Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009

H.R. 859, the Small Business CHOICE Act; health care reform legislation before the House and Senate. Legislation in both the House and Senate to reform the health care system in the United States (H.R. 3962 and H.R. 3590). Particular interest in the availability of small employer subsidies to tax-exempt organizations.

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform and its effect on the self-employed.Pooling mechanisms for health care provision.Small Business Empowerment Act of 2009(S.93).america's affordable Health Care Act of 2009(H.R.109) dealing with high risk pools.Small business health insurance cooperatives-Small Business Choice Act(H.R.859). Health care tax credits.Expanding and preserving Health Savings Accounts and Health Reimbursement Arrangements.Leveling the playing field for sole proprietor tax treatment-Equity for Our Nation's Self-Employed Act(H.R.1470/S.725).Patient Protection and Affordable Care Act(H.R.3590).Affordable Health Care for America Act(H.R.3962).

Client expense: $255,000 · Firm income: Not reported

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

H.R. 716, Access to Cancer Clinical Trials Act (Israel) clinical trials coverage mandate; H.R. 850, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 859, Small Business CHOICE Act (Velazquez) small employer health options; (cont.) INS (Legislative) H.R. 1085, Health Insurance Coverage Protection Act (Eshoo) lifetime benefit limits; H.R. 1092, No Discrimination in Health Insurance Act (Kagen) preexisting condition exclusions, affiliation periods, uniform premiums; H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1321, Healthy Americans Act (Eshoo) comprehensive health reform; H.R. 1558, Preexisting Condition Patient Protection Act (Courtney) preexisting condition exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran Ferguson reforms; H.R. 1619, Children's Health Protection Act (Schwartz) preexisting condition exclusions for children; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) rescissions, hospital stays for breast cancer patients; H.R. 1721, CLASS Act (Pallone) national LTC program; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2360, SHOP Act (Kind) small employer health options; H.R. 2402, Woman's Health Insurance Fairness Act (Neal) gender rating for health insurance; H.R. 2413, Autism Treatment Acceleration Act (Doyle) coverage for autism spectrum disorders; H.R. 2427, Informed Consumer Choices in Health Care Act (DeLauro) federal standards for health insurance, consumer information; H.R. 2457, Right to a Second Medical Opinion Act (Davis) coverage of second opinions; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 2635, Gender Equity in Health Premiums Act (Sanchez) gender rating for health insurance; H.R. 2833, Medical Loss Ratios (Ellison) medical loss ratios; H.R. 2940, Women's Obstetrician and Gynecologist Medical Access Now Act (Davis) direct access to ob/gyns; H.R. 3200, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance; 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) government-run health plan, 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, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act; H.R.3681, Fairness in Health Insurance Act (Ellison) medical loss ratios; H.R. 3962, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, federal rate review process, health care choice compacts, high risk pool program, McCarran-Ferguson Act; 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 antitrust exemption; 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; S. 79, Healthy Businesses, Healthy Workers Reinsurance Act (Kerry) reinsurance; S. 93, Small Business Empowerment Act (Brown) small employer health options; S. 391, Healthy Americans Act (Wyden) comprehensive health reform; S. 442, Health Insurance Coverage Protection Act (Dorgan) lifetime benefit limits; S. 488, Access to Cancer Clinical Trials Act (Brown) clinical trials coverage mandate; S. 623, Pre-existing Condition Patient Protection Act (Rockefeller) preexisting condition exclusions; S. 643, Children's Health Protection Act (Lautenberg) preexisting condition exclusions for children; S. 688, Breast Cancer Patient Protection Act (Snowe) rescissions, hospital stays for breast cancer patients; S. 697, CLASS Act (Kennedy) national LTC program; S. 819, Autism Treatment Acceleration Act (Durbin) coverage for autism spectrum disorders; S. 969, Women's Health Insurance Fairness Act (Kerry) gender rating for health insurance; S. 979, SHOP Act (Durbin) small employer health options; S. 1050, Informed Consumer Choices in Health Care Act (Rockefeller) federal standards for health insurance, consumer information; S. 1149, Annual and Lifetime Health Care Limit Elimination Act (Rockefeller) annual and lifetime coverage limits; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; (cont.) INS (Legislative) 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. 1679, Affordable Health Choices Act (Harkin) government-run health plan, insurance market reforms, health benefit gateways, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) changes to McCarran-Ferguson Act; S. 1730, Fairness in Health Insurance Act (Franken) medical loss ratios; S. 1796, Americas Healthy Future Act (Baucus) government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process 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, and issues related to genetic nondiscrimination.

Client expense: $2,700,000 · 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

S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending HR 859 To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit HR 956 To expand the number of individuals and families with health insurance coverage, and for other purposes HR 1558 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets H.R. 1897 to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes H.R. 2520 to provide comprehensive solutions for the health care system of the United States, and for other purposes HR 2847COBRA, extend benefits period; extend termination date eligibility to June 30, 2010 HR 3200 America's Affordable Health Choices Act of 2009 H.R.3590: An act entitled The Patient Protection and Affordable Care Act. H.R.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. H.R. 3925, to amend the Employee Retirement Income Security Act of 1974 to preclude preemption of a state cause of action relating to a denial of a claim for benefits under a health care plan H.R. 3930, to extend for 6 months the maximum COBRA continuation coverage period for individuals who were involuntarily terminated between April 1, 2009, and Dec. 31, 2009, and to amend the American Reinvestment and Recovery Act of 2009 to extend the eligibility period and maximum assistance period for COBRA premium assistance under such Act. H.R.3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending. H.R. 3326: Extends from nine to 15 months the 65% COBRA health insurance subsidy for individuals who have lost their jobs. The job lost eligibility date is extended in the provision to February 28, 2010. Approximately seven million people benefited from the premium subsidy provided in the Recovery Act. HR 4757 to provide for the establishment of a health insurance rate authority to establish limits on premium rating HR 4872 The bill makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act enacted by H.R.3590 and modifies higher education assistance provisions S 179 To improve quality in health care by providing incentives for adoption of modern information technology S 623 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets S 803 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. S. Amdt 98 In the nature of a substitute S. 1099 to provide comprehensive solutions for the health care system of the United States, and for other purposes S. 1149 to eliminate annual and lifetime aggregate limits imposed by health plans S. 1152 to allow Americans to earn paid sick time so that they can address their own health needs and the health needs of their families S. Res. 156 expressing the sense of the Senate that reform of our nation's health care system should include the establishment of a federally-backed insurance pool S. 1488 to extend temporarily the 18-month period of continuation coverage under group health plans required under COBRA continuation coverage provisions so as to provide for a total period of continuation coverage of up to 24 months S. 1679 the 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. 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 S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending S. 3078 to provide for the establishment of a health insurance rate authority to establish limits on premium rating

Client expense: $1,050,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 676, Expanded and Improved Medicare for All Act S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 15, National Health Insurance Act H.R. 194, MediKids Health Insurance Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 S. 1099, Patients Choice Act and Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4872, Health Care and Education Reconciliation Act of 2010 Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010)

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

Expansion of Small Business Health Coverage: H.R. 2360/S. 979 - "Small Business Options Program Act of 2009 (SHOP)" H.R. 859 Small Business CHOICE Act of 2009 Expansion of Small Business Health Coverage (cont'd): H.R. 3590 - "Patient Protection and Affordable Care Act" H.R. 4872 - "Health Care and Education Reconciliation Act of 2010" H.R. 3962 - "Affordable Health Care for America Act" S. 1796 - "America's Healthy Future Act of 2009" H.R. 3200 - "America's Affordable Health Choices Act of 2009" S. 1679 - "Affordable Health Choices Act" H.R. 193 - "AmeriCare Health Care Act of 2009" S. 93 - Small Business Empowerment Act S. 79 - Healthy Businesses, Healthy Workers Reinsurance Act of 2009 S. 45 - Medical Care Access Protection Act of 2009 S. 391 - Healthy Americans Act H.R. 879 - Affordable Health Care Expansion Act of 2009 Payroll Tax Treatment of Health Insurance Premiums Paid for Self-Employed Individuals: S. 725 - "Equity for Our Nation's Self Employed Act of 2009" H.R. 1470 - "Equity for Our Nations Self-Employed Act of 2009"

Client expense: $4,300,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Council on Environmental Quality (CEQ), Energy, Dept of, Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Emergency Management Agency (FEMA), Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Govt-run health plan, health insurance exchanges, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, Federal rate review process, healthcare choice compacts, high risk pool program, McCarran-Ferguson Act - HR 3962, Affordable Health Care for America Act; Govt-run health plan, health insurance cooperatives, multi-state plans, health insurance exchanges, regulatory reform, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, Federal rate review process, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act - HR 3590, Patient Protection and Affordable Care Act. 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. *National LTC program - HR 1721, To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes; S 697, A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. *Clinical trials coverage mandate - HR 716, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials; S 488, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials. *Small employer health options - HR 850, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; HR 859, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; S 93, A bill to provide quality, affordable health insurance for small employers and individuals; HR 2360, 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; S 979, 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. *Lifetime benefit limits - HR 1085, To impose a limitation on lifetime aggregate limits imposed by health plans; S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. *Pre-existing condition exclusions, affiliation periods, uniform premiums - HR 1092, To amend the Employee Retirement Income Security Act of 1974, Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit discrimination in group health coverage and individual health insurance coverage. *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. *Comprehensive health reform - HR 1321, To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away, S 391, A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. *Pre-existing condition exclusions - HR 1558, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets; S 623, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry. *Pre-existing condition exclusions for children - HR 1619, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets; S 643, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets. *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. *Gender rating for health insurance - HR 2402, To amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market; HR 2635, To amend title XXVII of the Public Health Service Act to prohibit gender rating in the group and individual markets for health insurance coverage, and for other purposes; S 969, A bill to amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market. *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. *Federal standards for health insurance, consumer information - HR 2427, 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, and for other purposes; S 1050, 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, and for other purposes. *Coverage of second opinions - HR 2457, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to require that group health plans and issuers of health insurance coverage provide coverage for second opinions. *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. *Medical loss ratios - HR 2833, To require a minimum loss ratio for 90 percent for health insurance coverage offered through an insurance exchange. *Direct access to Ob/Gyns - HR 2940, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans permit enrollees direct access to services of obstetrical and gynecological physician services directly and without a referral. *Coverage for autism spectrum disorders - HR 2413, To provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families; S 819, A bill to provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families. *Reinsurance - S 79, A bill to amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *Annual and lifetime coverage limits - S 1149, A bill to eliminate annual and lifetime aggregate limits imposed by health plans. *Lifetime benefit limits - S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. *Small employer health options - HR 2360, 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. *Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. *National marketplace, health insurance coverage offered in interstate commerce; 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. *Medical loss ratios - HR 3681, To provide for minimum loss ratios for health insurance coverage; S 1730, A bill to provide for minimum loss ratios for health insurance coverage. *Third-party review of LTCI 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. *Government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010.

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

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

HR3763 To amend the Fair Credit Reporting Act to provide for an exclusion from Red Flag Guidelines for certain businesses. HR 859 Small Business Cooperatives for Healthcare Options to Improve Coverage for Employees (CHOICE) Act.

Client expense: $450,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 859, the Small Business CHOICE Act; health care reform legislation before the House and Senate. Legislation in both the House and Senate to reform the health care system in the United States (H.R. 3962 and H.R. 3590). Particular interest in the availability of small employer subsidies to tax-exempt organizations.

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

*National LTC program - HR 1721, To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes; S 697, A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. *Immunization coverage mandate - HR 323, To amend title XXVII of the Public Health Service Act and title I of the Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide comprehensive coverage for childhood immunization. *Coverage mandate for hormone replacement therapy - HR 584, To provide for coverage of hormone replacement therapy for treatment of menopausal symptoms, and for coverage of an alternative therapy for hormone replacement therapy for such symptoms, under the Medicare and Medicaid Programs, group health plans and individual health insurance coverage, and other Federal health insurance programs. *Clinical trials coverage mandate - HR 716, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials; S 488, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials. *Small employer health options - HR 850, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; HR 859, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; S 93, A bill to provide quality, affordable health insurance for small employers and individuals; HR 2360, 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; S 979, 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. *Coverage mandate for mammograms - HR 995, To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for annual screening mammography for women 40 years of age or older and for such screening and annual magnetic resonance imaging for women at high risk for breast cancer if the coverage or plans include coverage for diagnostic mammography for women 40 years of age or older. *Lifetime benefit limits - HR 1085, To impose a limitation on lifetime aggregate limits imposed by health plans; S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. *Pre-existing condition exclusions, affiliation periods, uniform premiums - HR 1092, To amend the Employee Retirement Income Security Act of 1974, Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit discrimination in group health coverage and individual health insurance coverage. 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. Comprehensive health reform - HR 1321, To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away, S 391, A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. Coverage mandate for cancer screening - HR 1330, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, to require that group and individual health insurance coverage and group health plans and Federal employees health benefit plans provide coverage of colorectal cancer screening. Coverage mandate for treatment of a child's congenital or developmental deformity - HR 1339, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease; S 1235, A bill to amend the Public Health Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. Pre-existing condition exclusions - HR 1558, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets; S 623, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets. McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry. Pre-existing condition exclusions for children - HR 1619, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets; S 643, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets. 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. Gender rating for health insurance - HR 2402, To amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market; HR 2635, To amend title XXVII of the Public Health Service Act to prohibit gender rating in the group and individual markets for health insurance coverage, and for other purposes; S 969, A bill to amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market. Federal standards for health insurance, consumer information - HR 2427, 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, and for other purposes; S 1050, 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, and for other purposes. Coverage of second opinions - HR 2457, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to require that group health plans and issuers of health insurance coverage provide coverage for second opinions. 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. Medical loss ratios - HR 2833, To require a minimum loss ratio for 90 percent for health insurance coverage offered through an insurance exchange. Direct access to Ob/Gyns - HR 2940, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans permit enrollees direct access to services of obstetrical and gynecological physician services directly and without a referral. Coverage for autism spectrum disorders - HR 2413, To provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families; S 819, A bill to provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families. Reinsurance - S 79, A bill to amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs. Coverage mandate for infertility treatments - HR 697, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility; S 1258, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility. LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. Annual and lifetime coverage limits - S 1149, A bill to eliminate annual and lifetime aggregate limits imposed by health plans. Lifetime benefit limits - S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. Small employer health options - HR 2360, 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. Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. Government-run health plan, health insurance exchanges, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS act, medical loss ratios, premium assistance - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; S 1679, 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. National marketplace - HR 3217, To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; 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. Medical loss ratios - HR 3681, To provide for minimum loss ratios for health insurance coverage; S 1730, A bill to provide for minimum loss ratios for health insurance coverage. Third-party review of LTCI 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. Medicare physician payments - HR 3961, To amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. 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. Government-run health plan, 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, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act - HR 3590, An act entitled The Patient Protection and Affordable Care Act. Government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, federal rate review process, healthcare choice compacts, high risk pool program, McCarran-Ferguson Act - HR 3962, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

H.R. 323, Comprehensive Insurance Coverage of Childhood Immunization Act (Green) immunization coverage mandate; H.R. 584, Menopausal Hormone Replacement Therapies and Alternative Treatments and Fairness Act (Lee) coverage mandate for hormone replacement therapy (cont.) H.R. 697, Family Building Act (Weiner) coverage mandate for infertility treatments; H.R. 716, Access to Cancer Clinical Trials Act (Israel) clinical trials coverage mandate; H.R. 850, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 859, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 995, Mammogram and MRI Availability Act (Nadler) coverage mandate for mammograms; H.R. 1085, Health Insurance Coverage Protection Act (Eshoo) lifetime benefit limits; H.R. 1092, No Discrimination in Health Insurance Act (Kagen) preexisting condition exclusions, affiliation periods, uniform premiums; H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1321, Healthy Americans Act (Eshoo) comprehensive health reform; H.R. 1330, Colorectal Cancer Screening and Detection Coverage Act (Boren) coverage mandate for cancer screening; H.R. 1339, Children's Access to Reconstructive Evaluation & Surgery Act (McCarthy) coverage mandate for treatment of a child's congenital or developmental deformity; H.R. 1558, Preexisting Condition Patient Protection Act (Courtney) preexisting condition exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran Ferguson reforms; H.R. 1619, Children's Health Protection Act (Schwartz) preexisting condition exclusions for children; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) rescissions, hospital stays for breast cancer patients; H.R. 1721, CLASS Act (Pallone) national LTC program; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2360, SHOP Act (Kind) small employer health options; H.R. 2402, Woman's Health Insurance Fairness Act (Neal) gender rating for health insurance; H.R. 2413, Autism Treatment Acceleration Act (Doyle) coverage for autism spectrum disorders; H.R. 2427, Informed Consumer Choices in Health Care Act (DeLauro) federal standards for health insurance, consumer information; H.R. 2457, Right to a Second Medical Opinion Act (Davis) coverage of second opinions; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 2635, Gender Equity in Health Premiums Act (Sanchez) gender rating for health insurance; H.R. 2833, Medical Loss Ratios (Ellison) medical loss ratios; H.R. 2940, Women's Obstetrician and Gynecologist Medical Access Now Act (Davis) direct access to ob/gyns; H.R. 3200, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance; 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) government-run health plan, 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, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act; H.R.3681, Fairness in Health Insurance Act (cont.) H.R. 3961, Medicare Physician Payment Reform Act (Dingell) Medicare physician payment; H.R. 3962, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, federal rate review process, health care choice compacts, high risk pool program, McCarran-Ferguson Act; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; S. 79, Healthy Businesses, Healthy Workers Reinsurance Act (Kerry) reinsurance; S. 93, Small Business Empowerment Act (Brown) small employer health options; S. 391, Healthy Americans Act (Wyden) comprehensive health reform; S. 442, Health Insurance Coverage Protection Act (Dorgan) lifetime benefit limits; S. 488, Access to Cancer Clinical Trials Act (Brown) clinical trials coverage mandate; S. 623, Pre-existing Condition Patient Protection Act (Rockefeller) preexisting condition exclusions; S. 643, Children's Health Protection Act (Lautenberg) preexisting condition exclusions for children; S. 688, Breast Cancer Patient Protection Act (Snowe) rescissions, hospital stays for breast cancer patients; S. 697, CLASS Act (Kennedy) national LTC program; S. 819, Autism Treatment Acceleration Act (Durbin) coverage for autism spectrum disorders; S. 969, Women's Health Insurance Fairness Act (Kerry) gender rating for health insurance; S. 979, SHOP Act (Durbin) small employer health options; S. 1050, Informed Consumer Choices in Health Care Act (Rockefeller) federal standards for health insurance, consumer information; S. 1149, Annual and Lifetime Health Care Limit Elimination Act (Rockefeller) annual and lifetime coverage limits; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1235, Children's Access to Reconstructive Evaluation & Surgery Act (Landrieu) coverage mandate for treatment of a child's congenital or developmental deformity; S. 1258, Family Building Act (Gillibrand) coverage mandate for infertility treatments; 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. 1679, Affordable Health Choices Act (Harkin) government-run health plan, insurance market reforms, health benefit gateways, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) changes to McCarran-Ferguson Act; S. 1730, Fairness in Health Insurance Act (Franken) medical loss ratios; S. 1796, Americas Healthy Future Act (Baucus) government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform 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, and issues related to genetic nondiscrimination.

Client expense: $2,540,000 · 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), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 15, National Health Insurance Act H.R. 194, MediKids Health Insurance Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

*National LTC program - HR 1721, To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes; S 697, A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. *Immunization coverage mandate - HR 323, To amend title XXVII of the Public Health Service Act and title I of the Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide comprehensive coverage for childhood immunization. *Coverage mandate for hormone replacement therapy - HR 584, To provide for coverage of hormone replacement therapy for treatment of menopausal symptoms, and for coverage of an alternative therapy for hormone replacement therapy for such symptoms, under the Medicare and Medicaid Programs, group health plans and individual health insurance coverage, and other Federal health insurance programs. *Clinical trials coverage mandate - HR 716, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials; S 488, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials. *Small employer health options - HR 850, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; HR 859, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; S 93, A bill to provide quality, affordable health insurance for small employers and individuals; HR 2360, 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; S 979, 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. *Coverage mandate for mammograms - HR 995, To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for annual screening mammography for women 40 years of age or older and for such screening and annual magnetic resonance imaging for women at high risk for breast cancer if the coverage or plans include coverage for diagnostic mammography for women 40 years of age or older. *Lifetime benefit limits - HR 1085, To impose a limitation on lifetime aggregate limits imposed by health plans; S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. *Pre-existing condition exclusions, affiliation periods, uniform premiums - HR 1092, To amend the Employee Retirement Income Security Act of 1974, Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit discrimination in group health coverage and individual health insurance coverage. 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. Comprehensive health reform - HR 1321, To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away, S 391, A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. Coverage mandate for cancer screening - HR 1330, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, to require that group and individual health insurance coverage and group health plans and Federal employees health benefit plans provide coverage of colorectal cancer screening. Coverage mandate for treatment of a child's congenital or developmental deformity - HR 1339, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease; S 1235, A bill to amend the Public Health Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. Pre-existing condition exclusions - HR 1558, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets; S 623, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets. McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry. Pre-existing condition exclusions for children - HR 1619, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets; S 643, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets. 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. Gender rating for health insurance - HR 2402, To amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market; HR 2635, To amend title XXVII of the Public Health Service Act to prohibit gender rating in the group and individual markets for health insurance coverage, and for other purposes; S 969, A bill to amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market. Federal standards for health insurance, consumer information - HR 2427, 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, and for other purposes; S 1050, 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, and for other purposes. Coverage of second opinions - HR 2457, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to require that group health plans and issuers of health insurance coverage provide coverage for second opinions. 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. Medical loss ratios - HR 2833, To require a minimum loss ratio for 90 percent for health insurance coverage offered through an insurance exchange. Direct access to Ob/Gyns - HR 2940, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans permit enrollees direct access to services of obstetrical and gynecological physician services directly and without a referral. Coverage for autism spectrum disorders - HR 2413, To provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families; S 819, A bill to provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families. Reinsurance - S 79, A bill to amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs. Coverage mandate for infertility treatments - HR 697, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility; S 1258, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility. LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. Annual and lifetime coverage limits - S 1149, A bill to eliminate annual and lifetime aggregate limits imposed by health plans. Lifetime benefit limits - S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. Small employer health options - HR 2360, 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. Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. Government-run health plan, health insurance exchanges, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS act, medical loss ratios, premium assistance - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; S 1679, 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. National marketplace - HR 3217, To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; 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. Medical loss ratios - HR 3681, To provide for minimum loss ratios for health insurance coverage; S 1730, A bill to provide for minimum loss ratios for health insurance coverage. Third-party review of LTCI 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. Medicare physician payments - HR 3961, To amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. 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. Government-run health plan, 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, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program, McCarran-Ferguson Act - HR 3590, An act entitled The Patient Protection and Affordable Care Act. Government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance, federal rate review process, healthcare choice compacts, high risk pool program, McCarran-Ferguson Act - HR 3962, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

Legislative initiatives to make access and affordability easier for small businesses such as Small Business Health Plans, expansion of Health Savings Accounts and Health IT. H.R. 859, the Small Business CHOICE Act; H.R. 3200/S. 1679, Affordable Health Choices Act; America's Healthy Future Act; H.R. 3590, the Patient Protection and Affordable Care Act

Client expense: $150,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Small Business Administration (SBA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

HR 859, Small Business CHOICE Act of 2009, all provisions. HR 3014, Small Business Health Information Technology Financing Act, all provisions. HR, 3763, To amend the Fair Credit Reporting Act to provide for an exclusion from Red Flag Guidelines for certain businesses, all provisions.

Client expense: $446,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform and its effect on the self-employed.Pooling mechanisms for health care provision.Small business health insurance cooperatives-Small Business Choice Act(H.R.859).Health care tax credits.Expanding and preserving Health Savings Accounts and Health Reimbursement Arrangements.Leveling the playing field for small business tax treatment-Equity for Our Nation's Self-Employed Act(H.R.1470/S.725).Patient Protection and Affordable Care Act(H.R.3590).Affordable Health Care for America Act(H.R.3962).

Client expense: $230,902 · Firm income: Not reported

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

Expansion of Small Business Health Coverage: H.R. 2360/S. 979 - "Small Business Options Program Act of 2009 (SHOP)" H.R. 859 Small Business CHOICE Act of 2009 Expansion of Small Business Health Coverage (cont'd): H.R. 3590 - "Patient Protection and Affordable Care Act" H.R. 3962 - "Affordable Health Care for America Act" S. 1796 - "America's Healthy Future Act of 2009" H.R. 3200 - "America's Affordable Health Choices Act of 2009" S. 1679 - "Affordable Health Choices Act" H.R. 193 AmeriCare Health Care Act of 2009 S. 93 - Small Business Empowerment Act S. 79 - Healthy Businesses, Healthy Workers Reinsurance Act of 2009 S. 45 - Medical Care Access Protection Act of 2009 S. 391 - Healthy Americans Act H.R. 879 - Affordable Health Care Expansion Act of 2009

Client expense: $5,600,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Council on Environmental Quality (CEQ), Energy, Dept of, Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Emergency Management Agency (FEMA), Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Supported the Small Business CHOICE Act (H.R. 859) Opposed the America's Affordable Health Choices Act (H.R. 3962) Opposed the Patient Protection and Affordable Care ACt (H.R. 3950)

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending HR 859 To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit HR 956 To expand the number of individuals and families with health insurance coverage, and for other purposes HR 1558 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets H.R. 1897 to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes H.R. 2520 to provide comprehensive solutions for the health care system of the United States, and for other purposes HR 2847COBRA, extend benefits period; extend termination date eligibility to June 30, 2010 HR 3200 America's Affordable Health Choices Act of 2009 H.R.3590: An act entitled The Patient Protection and Affordable Care Act. H.R.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. H.R. 3925, to amend the Employee Retirement Income Security Act of 1974 to preclude preemption of a state cause of action relating to a denial of a claim for benefits under a health care plan H.R. 3930, to extend for 6 months the maximum COBRA continuation coverage period for individuals who were involuntarily terminated between April 1, 2009, and Dec. 31, 2009, and to amend the American Reinvestment and Recovery Act of 2009 to extend the eligibility period and maximum assistance period for COBRA premium assistance under such Act. H.R.3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending. H.R. 3326: Extends from nine to 15 months the 65% COBRA health insurance subsidy for individuals who have lost their jobs. The job lost eligibility date is extended in the provision to February 28, 2010. Approximately seven million people benefited from the premium subsidy provided in the Recovery Act. S 179 To improve quality in health care by providing incentives for adoption of modern information technology S 623 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets S 803 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. S. Amdt 98 In the nature of a substitute S. 1099 to provide comprehensive solutions for the health care system of the United States, and for other purposes S. 1149 to eliminate annual and lifetime aggregate limits imposed by health plans S. 1152 to allow Americans to earn paid sick time so that they can address their own health needs and the health needs of their families S. Res. 156 expressing the sense of the Senate that reform of our nation's health care system should include the establishment of a federally-backed insurance pool S. 1488 to extend temporarily the 18-month period of continuation coverage under group health plans required under COBRA continuation coverage provisions so as to provide for a total period of continuation coverage of up to 24 months S. 1679 the 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. 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 S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending

Client expense: $460,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

H.R. 859, the Small Business CHOICE Act; health care reform legislation before the House and Senate. Legislation in both the House and Senate to reform the health care system in the United States (no specific legislation introduced). Particular interest in the availability of small employer subsidies to tax-exempt organizations.

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Supported the Small Business CHOICE Act (H.R. 859) Opposed the Affordable Health Choices Act (H.R. 3200) Monitored Senate Finance Committee mark-up on America's Healthy Future Act (S. 1769)

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

H.R. 25 - Fair Tax Act of 2009 Legislation to abolish the Internal Revenue Service and enact a national retail sales tax. NSBA supported. H.R. 275 - Withholding Tax Relief Act of 2009 A bill to repeal the mandatory three-percent withholding requirement on all payments for goods and services made to federal, state and local contractors. NSBA supported. H.R. 859 - Small Business CHOICE Act of 2009 To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit. NSBA supports elements of this legislation to the extent it addresses rising health care cost and insurance availability for small business owners. However, NSBA maintains reservations about the use of cooperatives to achieve this. H.R. 946 - The Plain Language Act of 2009 Bill would establish plain language as the standard style for Government documents issued to the public, and for other purposes. NSBA supported. H.R. 1321 Healthy Americans Act To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. NSBA has been supportive of many provisions but withheld judgment on the overall bill. H.R. 1409 - Employee Free Choice Act of 2009 To amend the National Labor Relations Act to establish an efficient system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts, and for other purposes. NSBA opposed. H.R. 1470 - Equity for Our Nations Self-Employed Act of 2009 The bill would allow self-employed individuals to fully-deduct the cost of their health insurance, thus eliminating the self-employed tax on health care. NSBA supported. H.R. 2360 Small Business Health Options Program 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. NSBA maintains reservation about pooling and connector provisions included in the bill. H.R. 2382 Credit Card Interchange Fees Act Bill would amend the Truth in Lending Act to prohibit unfair practices in electronic payment system networks, and for other purposes. NSBA supported. H.R. 2910 S Corporation Modernization Act of 2009 To provide permanent relief, the bill would allow S corporations to liquidate unproductive assets after seven yearsfreeing up capital to be used to grow the business and create jobs. NSBA supported. H.R. 2920 - Statutory Pay-As-You-Go Act of 2009 Bill would reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. NSBA supported certain provisions of the legislation. H.R. 2963 IT Tax Credit for Small Business Act Bill provides a modest and time-limited tax credit to small businesses for the purchase of computer hardware and software. NSBA supported. H.R. 2965 Enhancing Small Business Research and Innovation Act of 2009 Bill would amend and reauthorize the Small Business Act with respect to the Small Business Innovation Research Program and the Small Business Technology Transfer Program. NSBA opposed. H.R. 3170 Fiscal Year 2010 Financial Services Appropriations Bill Bill contains $24.2 billion in total spending, with funding to the Treasury Department, the Executive Office of the President, the Judiciary, and the District of Columbia, and several other related agencies, including funds for combating tax evasion and improving services to taxpayers through Internal Revenue Services funding. NSBA supported funding for taxpayer assistance and education. H.R. 3200 Americas Affordable Health Choices Act To provide affordable, quality health care to all Americans and reduce the growth of health care spending, and for other purposes. NSBA supports the insurance market reforms and cost containment provisions; however, is opposed to the employer mandate provisions. H.R. 3380 Promoting Lending to Americas Small Business Act Bill would amend the Federal Credit Union Act to advance the ability of credit unions to promote small business growth and economic development opportunities, and for other purposes. NSBA supported. H.R. 3457 Small Business Credit Card Act of 2009 Bill would amend the Truth in Lending Act to provide coverage under such Act for credit cards issued to small businesses, and for other purposes. NSBA supported. H.R. 3615 - Home Office Tax Deduction Act of 2009 It amends the Internal Revenue Code to allow a taxpayer who uses a residence to conduct a trade or business a standard tax deduction equal to the lesser of $1,500 or the taxpayer's gross trade or business income derived from the business use of such residence. NSBA supported. H.R. 3639 - Expedited CARD Reform for Consumers Act of 2009 Bill would amend the Credit CARD Act of 2009 to establish an earlier effective date for various consumer protections, and for other purposes. NSBA supported. H.R. 3952 - Helping Small Businesses Grow and Prosper Act of 2009 Bill would amend the Internal Revenue Code of 1986 increase the amount allowable as a deduction for meals and entertainment expenses of small businesses. NSBA supported. S. 292 - Withholding Tax Relief Act of 2009 A bill to repeal the mandatory three-percent withholding requirement on all payments for goods and services made to federal, state and local contractors. NSBA supported. S. 391 Healthy Americans Act To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. NSBA has been supportive of many provisions but withheld judgment on the overall bill. S. 515 The Patent Reform Act of 2009 Bill would reform U.S. patent system. NSBA opposed. S. 560 Employee Free Choice Act of 2009 To amend the National Labor Relations Act to establish an efficient system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts, and for other purposes. NSBA opposed. S. 574 - Plain Writing Act of 2009 Bill would establish plain language as the standard style for Government documents issued to the public, and for other purposes. NSBA supported. S. 725 - Equity for Our Nations Self-Employed Act of 2009 The bill would allow self-employed individuals to fully-deduct the cost of their health insurance, thus eliminating the self-employed tax on health care. NSBA supported. S. 979 Small Business Health Options Program 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. NSBA maintains reservation about pooling and connector provisions included in the bill. S. 996 S Corporation Modernization Act of 2009 To provide permanent relief, the bill would allow S corporations to liquidate unproductive assets after seven yearsfreeing up capital to be used to grow the business and create jobs. NSBA supported. S. 998 SIMPLE Cafeteria Plan Act of 2009 Bill would update the tax code to allow small business employees to purchase employer-provided health insurance with pre-tax dollars. It also strengthens current law for all cafeteria plans by expanding dependent flexible spending accounts (DCFSA) and including coverage for long-term care benefits. NSBA supported. S. 1233 SBIR/STTR Reauthorization Act of 2009 Bill would reauthorize and improve the SBIR and STTR programs. NSBA supported. S. 1402 Small Business Jump Start Act of 2009 Bill would increase the threshold for the deduction phase-out for start-up costs from $50,000 to $60,000 and widens the pool of businesses who can claim the entire $10,000 deduction that first year. NSBA supported. S. 1615 Next Step for Main Street Credit Availability Act of 2009 Bill would amend the Small Business Act and the Small Business Investment Act of 1958 to stop the small business credit crunch, and for other purposes. NSBA supported. S. 1679 Affordable Health Choices Act Bill would provide for comprehensive health care reform. NSBA has opposed provisions in the bill that provide for employer mandates and a public health insurance options, while supported the addition of provisions that provide for greater tax credits for small businesses and more aggressive cost-containment provisions. NSBA maintains reservations and has not supported or opposed the legislation. S. 1754 - Home Office Deduction Simplification Act of 2009 It amends the Internal Revenue Code to allow a taxpayer who uses a residence to conduct a trade or business a standard tax deduction equal to the lesser of $1,500 or the taxpayer's gross trade or business income derived from the business use of such residence. NSBA supported. S. 1796 Americas Healthy Future Act of 2009 Bill would provide for comprehensive health care reform. NSBA has expressed concerns with several provisions, including the excise tax on high-cost insurance, the unintended consequences resulting from the threshold established in the free-rider provisions for employers, and others. In addition, NSBA has supported several provisions that aim to reduce the cost of health care while advocated for additional efforts to reduce the long-term cost of health care. NSBA maintains reservations and has not supported or opposed the legislation. S. 1832 Small Business Access to Capital Act of 2009 Bill would increase loan limits for small business concerns, provide for low interest refinancing for small business concerns, and for other purposes. NSBA supported. Issue: Comprehensive Immigration Reform A virtual proposal for comprehensive immigration reform was been discussed in the House and Senate. NSBA has advocated for provisions that would protect small businesses against overly burdensome regulations resulting from mandates on small businesses. NSBA continues to monitor developments and advocate with staff the potential for unintended consequences resulting from immigration legislation to small businesses.

Client expense: $80,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Treasury, Dept of, White House Office

HR 3354 -Amend the Internal Revenue Code of 1986 - 7.5% deduction; HR 3508 -Healthy Savings Act, HR 3610 - Health Savings and Affordability Act, HR 859 - Small Business CHOICE Act, S 207 - Health Insurance Tax Relief Act, S 29 -Coverage Continuity Act

Client expense: $375,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Expansion of Small Business Health Coverage: H.R. 2360/S. 979 - "Small Business Options Program Act of 2009 (SHOP)" H.R. 859 Small Business CHOICE Act of 2009 Expansion of Small Business Health Coverage (cont'd): H.R. 3200 - "America's Affordable Health Choices Act of 2009" S. 1679 - "Affordable Health Choices Act" S. ____ (Senate Finance Committee Draft Health Reform Legislation) - "America's Affordable Health Choices Act of 2009" H.R. 193 AmeriCare Health Care Act of 2009 S. 93 - Small Business Empowerment Act S. 79 - Healthy Businesses, Healthy Workers Reinsurance Act of 2009 S. 45 - Medical Care Access Protection Act of 2009 S. 391 - Healthy Americans Act H.R. 879 - Affordable Health Care Expansion Act of 2009 Discussions with White House Office of Health Policy

Client expense: $4,220,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Energy, Dept of, Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Emergency Management Agency (FEMA), Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Small Business Administration (SBA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 15, National Health Insurance Act H.R. 194, MediKids Health Insurance Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. 1679, Affordable Health Choices Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

Senate Finance Committee Americas Healthy Future Act HR 859 To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit HR 956 To expand the number of individuals and families with health insurance coverage, and for other purposes HR 1558 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets H.R. 1897 to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes H.R. 2520 to provide comprehensive solutions for the health care system of the United States, and for other purposes HR 3200 America's Affordable Health Choices Act of 2009 S 179 To improve quality in health care by providing incentives for adoption of modern information technology S 623 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets S 803 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. S. Amdt 98 In the nature of a substitute S. 988 to amend the Internal Revenue Code of 1986 to allow small businesses to set up simple cafeteria plans to provide nontaxable employee benefits to their employees, to make changes in the requirements for cafeteria plans, flexible spending accounts, and benefits provided under such plans or accounts, and for other purposes S. 979 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 S. 1099 to provide comprehensive solutions for the health care system of the United States, and for other purposes S. 1149 to eliminate annual and lifetime aggregate limits imposed by health plans S. 1152 to allow Americans to earn paid sick time so that they can address their own health needs and the health needs of their families S. Res. 156 expressing the sense of the Senate that reform of our nation's health care system should include the establishment of a federally-backed insurance pool S. 1488 to extend temporarily the 18-month period of continuation coverage under group health plans required under COBRA continuation coverage provisions so as to provide for a total period of continuation coverage of up to 24 months S. 1679 the 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.

Client expense: $490,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

Government-run health plan, health insurance cooperatives, health insurance exchanges, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform - Draft legislation re these issues. *National LTC program - HR 1721, To amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes; S 697, A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes. *Immunization coverage mandate - HR 323, To amend title XXVII of the Public Health Service Act and title I of the Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide comprehensive coverage for childhood immunization. *Coverage mandate for hormone replacement therapy - HR 584, To provide for coverage of hormone replacement therapy for treatment of menopausal symptoms, and for coverage of an alternative therapy for hormone replacement therapy for such symptoms, under the Medicare and Medicaid Programs, group health plans and individual health insurance coverage, and other Federal health insurance programs. *Clinical trials coverage mandate - HR 716, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials; S 488, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide coverage for individuals participating in approved cancer clinical trials. *Small employer health options - HR 850, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; HR 859, To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit; S 93, A bill to provide quality, affordable health insurance for small employers and individuals; HR 2360, 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; S 979, 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. *Coverage mandate for mammograms - HR 995, To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for annual screening mammography for women 40 years of age or older and for such screening and annual magnetic resonance imaging for women at high risk for breast cancer if the coverage or plans include coverage for diagnostic mammography for women 40 years of age or older. *Lifetime benefit limits - HR 1085, To impose a limitation on lifetime aggregate limits imposed by health plans; S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. *Pre-existing condition exclusions, affiliation periods, uniform premiums - HR 1092, To amend the Employee Retirement Income Security Act of 1974, Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit discrimination in group health coverage and individual health insurance coverage. 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. Comprehensive health reform - HR 1321, To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away, S 391, A bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. Coverage mandate for cancer screening - HR 1330, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and title 5, United States Code, to require that group and individual health insurance coverage and group health plans and Federal employees health benefit plans provide coverage of colorectal cancer screening. Coverage mandate for treatment of a child's congenital or developmental deformity - HR 1339, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease; S 1235, A bill to amend the Public Health Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. Pre-existing condition exclusions - HR 1558, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets; S 623, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets. McCarran Ferguson reforsm - HR 1583, To further competition in the insurance industry. Pre-existing condition exclusions for children - HR 1619, To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets; S 643, A bill to amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions for children in group health plans and health insurance coverage in the group and individual markets. 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. Gender rating for health insurance - HR 2402, To amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market; HR 2635, To amend title XXVII of the Public Health Service Act to prohibit gender rating in the group and individual markets for health insurance coverage, and for other purposes; S 969, A bill to amend the Public Health Service Act to ensure fairness in the coverage of women in the individual health insurance market. Federal standards for health insurance, consumer information - HR 2427, 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, and for other purposes; S 1050, 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, and for other purposes. Coverage of second opinions - HR 2457, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code to require that group health plans and issuers of health insurance coverage provide coverage for second opinions. 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. Medical loss ratios - HR 2833, To require a minimum loss ratio for 90 percent for health insurance coverage offered through an insurance exchange. Direct access to Ob/Gyns - HR 2940, To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans permit enrollees direct access to services of obstetrical and gynecological physician services directly and without a referral. Coverage for autism spectrum disorders - HR 2413, To provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families; S 819, A bill to provide for enhanced treatment, support, services, and research for individuals with autism spectrum disorders and their families. Reinsurance - S 79, A bill to amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs. Coverage mandate for infertility treatments - HR 697, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility; S 1258, A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility. LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. Annual and lifetime coverage limits - S 1149, A bill to eliminate annual and lifetime aggregate limits imposed by health plans. Lifetime benefit limits - S 442, A bill to impose a limitation on lifetime aggregate limits imposed by health plans. Small employer health options - HR 2360, 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. Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. Government-run health plan, health insurance exchanges, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS act, medical loss ratios, premium assistance - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; S 1679, 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. National marketplace - HR 3217, To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; 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. Medical loss ratios - HR 3681, To provide for minimum loss ratios for health insurance coverage; S 1730, A bill to provide for minimum loss ratios for health insurance coverage. Third-party review of LTCI 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.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Americas Healthy Future Act (Baucus) government-run health plan, health insurance cooperatives, health insurance exchange, insurance market reforms, individual coverage requirement, benefit packages, premium assistance, medical loss ratios, regulatory reform (cont.) H.R. 323, Comprehensive Insurance Coverage of Childhood Immunization Act (Green) immunization coverage mandate; H.R. 584, Menopausal Hormone Replacement Therapies and Alternative Treatments and Fairness Act (Lee) coverage mandate for hormone replacement therapy; H.R. 697, Family Building Act (Weiner) coverage mandate for infertility treatments; H.R. 716, Access to Cancer Clinical Trials Act (Israel) clinical trials coverage mandate; H.R. 850, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 859, Small Business CHOICE Act (Velazquez) small employer health options; H.R. 995, Mammogram and MRI Availability Act (Nadler) coverage mandate for mammograms; H.R. 1085, Health Insurance Coverage Protection Act (Eshoo) lifetime benefit limits; H.R. 1092, No Discrimination in Health Insurance Act (Kagen) preexisting condition exclusions, affiliation periods, uniform premiums; H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1321, Healthy Americans Act (Eshoo) comprehensive health reform; H.R. 1330, Colorectal Cancer Screening and Detection Coverage Act (Boren) coverage mandate for cancer screening; H.R. 1339, Children's Access to Reconstructive Evaluation & Surgery Act (McCarthy) coverage mandate for treatment of a child's congenital or developmental deformity; H.R. 1558, Preexisting Condition Patient Protection Act (Courtney) preexisting condition exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran Ferguson reforms; H.R. 1619, Children's Health Protection Act (Schwartz) preexisting condition exclusions for children; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) rescissions, hospital stays for breast cancer patients; H.R. 1721, CLASS Act (Pallone) national LTC program; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2360, SHOP Act (Kind) small employer health options; H.R. 2402, Woman's Health Insurance Fairness Act (Neal) gender rating for health insurance; H.R. 2413, Autism Treatment Acceleration Act (Doyle) coverage for autism spectrum disorders; H.R. 2427, Informed Consumer Choices in Health Care Act (DeLauro) federal standards for health insurance, consumer information; H.R. 2457, Right to a Second Medical Opinion Act (Davis) coverage of second opinions; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 2635, Gender Equity in Health Premiums Act (Sanchez) gender rating for health insurance; H.R. 2833, Medical Loss Ratios (Ellison) medical loss ratios; H.R. 2940, Women's Obstetrician and Gynecologist Medical Access Now Act (Davis) direct access to ob/gyns; H.R. 3200, Americas Affordable Health Choices Act (Dingell) government-run health plan, health insurance exchange, regulatory reform, health choices commissioner, insurance market reforms, individual coverage requirement, benefit packages, CLASS Act, medical loss ratios, premium assistance; 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) changes to McCarran-Ferguson Act; H.R.3681, Fairness in Health Insurance Act (Ellison) medical loss ratios; S. 79, Healthy Businesses, Healthy Workers Reinsurance Act (Kerry) reinsurance; S. 93, Small Business Empowerment Act (Brown) small employer health options; S. 391, Healthy Americans Act (Wyden) comprehensive health reform;S. 442, Health Insurance Coverage Protection Act (Dorgan) lifetime benefit limits; S. 488, Access to Cancer Clinical Trials Act (Brown) clinical trials coverage mandate; S. 623, Pre-existing Condition Patient Protection Act (Rockefeller) preexisting condition exclusions; S. 643, Children's Health Protection Act (Lautenberg) preexisting condition exclusions for children; S. 688, Breast Cancer Patient Protection Act (Snowe) rescissions, hospital stays for breast cancer patients; S. 697, CLASS Act (Kennedy) national LTC program; S. 819, Autism Treatment Acceleration Act (Durbin) coverage for autism spectrum disorders; S. 969, Women's Health Insurance Fairness Act (Kerry) gender rating for health insurance; S. 979, SHOP Act (Durbin) small employer health options; S. 1050, Informed Consumer Choices in Health Care Act (Rockefeller) federal standards for health insurance, consumer information; S. 1149, Annual and Lifetime Health Care Limit Elimination Act (Rockefeller) annual and lifetime coverage limits; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1235, Children's Access to Reconstructive Evaluation & Surgery Act (Landrieu) coverage mandate for treatment of a child's congenital or developmental deformity; S. 1258, Family Building Act (Gillibrand) coverage mandate for infertility treatments; 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. 1679, Affordable Health Choices Act (Harkin) government-run health plan, insurance market reforms, health benefit gateways, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) changes to McCarran-Ferguson Act; S. 1730, Fairness in Health Insurance Act (Franken) medical loss ratios (cont.) 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; crossover fees for Medigap claims; 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, and issues related to genetic nondiscrimination.

Client expense: $2,410,000 · 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), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

Health care reform and its effect on the self-employed.Pooling mechanisms for health care provision.Small business health insurance cooperatives-Small Business Choice Act(H.R.859)Health care tax credits.Expanding and preserving Health savings Accounts and Health Reimbursement Arrangements.Leveling the playing field for small business tax treatment-Equity for Our Nation's Self-Employed Act(H.R.1470/S.725).America's Affordable Health Choice Act(H.R.3200).

Client expense: $230,000 · Firm income: Not reported

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

HR 859 - Small Business Cooperatives for Healthcare Options to Improve Coverage for Employees (CHOICE) Act, all provisions. HR 2345 - Fairness in Cocaine Sentencing Act of 2009, all provisions. HR 3014 - Small Business Health Information Technology Financing Act, all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative initiatives to make access and affordability easier for small businesses such as Small Business Health Plans, expansion of Health Savings Accounts and Health IT. H.R. 859, the Small Business CHOICE Act H.R. 3200/S. 1679, Affordable Health Choices Act; America's Healthy Future Act

Client expense: $150,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Small Business Administration (SBA), Treasury, Dept of, Veterans Affairs, Dept of (VA)

HR 1204 (Antitrust exception for Pharmacists). HR 1493 (Antitrust exemption for physicians). HR 1 (COBRA coverage subsidy; comparative effectiveness, wellness, HIT finding and privacy). HR 1427/S. 726/ HR 1548 (FDA pathwqy to approve generic Biopharmaceutical medicines). S. 369/HR 1706 (generic/brand "settlements"). S. 93 (establish FEHBP for small employers. S. 391/ HR 1321 (National health insurance). HR 676/S. 703 (single-payer health plan) HR 193 (Medicare "for all"). S. 1099/HR2520 (Federal-State "One Stop Shopping" for health care). S. 979/HR 2360 (SHOP Act-Small business coverage). HR 859 (CHOICE Act-small business coverage). HR 2502 (Comparative Effectiveness Research). HR 3200 (House Tri-Committee health care reform bill).

