healthy Future Act of 2009, Senate Finance Committee health reform bill with provisions on coverage, disease prevention and wellness, delivery system reform, health care quality and efficiency, transparency and program integrity, and financing; Meeting with FTC, senate congressional staff re barriers to clinical integration; HR 3590 Patient Protection and Affordable Care Act, the merged product of the health reform bills from the Senate Finance and Health, Education, Labor and Pensions (HELP) committees; HR 3962 Affordable Health Care for America Act, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; HR 3700 Health Care Bill of Rights Act, a bill to establish requirements for any health reform legislation enacted by the Congress or the President during the 111th Congress; HR 3713 American Health Care Solutions Act of 2009, a bill to provide bipartisan solutions to lower health costs, increase access to affordable coverage, and give patients more choices and control; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comments to CMS proposed rule defining meaningful use of electronic Health Records concern that the rules will severely limit hospitals' ability to access federal financing for health information technology and put many hospitals at risk for Medicare payment penalties beginning in 2015; FDA Grants Hospitals 18 Months to Replace Steris System 1 Processor; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services

Client expense: $4,270,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

H.R.914-Physician Workforce Enhancement Act of 2009 H.R.1086-Help, Efficient, Accessible, Low Cost, Timely Healthcare Act of 2009 H.R.1188-Access to Emergency Medical Services Act of 2009 H.R.1253-Health Insurance Restrictions and Limitations Clarification Act of 2009 H.R.1384-To amend part B of title XVIII of the Social Security Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit balance billing H.R.1386-Pay for all your Undocumented Procedures (PAY UP!) Act of 2009 H.R.1468-Medical Justice Act of 2009 H.R.1586/P.L.111-226, FAA Air Transportation Modernization and Safety Improvement Act (Title II) H.R.1639-Border Health Care Relief Act of 2009 H.R.1678-Mitigating the Impact of Uncompensated Service and Time Act of 2009 H.R.1796-Residential Carbon Monoxide Poisoning Prevention Act H.R.1998-Health Care Safety Net Enhancement Act of 2009 H.R.3199-Emergency Medic Transition (EMT) Act of 2009 H.R.3360/P.L.111-332-Cruise Vessel Security and Safety Act of 2010 H.R.3590/P.L.111-148-Patient Protection and Affordable Care Act H.R.3596-Health Insurance Industry Antitrust Enforcement Act of 2009 H.R.3962-Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R.4213-Tax Extenders Act of 2009 H.R.4626-Health Insurance Industry Fair Competition Act H.R.4851-To Provide a Temporary Extension of Certain Programs, and for other purposes H.R.5710-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2010 H.R.5950-Improving Access to Medicare Coverage Act of 2010 H.R.6306-Critical Care Assessment and Improvement Act of 2010 S.468-Access to Emergency Medical Services Act of 2009 S.1216-Residential Carbon Monoxide Poisoning Prevention Act S.1681-Health Insurance Industry Antitrust Enforcement Act of 2009 S.3575-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2010

Client expense: $589,902 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation, health care reform H.R. 4626 - Health Insurance Industry Fair Competition Act, Anti-trust exemption ***, no specific bill(s), Health Savings Accounts/Medical Saving Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Government Plan Option, Uninsured, Employer Based Health System, Health Care Reform, small group market reform, exchanges, health care reform implementation

Client expense: Not reported · Firm income: $100,000

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

See attachment. RET Third Quarter Report 2010 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H.R. 4626 - Health Insurance Industry Fair Competition Act. Issue: Amends the McCarran-Ferguson Act to apply to the business of health insurance. H.R. 4742 - SAVE Act. Issue: simplifies SIMPLE IRAs and provides for voluntary Auto IRAs. H.R. 5297 Small Business Lending Fund Act. Issue: Partial Annuitization and Roth Conversions of 401 (k) savings. H.R. 5853 - Fiscal Responsibility and Retirement Security Act. Issue: Changes to the CLASS Act. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. S. 3760/ H.R. 6099 - Automatic IRA Act of 2010. Issue: Both provide for mandatory Auto IRAs for workers without pension coverage. S. 3829 - Long-Term Care Bailout Prevention Act. Issue: Repeal of the CLASS Act.

