Employer Reporting Improvement Act

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Tax Relief and Reform Tax Cuts and Jobs Act of 2017: Support extending/making permanent the expiring provisions of the legislation that terminate in 2025 and have expressed opposition to raising taxes on small businesses. Submitted comments to the House Ways and Means Tax Working group detailing the benefits of the TCJA and our support for permanency. R&D Tax Credit-Immediate Expensing: Continue to support restoring and making permanent full expensing for R&D expenditures for small businesses. Support "American Innovation and Jobs Act" (S. 866) in the Senate and "American Innovation and R&D Competitiveness Act" (H.R. 2673) in the House. Main Street Tax Certainty Act of 2023 (S. 1706, H.R. 4721): Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small businesses (Section 199A). Death Tax Repeal Act of 2023 (S. 1108): Support House and Senate bills to permanently repeal the death tax and continue to support action by Congress. Regulation Basel III Endgame Implementation: Continue to express concern about the proposal by the U.S. Federal Reserve and Federal Deposit and Insurance Corporation in regard to the impact on small business capital access and affordability. Save Local Businesses Act (S.1261, HR 2826): Continue to support the legislation. Protecting the Right to Organize (PRO) Act (S. 567): Continue to oppose the legislation. The Protect Small Business and Prevent Illicit Financial Activity Act: SBE Council supports S. 3625 to delay implementation of the Corporate Transparency Act and H.R. 9278, legislation to delay the Corporate Transparency Acts year-end compliance deadline. We have also supported repeal of this measure via the "Repeal Big Brother Overreach Act." Consumer Financial Protection Bureaus (CFPBs) Rule Capping Credit-Card Late Fees: Continue to voice concern about the rules unintended consequences for small businesses. Prove-It Act (H.R. 7198): Supported House passage of the legislation. Midnight Rules Relief Act (H.R. 115): Supported House passage of the legislation. The Credit Card Competition Act (S.1838): Continue to oppose the legislation. Railway Safety Act (S. 576): SBE Council continues to express concern about the legislation as well as proposals to intrusively regulate the railroad industry, which is dominated by small businesses. The Small Business Regulatory Reduction Act (H.R. 3995): Continue to support full House passage. The Fishery Improvement to Streamline Untimely Regulatory Hurdles post Emergency Situation Act (FISHES Act): Supported House passage of the legislation. Warehouse Worker Protection Act (S.4260): Opposed the introduction of legislation in the U.S. Senate. DOLs Overtime Rule: Requested Wage and Hour Division to delay implementation of the second increase to the minimum salary threshold as mandated by the Final Rule from January 1, 2025 to at least May 1, 2025 pending judicial review, which was currently underway. Federal Trade Commission: SBE Council commented on the Reopening of Solicitation for Public Comments on Provisions of Franchise Agreements and Franchisor Business Practices {Docket No: FTC-2023-0026) because of its one-size-fits-all approach and that it has been pursued and advanced without empirical data or the required cost-benefit analysis. Moreover, reopening the rule in the hopes of acquiring more anecdote to justify it does not address its primary flaws. Federal Deposit Insurance Corporation: SBE Council submitted comments outlining the unnecessary actions proposed by the Change in Bank Control Act proposal (RIN 3064-AG04). Blacklisting: Expressed opposition to the unrelated blacklisting provision in the Workforce Innovation and Opportunity Act (WIOA). Privacy Policy: Continue to express the need for a national regulatory framework, but for Congress to consider a framework that avoids adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. Access to Capital Expanding Access to Capital Act (H.R. 2799): SBE Council supported House passage and action by the U.S. Senate. Affordable Health Coverage and Health Care Innovation Continue to voice ongoing concerns about the rising costs of health coverage and lack of choices in many markets. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. CHOICE Arrangement Act (H.R. 2799): Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. HSA Modernization Act (H.R. 5687) and Bipartisan HSA Improvement Act (H.R. 5688): Continue to support full House action. Telehealth Expansion Act of 2023 (H.R. 1843) (S. 1001): Continue to support full House and Senate action. Telehealth: Joined allies in urging the Centers for Medicare and Medicaid Services (CMS) to expedite the creation of permanent policy related to telehealth practitioners and requirements related to the reporting of their location at the time of service. Chronic Disease Flexible Coverage Act (H.R. 3800): Supported full House passage and Senate action. Paperwork Burden Reduction Act (H.R. 3797): Supported full House passage and Senate action. Employer Reporting Improvement Act (H.R. 3801): Supported full House passage and Senate action. Small Business Flexibility Act (H.R. 3798): Support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799): Support full House passage. SMART Prices Act (S. 1264): Continue to oppose the legislation. Property Rights and IP March-In and the Bayh Dole Act: Continue to express opposition to a regulatory guidance proposal via the National Institutes of Health (NIST) that considers price as a basis for invalidating the patents of research and innovations seeded with federal government dollars. Patent Eligibility Restoration Act (S.2140): Support the legislation. Promoting and Respecting Economically Vital American Innovation Leadership Act (PREVAIL Act) (S.2220): Support the legislation. Trade and Global Market Access Digital Trade Principles: Continue to express concern about the U.S. pulling away from these global principles and the need for President Biden to revisit the United State Trade Representatives action to withdraw from for foundational positions on digital trade policy within the World Trade Organization (WTO). Supporting Business Competitiveness and Startup Activity Comprehensive Resources for Entrepreneurs in the Arts to Transform the Economy (CREATE) Act (S.3759): Support the legislation. Small Business Technological Advancement Act (S.2330/H.R. 10269): SBE Council supports the legislation. Access to Broadband and Next Gen Technology Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216): Continue to support the legislation. Development of a National Spectrum Strategy (NSS): Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G. Nominations National Labor Relations Board Nomination (NLRB): SBE Council opposed the nomination and Senate confirmation of Lauren McFerran to serve another term as Chair of the NLRB.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to insurance coverage, employer sponsored insurance, prescription drugs, and telemedicine; H.R. 3801/S.3204 - Employer Reporting Improvement Act (PL 118-168); H.R. 5378 - Lower Cost, More Transparency Act.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; H.R.824, Telehealth Benefit Expansion for Works Act of 2023; H.R.1264, Commonsense Reporting Act; H.R.1843, Telehealth Expansion Act of 2023; H.R.2813, Self Insurance Protection Act; H.R.2868, Association Health Plan Act; H.R.3797, Paperwork Burden Reduction Act; H.R.3798, Small Business Flexibility Act; H.R.3799, CHOICE Arrangement Act; H.R.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption; Issues related to employer sponsored health coverage