Client expense: $580,743 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

H.R. 859, the Small Business CHOICE Act; health care reform legislation before the House and Senate. Legislation in both the House and Senate to reform the health care system in the United States (no specific legislation introduced).

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Supported the Small Business CHOICE Act (H.R. 859) Opposed the Affordable Health Choices Act in Senate HELP Committee.

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE

The association monitors and reacts to policy concepts that may impact its ability to continue providing its high quality Group Health Plan to members, their employees, and the association staff at affordable rates and on reasonable terms and conditions. During the reporting period the association lobbied on both concepts that were under discussion, as well as the following: H.R. 859 -To encourage the development of small business cooperatives for healthcare options to improve coverage (CHOICE) including through a small business CHOICE tax credit - all sections.

Client expense: $170,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Natl Telecommunications & Information Administration (NTIA), SENATE

H.R. 25 - Fair Tax Act of 2009 Legislation to abolish the Internal Revenue Service and enact a national retail sales tax. NSBA supported. H.R. 275 - Withholding Tax Relief Act of 2009 A bill to repeal the mandatory three-percent withholding requirement on all payments for goods and services made to federal, state and local contractors. NSBA supports. H.R. 627 - Credit Cardholders Bill of Rights Act of 2009 Bill would prohibit or reform various credit-card practices. NSBA supported. H.R. 859 - Small Business CHOICE Act of 2009 To encourage the development of small business cooperatives for healthcare options to improve coverage for employees (CHOICE) including through a small business CHOICE tax credit. NSBA supports elements of this legislation to the extent it addresses rising health care cost and insurance availability for small business owners. However, NSBA maintains reservations about the use of cooperatives to achieve this. H.R. 946 - The Plain Language Act of 2009 Bill would establish plain language as the standard style for Government documents issued to the public, and for other purposes. NSBA supported. H.R. 1321 Healthy Americans Act To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. NSBA has been supportive of many provisions but withheld judgment on the overall bill. H.R. 1409 - Employee Free Choice Act of 2009 To amend the National Labor Relations Act to establish an efficient system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts, and for other purposes. NSBA opposed. H.R. 1470 - Equity for Our Nations Self-Employed Act of 2009 The bill would allow self-employed individuals to fully-deduct the cost of their health insurance, thus eliminating the self-employed tax on health care. NSBA supported. H.R. 1509 - Home Office Deduction Simplification Act It amends the Internal Revenue Code to allow a taxpayer who uses a residence to conduct a trade or business a standard tax deduction equal to the lesser of $1,500 or the taxpayer's gross trade or business income derived from the business use of such residence. NSBA supported. H.R. 2360 Small Business Health Options Program 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. NSBA maintains reservation about pooling and connector provisions included in the bill. H.R. 2460 Health Families Act A bill to provide for paid sick leave to ensure that Americans can address their own health needs and the health needs of their families. NSBA opposed. H.R. 2910 S Corporation Modernization Act of 2009 To provide permanent relief, the bill would allow S corporations to liquidate unproductive assets after seven yearsfreeing up capital to be used to grow the business and create jobs. NSBA supported. H.R. 2963 IT Tax Credit for Small Business Act Bill provides a modest and time-limited tax credit to small businesses for the purchase of computer hardware and software. NSBA supported. H.R. 2965 Enhancing Small Business Research and Innovation Act of 2009 Bill would amend and reauthorize the Small Business Act with respect to the Small Business Innovation Research Program and the Small Business Technology Transfer Program. NSBA opposed. H.R. 3200 Americas Affordable Health Choices Act To provide affordable, quality health care to all Americans and reduce the growth of health care spending, and for other purposes. NSBA supports the insurance market reforms and cost containment provisions; however, is opposed to the employer mandate provisions. S. 292 - Withholding Tax Relief Act of 2009 A bill to repeal the mandatory three-percent withholding requirement on all payments for goods and services made to federal, state and local contractors. NSBA supports. S. 391 Healthy Americans Act To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away. NSBA has been supportive of many provisions but withheld judgment on the overall bill. S. 414 - Credit C.A.R.D. (Credit Card Accountability, Responsibility and Disclosure) Act Bill would prohibit or reform various credit-card practices. NSBA supported. S. 560 Employee Free Choice Act of 2009 To amend the National Labor Relations Act to establish an efficient system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts, and for other purposes. NSBA opposed. S. 574 - Plain Writing Act of 2009 Bill would establish plain language as the standard style for Government documents issued to the public, and for other purposes. NSBA supported. S. 725 - Equity for Our Nations Self-Employed Act of 2009 The bill would allow self-employed individuals to fully-deduct the cost of their health insurance, thus eliminating the self-employed tax on health care. NSBA supported. S. 979 Small Business Health Options Program 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. NSBA maintains reservation about pooling and connector provisions included in the bill. S. 996 S Corporation Modernization Act of 2009 To provide permanent relief, the bill would allow S corporations to liquidate unproductive assets after seven yearsfreeing up capital to be used to grow the business and create jobs. NSBA supported. S. 998 SIMPLE Cafeteria Plan Act of 2009 Bill would update the tax code to allow small business employees to purchase employer-provided health insurance with pre-tax dollars. It also strengthens current law for all cafeteria plans by expanding dependent flexible spending accounts (DCFSA) and including coverage for long-term care benefits. S. 1152 Health Families Act A bill to provide for paid sick leave to ensure that Americans can address their own health needs and the health needs of their families. NSBA opposed. S. 1233 SBIR/STTR Reauthorization Act of 2009 Bill would reauthorize and improve the SBIR and STTR programs. NSBA supported. S. 1402 Small Business Jump Start Act of 2009 Bill would increase the threshold for the deduction phase-out for start-up costs from $50,000 to $60,000 and widens the pool of businesses who can claim the entire $10,000 deduction that first year. NSBA supported. Issue: Comprehensive Health Care Reform A virtual proposal for comprehensive health care reform has been vetted through committees in the first quarter of 2009. NSBA has advocated for several principles in comprehensive health care reform, including robust reforms to the health delivery system and insurance market. In addition, NSBA has advocated for a broad proposal for health care reform that provides for a long-term solution for all. In addition, NSBA has expressed the need for further consideration and consultation with the small business community on several proposals in health care reform, including the public health insurance option, health insurance exchange, and a potential role for employers.

Client expense: $75,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Treasury, Dept of, White House Office

Legislative initiatives to make access and affordability easier for small businesses such as Small Business Health Plans, expansion of Health Savings Accounts and Health IT. H.R. 859, the Small Business CHOICE Act Affordable Health Choices Act

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA)

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. ___, Affordable Health Choices Act

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

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

S. 93, Small Business Empowerment Act H.R. 850/H.R. 859, Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (CHOICE) Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing Act of 2009 S. 1099, Independent Health Record Trust Act of 2009 S. 391, Healthy Americans Act S. ___, Affordable Health Choices Act

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

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