Client expense: $830,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1322, Emergency Retiree Health Benefits Protection Act of 2009 H.R. 1346 / S. 540, Medical Device Safety Act of 2009 H.R. 4626, Health Insurance Industry Fair Competition Act H.R. 5141 / S. 3578, Small Business Paperwork Mandate Elimination Act, including provisions related to 1099 reporting H.R. 5297, Small Business Jobs and Credit Act of 2010, including amendments related to the repeal of the 1099 reporting mandate S. 3501, American Job Protection Act, including provisions related to an employer mandate S. 3673, Patients' Freedom to Choose Act, including issues related to FSA and HSA provisions H.R. 5853, Fiscal Responsibility and Retirement Security Act, including provisions related to class act reform H.R. 5982, Small Business Tax Relief Act of 2010 S. 3653, Health Care Bureaucrats Elimination Act, IPAB Reform provisions S.J. Res. 39, A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act, including provisions related to PPACA grandfathering and IFR The Consumer Information Enhancement Act of 2010, provisions related to Medicare claims database release (bill number not yet assigned) Draft Comprehensive health reform, all provisions relating to coverage, financing, and delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, and employer mandate (bills in the Senate and House) Various issues related to the regulatory and legislative corrections to the following bills: H.R. 3590, Patient Protection and Affordable Care Act (P.L. 111-148), provisions related to coverage, delivery reform, and financing aspects H.R. 4872, Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), provisions related to coverage, delivery reform, and financing aspects General issues related to ERISA preemption and implementation and the regulatory process following the passage and enactment of health care reform (specific legislation not yet introduced)

Client expense: $29,250,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Export-Import Bank of the United States (EXIM Bank), Federal Communications Commission (FCC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Aeronautics & Space Administration (NASA), Natl Economic Council (NEC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), St. Lawrence Seaway Development Corporation, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

H.R. 4626, Health Insurance Industry Fair Competition Act, McCarran Ferguson repeal for health insurance

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3590: the Patient Protection and Affordable Care Act H.R. 4872: Health Care and Education Reconciliation Act H.R. 2847: The Hiring Incentives To Restore Employment (HIRE) H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stablization, for fiscal year ending Sept. 30. 2009 and other purposes. S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title for certain non-instutionalized full benefit dual eligible individuals. S. 631: A bill to amend the Internal Revenue Code of 1986 to allow long-term insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. S. 245: A bill to expand, train and support all sectors of the health care workforce to care for the growing population of older individuals in the United States. H.R. 1642: Fire safety legislation that would assist all of our nation's nursing facilities in becoming fully sprinklered. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 468: To expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States. H.R. 2536: To provide relief forthe shortage of nurses in the United States, and for other purposes. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S.1796: America's Healthy Future Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 2043: To amend the Public Health Service Act to authorize capitation grants to increase the number of nursing facilities and students, and for other purposes. S. 795: A bill to amend the Social Security Act to enhance the social security of the Nation bu ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. H.R. 3590: The Patient Protection and Affordable Care Act. H.R. 4626: Health Insurance Industry Fair Competition Act. H.Res.1291: Expressing support for designation of the week beginning May 9, 2010, as National Nursing Home Week. S.Res. 518: Senate support for National Nursing Home Week. H.R. 5457: Nursing Home Patient and Medicaid Assistance Act of 2010. H.R. 4504: A bill that will allow state veterans homes to provide services to non-veterans parents of any chlid (one or more) who died while serving in the armed forces, has passed in the House and Senate. S. 2871: Rosa's Law. Child Labor Law final rule, 29 CFR parts 570 and 579

Client expense: $500,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), SENATE

Health Insurance Reform (generally) H.R. 3200 America's Affordable Health Choices Act of 2009 (all provisions) H.R. 15 National Health Insurance Act of 2009 (all provisions) S. 1681 & H.R. 3596-Health Insurance Antitrust Enforcement Act (all provisions) H.R. 3962- Affordable Health Care for America Act (all provisions) H.R. 3590- Patient Protection and Affordable Care Act (all provisions) H.R. 4892- Health Care & Education Reconciliation Act of 2010 (health provisions) H.R. 4626 Health Insurance Industry Fair Competition Act of 2010 (all provisions) PPACA Implementation (generally) H.R. 5808-Amends PPACA to add a public option (all provisions)

Client expense: $280,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Agriculture/food-related provisions of: H.R.4626, to restore federal antitrust law application to health insurance business. Issues other than legislation: Expansion and strengthening of antitrust enforcement. Merger review. Merger moratorium on large agribusiness consolidations. Impact of concentration in the banking industry. Impact of concentration in the agricultural chemical industry. Pricing practices of the agricultural chemical industry. Limitations on packer market power.

Client expense: $200,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Bureau of Indian Affairs (BIA), Commodity Futures Trading Commission (CFTC), Council of Economic Advisers (CEA), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Farm Credit Administration, Federal Emergency Management Agency (FEMA), Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Aeronautics & Space Administration (NASA), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Surface Transportation Board (STB), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Immigration & Customs Enforcement (ICE), U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR)