Pay Back the Taxpayers Act of 2015

H.R. 101, Home Foreclosure Reduction Act of 2015 H.R. 189, Service member Foreclosure Protections Extension Act of 2015 H.R. 190, Making Service member Foreclosure Protections Permanent Act H.R. 233, Tenant Income Verification Relief Act of 2015 H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit

Client expense: $137,712 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2017. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support HR 2997 Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Support HR 1662 Oppose S. 2038 Support principle reduction of mortgages Support the Low Income Housing Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Labor-HHS-Education funding bill. Specifically, Specifically, Services and Benefits for Victims of Trafficking; $32,000,000 for the HHS / Administration for Children and Families; $2,500, for the HHS / Administration for Children and Families / The National Human Trafficking Resource Center; $165,000,000 for the HHS / Administration of Children and Families / Runaway and Homeless Youth Act; Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Transportation-HUD funding bill. Specifically, $33,000,000 to fund comprehensive continuum of care projects for homeless and runaway youth. Support funding for HUDs Affirmatively Furthering Fair Housing program in FY17 Support substantive changes to ensure that the LIHTC program will further the Administrations goals of promoting racial and socioeconomic integration and provide ladders of opportunity to low-income families - particularly Black and Latino families. Support FHFAs effort to provide Extra Credit for Residential Economic Diversity Activities. Support EPA coordination with HUD, and both to engage in the AFFH process and leverage it for its other nondiscrimination investigations and enforcement. Support including language preference in the Uniform Residential Loan Application (URLA). Support $15 million for a new Housing Choice Voucher Mobility Demonstration. Support Al Green, TX, amendment to HR 3700 Support HR 3700 Support Moore (WI) Fair Housing amendment to HR 1927 Support Collins (ME) motion to table Lee (UT) amendment 3897 Oppose Lee (UT) amendment 3897 Support reassessment of Treasurys plan to eliminate the GSEs capital buffers by the end of 2017. Support making the AFFH Assessment tool more effective and closing gaps Support suspension of GSE dividend payments to Treasury, and require the GSEs to develop and implement capital restoration plans, so they have enough capital to safely manage their business and to support Americas housing finance system. Support HUD AFFH tools as designed to local PHAs and state and local governments with some strengthening suggestions. Support the elimination / reduction of loan level price adjustments Support capturing the borrowers preferred language on mortgage application forms. Support HR 4888 Support HR 4893 Support principal reduction by HUD and FHFA. Support S 3164 Support HUDs proposed rules to narrow the digital divide by requiring broadband infrastructure installation in HUD-funded construction and modernizing HUDs Consolidated Plan process. Support the Federal Housing Administration (FHA) permitting its borrowers to use the Property Assessed Clean Energy (PACE) program to finance home improvements that increase energy efficiency and lower utility costs Support HUDs proposal to implement Small Area Fair Market Rents in metropolitan areas where Housing Choice Voucher families are most severely clustered in high poverty neighborhoods. Support HUD responding to its IG report on down payment assistance (DPA) and not restricting DPA by geography Support the following improvements in the AFFH Local Assessment Tool: The need for stronger community participation and consultation elements; More accountability around the use of local knowledge and data (for which participants go beyond the HUD-supplied data, and assess the particular problems of the community in more range and depth); The need to assess whether the requirement to incorporate the AFHs goals into other planning processes has been met; Improvements to the Opportunity Indices, specifically in assessing education, environmental health, and transportation; The need to include assessment of other civil rights enforcement (beyond fair housing), such as Title V I; Changes to the Inserts that HUD includes for secondary participants, such as requiring them to identify contributing factors, incorporate community participation that focuses on those participants, and evaluate PHA programmatic features. Oppose Congressional efforts to attach piecemeal GSE reform as amendments to must pass legislation. Support HR 6211 Support Principal reduction

Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2017. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support HR 2997 Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Support HR 1662 Oppose S. 2038 Support principle reduction of mortgages Support the Low Income Housing Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Labor-HHS-Education funding bill. Specifically, Specifically, Services and Benefits for Victims of Trafficking; $32,000,000 for the HHS / Administration for Children and Families; $2,500, for the HHS / Administration for Children and Families / The National Human Trafficking Resource Center; $165,000,000 for the HHS / Administration of Children and Families / Runaway and Homeless Youth Act; Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Transportation-HUD funding bill. Specifically, $33,000,000 to fund comprehensive continuum of care projects for homeless and runaway youth. Support funding for HUDs Affirmatively Furthering Fair Housing program in FY17 Support substantive changes to ensure that the LIHTC program will further the Administrations goals of promoting racial and socioeconomic integration and provide ladders of opportunity to low-income families - particularly Black and Latino families. Support FHFAs effort to provide Extra Credit for Residential Economic Diversity Activities. Support EPA coordination with HUD, and both to engage in the AFFH process and leverage it for its other nondiscrimination investigations and enforcement. Support including language preference in the Uniform Residential Loan Application (URLA). Support $15 million for a new Housing Choice Voucher Mobility Demonstration. Support Al Green, TX, amendment to HR 3700 Support HR 3700 Support Moore (WI) Fair Housing amendment to HR 1927 Support Collins (ME) motion to table Lee (UT) amendment 3897 Oppose Lee (UT) amendment 3897 Support reassessment of Treasurys plan to eliminate the GSEs capital buffers by the end of 2017. Support making the AFFH Assessment tool more effective and closing gaps Support suspension of GSE dividend payments to Treasury, and require the GSEs to develop and implement capital restoration plans, so they have enough capital to safely manage their business and to support Americas housing finance system. Support HUD AFFH tools as designed to local PHAs and state and local governments with some strengthening suggestions. Support the elimination / reduction of loan level price adjustments Support capturing the borrowers preferred language on mortgage application forms. Support HR 4888 Support HR 4893 Support principal reduction by HUD and FHFA. Support S 3164 Support HUDs proposed rules to narrow the digital divide by requiring broadband infrastructure installation in HUD-funded construction and modernizing HUDs Consolidated Plan process. Support the Federal Housing Administration (FHA) permitting its borrowers to use the Property Assessed Clean Energy (PACE) program to finance home improvements that increase energy efficiency and lower utility costs Support HUDs proposal to implement Small Area Fair Market Rents in metropolitan areas where Housing Choice Voucher families are most severely clustered in high poverty neighborhoods. Support HUD responding to its IG report on down payment assistance (DPA) and not restricting DPA by geography Support the following improvements in the AFFH Local Assessment Tool: The need for stronger community participation and consultation elements; More accountability around the use of local knowledge and data (for which participants go beyond the HUD-supplied data, and assess the particular problems of the community in more range and depth); The need to assess whether the requirement to incorporate the AFHs goals into other planning processes has been met; Improvements to the Opportunity Indices, specifically in assessing education, environmental health, and transportation; The need to include assessment of other civil rights enforcement (beyond fair housing), such as Title V I; Changes to the Inserts that HUD includes for secondary participants, such as requiring them to identify contributing factors, incorporate community participation that focuses on those participants, and evaluate PHA programmatic features. Oppose Congressional efforts to attach piecemeal GSE reform as amendments to must pass legislation. Support HR 6211 Support Principal reduction

Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2017. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support HR 2997 Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Support HR 1662 Oppose S. 2038 Support principle reduction of mortgages Support the Low Income Housing Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Labor-HHS-Education funding bill. Specifically, Specifically, Services and Benefits for Victims of Trafficking; $32,000,000 for the HHS / Administration for Children and Families; $2,500, for the HHS / Administration for Children and Families / The National Human Trafficking Resource Center; $165,000,000 for the HHS / Administration of Children and Families / Runaway and Homeless Youth Act; Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Transportation-HUD funding bill. Specifically, $33,000,000 to fund comprehensive continuum of care projects for homeless and runaway youth. Support funding for HUDs Affirmatively Furthering Fair Housing program in FY17 Support substantive changes to ensure that the LIHTC program will further the Administrations goals of promoting racial and socioeconomic integration and provide ladders of opportunity to low-income families - particularly Black and Latino families. Support FHFAs effort to provide Extra Credit for Residential Economic Diversity Activities. Support EPA coordination with HUD, and both to engage in the AFFH process and leverage it for its other nondiscrimination investigations and enforcement. Support including language preference in the Uniform Residential Loan Application (URLA). Support $15 million for a new Housing Choice Voucher Mobility Demonstration. Support Al Green, TX, amendment to HR 3700 Support HR 3700 Support Moore (WI) Fair Housing amendment to HR 1927 Support Collins (ME) motion to table Lee (UT) amendment 3897 Oppose Lee (UT) amendment 3897 Support reassessment of Treasurys plan to eliminate the GSEs capital buffers by the end of 2017. Support making the AFFH Assessment tool more effective and closing gaps Support suspension of GSE dividend payments to Treasury, and require the GSEs to develop and implement capital restoration plans, so they have enough capital to safely manage their business and to support Americas housing finance system. Support HUD AFFH tools as designed to local PHAs and state and local governments with some strengthening suggestions. Support the elimination / reduction of loan level price adjustments Support capturing the borrowers preferred language on mortgage application forms. Support HR 4888 Support HR 4893 Support principal reduction by HUD and FHFA.

H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit

Client expense: $59,236 · Firm income: Not reported

H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit

Client expense: $59,236 · Firm income: Not reported

H.R. 101, Home Foreclosure Reduction Act of 2015 H.R. 189, Service member Foreclosure Protections Extension Act of 2015 H.R. 190, Making Service member Foreclosure Protections Permanent Act H.R. 233, Tenant Income Verification Relief Act of 2015 H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 650, To amend the Truth in Lending Act to modify the definitions of a mortgage originator and a high-cost mortgage H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 H.R.2997, Private Investment in Housing Act of 2015 H.R. 3700, To provide housing opportunities in the United States through modernization of various housing programs, and for other purposes S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit

Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2017. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support HR 2997 Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Support HR 1662 Oppose S. 2038 Support principle reduction of mortgages Support the Low Income Housing Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Labor-HHS-Education funding bill. Specifically, Specifically, Services and Benefits for Victims of Trafficking; $32,000,000 for the HHS / Administration for Children and Families; $2,500, for the HHS / Administration for Children and Families / The National Human Trafficking Resource Center; $165,000,000 for the HHS / Administration of Children and Families / Runaway and Homeless Youth Act; Support funding for several programs related to child labor, forced labor, and human trafficking in FY 2017 Transportation-HUD funding bill. Specifically, $33,000,000 to fund comprehensive continuum of care projects for homeless and runaway youth. Support funding for HUDs Affirmatively Furthering Fair Housing program in FY17 Support substantive changes to ensure that the LIHTC program will further the Administrations goals of promoting racial and socioeconomic integration and provide ladders of opportunity to low-income families - particularly Black and Latino families. Support FHFAs effort to provide Extra Credit for Residential Economic Diversity Activities. Support EPA coordination with HUD, and both to engage in the AFFH process and leverage it for its other nondiscrimination investigations and enforcement. Support including language preference in the Uniform Residential Loan Application (URLA). Support $15 million for a new Housing Choice Voucher Mobility Demonstration. Support Al Green, TX, amendment to HR 3700 Support HR 3700 Support Moore (WI) Fair Housing amendment to HR 1927

H.R. 101, Home Foreclosure Reduction Act of 2015 H.R. 189, Service member Foreclosure Protections Extension Act of 2015 H.R. 190, Making Service member Foreclosure Protections Permanent Act H.R. 233, Tenant Income Verification Relief Act of 2015 H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes. H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes. H.R. 650, To amend the Truth in Lending Act to modify the definitions of a mortgage originator and a high-cost mortgage. H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate. H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes. H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 H.R.2997, Private Investment in Housing Act of 2015 H.R. 3700, To provide housing opportunities in the United States through modernization of various housing programs, and for other purposes. S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt. S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes. S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit.

Support HUD reducing FHA mortgage premiums. Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2016. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support regulators consulting with fair housing advocates and representatives of the affected communities to identify additional regulatory, supervisory, or enforcement steps that might be needed to cure existing disparities and prevent future deficiencies in the maintenance of REO properties. Support HUD's Disparate Impact rule; oppose Garrett amendment to HR 2577 Support HUD's Affirmatively Furthering Fair Housing Rule; oppose Gosar amendment to HR 2577. Support HUD's FHIP / FHAP programs. Oppose Stivers amendment to HR 2577 Support requiring the FHA to improve its current proposal and adopt an enhanced certification requirement that requires lenders to certify that they meet all three of the following: Exercise of due diligence and good faith in underwriting the mortgage and submitting the application for insurance, which is proposed; Establish, operate and monitor a Quality Control program that complies with all FHA requirements; and For any defects that occur notwithstanding compliance with the first two lender duties, timely remediate or indemnify FHA for any defects that affect the insurability of the loan. Support HR 2997 Urge FHA to improve its current proposal to change the certification requirements that lenders must make in order to secure Federal Housing Administration insurance on a mortgage loan and adopt an enhanced certification requirement that requires lenders to certify that they meet all three of the following: Exercise of due diligence and good faith in underwriting the mortgage and submitting the application for insurance, which is proposed; Establish, operate and monitor a Quality Control program that complies with all FHA requirements; and For any defects that occur notwithstanding compliance with the first two lender duties, timely remediate or indemnify FHA for any defects that affect the insurability of the loan. Oppose recapturing $1.7 billion in uncommitted funds from Treasurys Hardest Hit Fund (HHF) program, which is part of the Troubled Asset Relief Program (TARP)and extending the guarantee fee increase expiration date from 2021 to 2025 to pay for the Highway Trust Fund. Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Oppose HUDs recent decision to remove homeowner-protective language from FHAs form single family note and mortgage Oppose Affirmatively Furthering Fair Housing Assessment Tool, Docket No. FR-5173-N-05 Oppose the omission of the Low Income Housing Tax Credit (LIHTC) program in the Treasurys Departments proposed regulation implementing Title VI of the Civil Rights Act. Support HR 1662 Support Duties to Serve in the secondary mortgage market, as well as the primary market. Support FHA continuing to have and deploy its full legal authority over all approved lenders to enforce its standards and responsibilities under the FHA insurance programs. Allow the GSEs to build capital reserves so there will not be a draw against the Treasury line of credit and that he oppose the proposed riders on financial services appropriations bills relating to housing finance Oppose S. 2038 and reject any effort to include it as a policy rider in the omnibus FY 2016 appropriations agreement. Support stronger attention to Fannie Mae and Freddie Macs performance on their Single-Family Housing Goals Oppose amendment #2840 being offered by Senators Lee (UT) and Cotton (AR) to H.R. 2577 Support principle reduction of mortgages Support the Low Income Housing Tax Credit

