To amend the Patient Protection and Affordable Care Act to establish a public health insurance option.

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

H.R. 3590 Patient Protection and Affordable Care Act, Pub. Law No: 111-148 H.R. 5710, National All Schedules Prescription Electronic Reporting Reauthorization Act H.R. 4872, The Health Care and Education Affordability Reconciliation Act of 2010 H.R. 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. Nondiscrimination language regarding paraprofessionals H.R. 5295, Healthcare Truth and Transparency Act: Healthcare Provider Transparency, Healthcare Provider Misrepresentation H.R. 756, National Pain Care Policy Act, S.660, National Pain Care Policy Act DEA E-Prescribing DEA Propofol Comparative Effectiveness Research Hospital Acquired Infections HITECH Implemenation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use Data Registry Funding HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Risk Evaluation and Mitigation Strategies Physician Antitrust Relief Physician Workforce Issues Medical Liability Reform FDA Safe Use Initiative FDA Operating Room Fires FDA ACTION Initiative FDA Propofol Shortage FDA Scheduling of Propofol FDA Sentinel Non-Anesthesia Provider Use of Propofol Prescription Drug User Fee Act Deep sedation NASPER Funding; controlled substance abuse, misuse and diversion Required Physician Supervision of Nurse Anesthetists, Nurse error rates State Exchanges pursuant to PPACA Patient Safety Initiatives FDA SEDASYS FDA Sedation Products Request for Assistance Interventional Pain OSHA Resident Hours regulation

Client expense: $210,000 · Firm income: Not reported

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

S.3307, Healthy, Hunger-Free Kids Act of 2010 H.R.5209, Healthy Communities through Helping to Offer Incentives and Choices to Everyone in Society Act of 2010 H.R.5777, To foster transparency about the commercial use of personal information, provide consumers with meaningful choice about the collection, use, and disclosure of such information, and for other purposes. S.3685, Insurance Competition and Transparency Act of 2010 H.R.5808, To amend the Patient Protection and Affordable Care Act to establish public health insurance option H.R.6303, Medicare Beneficiary Choice Preservation Act of 2010

Client expense: $281,000 · Firm income: Not reported

Employer Health Insurance Mandates S 3501- American Job Protection Act Epansion of Small Business Health Coverage; Possible Limits on Itemized Deductions as Pay-Fors; Affordability Tax Credits S 979 - Small Business Health Options Program (SHOP) Act S 1679 - Affordable Health Choices Act S 1796- America's Healthy Future Act of 2009 HR 2360- Small Business Health Options Program (SHOP) Act of 2009 HR 3200- America's Affordable Health Choices Act of 2009 HR 3962- Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 HR 1470- Equity for Our Nation's Self-Employed Act of 2009 S 725- Equity for Our Nation's Self-Employed Act of 2009 Expansion of Small Business Health Coverage S 45- Medical Care Access Protection (MCAP) Act of 2009 S 79- Healthy Businesses, Healthy Workers Reinsurance Act S 93- Small Business Empowerment Act S 391 - Healthy Americans Act HR 193 - AmeriCare Health Insurance Act of 2009 HR 859- Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 HR 879- Affordable Health Care Expansion Act of 2009 Employer Health Insurance Mandates S 3393 - COBRA Health Benefits Extension Act of 2010 S J Res 39 - A joint resolution providing for congressional disapproval under chapter eight 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. HR 5324 - COBRA Health Benefits Extension Act of 2010 Changes to Federal Health Laws HR 5808 - A bill to amend the Patient Protection and Affordable Care Act to establish a public health insurance option. Changes to Information Reporting Requirements Related to Health Laws S 3578 - Small Business Paperwork Mandate Elimination Act

Client expense: $4,500,000 · Firm income: Not reported

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.

See Attached HR 1583, Insurance Industry Competition Act of 2009 HR 1880, National Insurance Consumer Protection Act HR 2554, National Association of Registered Agents and Brokers Reform Act of 2009 HR 2571, Nonadmitted and Reinsurance Reform Act of 2009 HR 2609, Insurance Information Act of 2009 HR 3139, Natinal Flood Insurance Program Extension Act of 2010 HR 3139, National Flood Insurance Program Extension Act of 2009 HR 4164, A bill to amend the National Flood Insurance Act of 1968 to provide for a phased-in increase of chargeable premium rates for properties affected by updated Flood Insurance Rate Maps. HR 4213, American Workers, State and Business Relief Act of 2010 HR 4691, Temporary Extensions Act of 2010 HR 4778, Natinal Flood Insurance Program Extension Act of 2010 HR 4802, Risk Retention Modernization Act of 2010 HR 4851, Conitinuing Extention Act of 2010 HR 5114, Flood Insurance Reform Priorities Act HR 5297, Small Business Jobs Act of 2010 HR 5553, National Flood Insurance Program Extension Act of 2010 HR 5559, Flood Insurance Fairness Act of 2010 HR 5569, National Flood Insurance Program Extension Act of 2010 HR 5808, Amend PPACA to establish a public health insurance option HR 5982, Small Business Tax Relief Act of 2010 S 1363, Nonadmitted and Reinsurance Reform Act of 2009 S 3153, Conitnuing Extension Act of 2010 S 3203, A bill to extend the National Flood Insurance Program through May 31, 2010 S 3814, National Flood Insurance Reextension act of 2010

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

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.

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

Healthcare Reform: S.391, H.R. 1321 Healthy Americans Act; H.R. 193 American Healthcare Act; H.R. 3200, America's Affordable Health Choices Act; America's Healthy Futures Act of 2009; H.R. 3962, Affordable Healthcare for America Act; H.R. 3590 Patient Protection and Affordable Care Act, Pub. Law No: 111-148 H.R. 5710, National All Schedules Prescription Electronic Reporting Reauthorization Act H.R. 4872, The Health Care and Education Affordability Reconciliation Act of 2010 H.R. 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. Nondiscrimination language regarding paraprofessionals H.R. 5295, Healthcare Truth and Transparency Act: Healthcare Provider Transparency, Healthcare Provider Misrepresentation H.R. 756, National Pain Care Policy Act, S.660, National Pain Care Policy Act DEA E-Prescribing DEA Propofol Comparative Effectiveness Research Hospital Acquired Infections HITECH Implemenation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use Data Registry Funding HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Risk Evaluation and Mitigation Strategies Physician Antitrust Relief Physician Workforce Issues Medical Liability Reform FDA Safe Use Initiative FDA Operating Room Fires FDA ACTION Initiative FDA Propofol Shortage Compliance with Senate Finance Committee request FDA Scheduling of Propofol FDA Sentinel Non-Anesthesia Provider Use of Propofol Prescription Drug User Fee Act Deep sedation NASPER Funding Required Physician Supervision of Nurse Anesthetists, Nurse error rates State Exchanges pursuant to PPACA Patient Safety Initiatives

Client expense: $210,000 · Firm income: Not reported

H.R. 1586 Educations, Jobs and Medicaid Assistance Act S. 3685 Insurance Competition And Transparency Act H.R. 5808 To amend the Patient Protection and Affordable Care Act to establish a public health insurance option S. 3653 Health care Bureaucrats Elimination Act H.R. 5712 Veterans', Seniors and Children's Health Technical Corrections Act of 2010 H.R. 5297 Small business Jobs Act of 2010 H.R. 1745 Family Health Care Accessibility Act S. 3605 America COMPETES Reauthorizations Act H.R. 5116 America COMPETES Reauthorizations Act H.R. 6072 Electronic Health record Incentives for Multi-Campus Hospitals Act of 2010 S. 3708 Electronic Health record Incentives for Multi-Campus Hospitals Act of 2010 S. 3742 Data Security and Breach Notification Act of 2010 H.R. 5777 BEST PRACTICES Act of 2010 H.R. 5297 Small Business Jobs and Credit Act S. 3307 Healthy Hunger-Free Kids Act H.R. 5504 Improving Nutrition for America's Children Act

Client expense: $240,000 · Firm income: Not reported