Support HUD reducing FHA mortgage premiums. Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2016. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support regulators consulting with fair housing advocates and representatives of the affected communities to identify additional regulatory, supervisory, or enforcement steps that might be needed to cure existing disparities and prevent future deficiencies in the maintenance of REO properties. Support HUD's Disparate Impact rule; oppose Garrett amendment to HR 2577 Support HUD's Affirmatively Furthering Fair Housing Rule; oppose Gosar amendment to HR 2577. Support HUD's FHIP / FHAP programs. Oppose Stivers amendment to HR 2577 Support requiring the FHA to improve its current proposal and adopt an enhanced certification requirement that requires lenders to certify that they meet all three of the following: Exercise of due diligence and good faith in underwriting the mortgage and submitting the application for insurance, which is proposed; Establish, operate and monitor a Quality Control program that complies with all FHA requirements; and For any defects that occur notwithstanding compliance with the first two lender duties, timely remediate or indemnify FHA for any defects that affect the insurability of the loan. Support HR 2997 Urge FHA to improve its current proposal to change the certification requirements that lenders must make in order to secure Federal Housing Administration insurance on a mortgage loan and adopt an enhanced certification requirement that requires lenders to certify that they meet all three of the following: Exercise of due diligence and good faith in underwriting the mortgage and submitting the application for insurance, which is proposed; Establish, operate and monitor a Quality Control program that complies with all FHA requirements; and For any defects that occur notwithstanding compliance with the first two lender duties, timely remediate or indemnify FHA for any defects that affect the insurability of the loan. Oppose recapturing $1.7 billion in uncommitted funds from Treasurys Hardest Hit Fund (HHF) program, which is part of the Troubled Asset Relief Program (TARP)and extending the guarantee fee increase expiration date from 2021 to 2025 to pay for the Highway Trust Fund. Oppose HR 3192 Support, in the President's budget proposal for FY 17, Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program - Additional $400 million for McKinney-Vento HUD Homeless Assistance programs, of which $150 million be directed to serving homeless youth - Additional $40 million for 10 community demonstration projects to provide comprehensive approaches to serving homeless youth. - Clarifying language that all children, youth and families in vulnerable and unsafe situations should be eligible for HUD homeless assistance and waived from being required to provide third-part documentation to receive housing and supportive services with Continuum of Care funds. Support, in FY16, - Additional $50 million for the Runaway and Homeless Youth Act (RHYA) programs - $2.5 million for the national prevalence, needs, and characteristics of homeless youth in America authorized by RHYA - Additional $50 million for the McKinney-Vento Education for Homeless Children and Youth (EHCYA) Program Oppose HUDs recent decision to remove homeowner-protective language from FHAs form single family note and mortgage Oppose Affirmatively Furthering Fair Housing Assessment Tool, Docket No. FR-5173-N-05 Oppose the omission of the Low Income Housing Tax Credit (LIHTC) program in the Treasurys Departments proposed regulation implementing Title VI of the Civil Rights Act. Support HR 1662

H.R. 101, Home Foreclosure Reduction Act of 2015 H.R. 189, Service member Foreclosure Protections Extension Act of 2015 H.R. 190 Making Service member Foreclosure Protections Permanent Act H.R. 233 Tenant Income Verification Relief Act of 2015 H.R. 574 To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes. H.R. 576 To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes. H.R. 650, To amend the Truth in Lending Act to modify the definitions of a mortgage originator and a high-cost mortgage. H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate. H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes. H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 H.R. 2997, "Private Investment in Housing Act of 2015" H.R. 3700, To provide housing opportunities in the United States through modernization of various housing programs, and for other purposes. S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt. S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes. S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit.

Support HUD reducing FHA mortgage premiums. Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2016. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac. Support regulators consulting with fair housing advocates and representatives of the affected communities to identify additional regulatory, supervisory, or enforcement steps that might be needed to cure existing disparities and prevent future deficiencies in the maintenance of REO properties. Support HUD's Disparate Impact rule; oppose Garrett amendment to HR 2577 Support HUD's Affirmatively Furthering Fair Housing Rule; oppose Gosar amendment to HR 2577. Support HUD's FHIP / FHAP programs. Oppose Stivers amendment to HR 2577 Support requiring the FHA to improve its current proposal and adopt an enhanced certification requirement that requires lenders to certify that they meet all three of the following: Exercise of due diligence and good faith in underwriting the mortgage and submitting the application for insurance, which is proposed; Establish, operate and monitor a Quality Control program that complies with all FHA requirements; and For any defects that occur notwithstanding compliance with the first two lender duties, timely remediate or indemnify FHA for any defects that affect the insurability of the loan. Support HR 2997

Client expense: $68,750 · Firm income: Not reported

H.R. 101, Home Foreclosure Reduction Act of 2015 H.R. 189, Service member Foreclosure Protections Extension Act of 2015 H.R. 190, Making Service member Foreclosure Protections Permanent Act H.R. 233, Tenant Income Verification Relief Act of 2015 H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes. H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 650, To amend the Truth in Lending Act to modify the definitions of a mortgage originator and a high-cost mortgage H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate H.R. 1297, To amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to provide assistance for housing cooperatives damaged by a major disaster, to provide relief to homeowners affected by major disasters who have mortgages insured by the FHA or owned or guaranteed by Fannie Mae or Freddie Mac, and for other purposes H.R. 1354, Permanently Protecting Tenants at Foreclosure Act of 2015 H.R. 1491, Partnership to Strengthen Homeownership Act of 2015 H.R. 1577, Fannie Mae and Freddie Mac Transparency Act of 2015 S. 65, Moving to Work Charter Program Act of 2015 S. 256, Homeless Children and Youth Act of 2015 S. 351, A bill to prevent homeowners from being forced to pay taxes on forgiven mortgage loan debt S. 495, A bill to revoke the charters for the Federal National Mortgage Corporation and the Federal Home Loan Mortgage Corporation upon resolution of their obligations, to create a new Mortgage Finance Agency for the securitization of single family and multifamily mortgages, and for other purposes S. 730, Permanently Protecting Tenants at Foreclosure Act of 2015 S.752, A bill to establish a scorekeeping rule to ensure that increases in guarantee fees of Fannie Mae and Freddie Mac shall not be used to offset provisions that increase the deficit

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system; Advocated for extending the Medicare Primary Care Incentive Program beyond its 2015 sunset date. This program, which began in 2011, pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. 21st Century Cures: Commented on H.R. 6, the 21st Century Cures Act, which provides broad reforms to help incentive innovation and cures for disease; addresses FDA oversight, increased funding for the National Institutes of Health, immunization, the prescription drug approval process, and reforms to Health Information Technology and Electronic Health Records.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system; Advocated for extending the Medicare Primary Care Incentive Program beyond its 2015 sunset date. This program, which began in 2011, pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. 21st Century Cures: Commented on H.R. 6, the 21st Century Cures Act, which provides broad reforms to help incentive innovation and cures for disease; addresses FDA oversight, increased funding for the National Institutes of Health, immunization, the prescription drug approval process, and reforms to Health Information Technology and Electronic Health Records.

H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate

Client expense: $60,593 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 574, To prohibit contributions by Fannie Mae and Freddie Mac to the Housing Trust Fund and the Capital Market Fund while such enterprises are in conservatorship or receivership, and for other purposes H.R. 576, To amend the definition of "homeless person" under the McKinney-Vento Homeless Assistance Act to include certain homeless children and youth, and for other purposes H.R. 1001, To amend the Internal Revenue Code of 1986 to terminate certain energy tax subsidies and lower the corporate income tax rate

Client expense: $155,182 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HUD reducing FHA mortgage premiums. Support a larger 302 (b) allocation for the Transportation - HUD Appropriations bill for FY 2016. Support H.R. 372 oppose H.R. 574 Support the National Housing Trust Fund; support its funding through Fannie Mae and Freddie Mac.

Client expense: $68,750 · Firm income: Not reported

Government targets: Bureau of Alcohol Tobacco Firearms & Explosives, Bureau of Prisons (BOP), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Consumer Financial Protection Bureau (CFPB), Council of Economic Advisers (CEA), Defense, Dept of (DOD), Education, Dept of, Election Assistance Commission (EAC), Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Housing Finance Agency (FHFA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Institute of Standards & Technology (NIST), Office of Faith-Based & Community Initiatives, Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.