Client expense: $410,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform Employer Reporting under ACA (H.R. 3801) Employer-sponsored coverage ERISA Pharmacy Benefit Manager Reform Insulin copay caps End stage renal disease Mental Health Parity HSA Reform Site neutral payments Transparency H.R. 6860, Dialysis

Client expense: Not reported · Firm income: $12,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

Health care reform Employer Reporting under ACA (H.R. 3801) Employer-sponsored coverage ERISA Pharmacy Benefit Manager Reform Insulin copay caps End stage renal disease Mental Health Parity HSA Reform Site neutral payments Transparency H.R. 6860, Dialysis

Client expense: Not reported · Firm income: $21,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

Tax Relief and Reform Tax Relief for American Families and Workers Act of 2024: SBE Council supported U.S. Senate passage (which failed) of the House-passed bill. R&D Tax Credit-Immediate Expensing: Continue to support restoring and making permanent full expensing for R&D expenditures for small businesses. Support "American Innovation and Jobs Act" (S. 866) in the Senate and "American Innovation and R&D Competitiveness Act" (H.R. 2673) in the House. Main Street Tax Certainty Act of 2023 (S. 1706, H.R. 4721): Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small-and individually-owned businesses (Section 199A). Death Tax Repeal Act of 2023 (S. 1108): Support House and Senate bills to permanent repeal the death tax and continue to support action by Congress. Tax Cuts and Jobs Act of 2017: Support extending the expiring provisions of the legislation that terminate in 2025 and have expressed opposition to raising taxes on small businesses. Regulation Regulatory Pause and Review: In light of the Supreme Court decision in Loper Bright Enterprises et al. v. Raimondo, urged President Biden and the Administration to pause all current rulemakings and stop new rules from taking effect until there is a thorough legal review of each agencys constitutional and statutory authority to regulate in the way it proposes. Joint Employer Standard: Supported the specific provision in Fiscal Year 2025 Labor, Health and Human Services, Education and Related Agencies (LHHS) Appropriations Act to prevent federal funds from being used to administer, implement, or enforce the recent National Labor Relations Board (NLRB) rule entitled Standard for Determining Joint Employer Status. Blacklisting: Expressed opposition to the unrelated blacklisting provision in the Workforce Innovation and Opportunity Act (WIOA). Basel III Endgame Implementation: Continue to express concern and opposition to the proposal by the U.S. Federal Reserve and Federal Deposit and Insurance Corporation in regard to the impact on small business capital access and affordability. Save Local Businesses Act (S.1261, HR 2826): Continue to support the legislation. Protecting the Right to Organize (PRO) Act (S. 567): Continue to oppose the legislation. The Protect Small Business and Prevent Illicit Financial Activity Act: SBE Council supports S. 3625 to delay implementation of the Corporate Transparency Act and H.R. 9278, legislation to delay the Corporate Transparency Acts year-end compliance deadline. We have also supported repeal of this measure. Consumer Financial Protection Bureaus (CFPBs) Rule Capping Credit-Card Late Fees: Continue to voice concern about the rules unintended consequences for small businesses. Prove-It Act (H.R. 7198): Continue to support the legislation. Federal Communications Commission (FCC) Safeguarding and Securing the Open Internet Rule: Continues to express concern about intrusive government control of the internet as advanced by the rule and Section 214 regulations under the proposal. The Credit Card Competition Act: Continue to oppose the legislation. Railway Safety Act (S. 576): SBE Council continues to express concern about the legislation as well as proposals to intrusively regulate the railroad industry, which is dominated by small businesses. The Small Business Regulatory Reduction Act: Continue to support full House passage. The Fishery Improvement to Streamline Untimely Regulatory Hurdles post Emergency Situation Act (FISHES Act): Continue to support House and Senate passage of the legislation. Privacy Policy: Continue to express the need for a national regulatory framework, but for Congress to consider a framework that avoids adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. SBE Council expressed opposition to H.R. 8818, the American Rights Privacy Act. Access to Capital Expanding Access to Capital Act (H.R. 2799): SBE Council supported House passage and action by the U.S. Senate. Affordable Health Coverage and Health Care Innovation Continue to voice ongoing concerns about the rising costs of health coverage and lack of choices in many markets. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. CHOICE Arrangement Act (H.R. 2799): Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. HSA Modernization Act (H.R. 5687) and Bipartisan HSA Improvement Act (H.R. 5688): Continue to support full House action. Telehealth Expansion Act of 2023 (H.R. 1843) (S. 1001): Continue to support full House and Senate action. Telehealth Coverage and Extension: Urged Congress to intervene in Drug Enforcement Administrations non-action on allowing virtual prescriptions and other telehealth for a two-year extension. Chronic Disease Flexible Coverage Act (H.R. 3800): Supported full House passage and Senate action. Paperwork Burden Reduction Act (H.R. 3797): Supported full House passage and Senate action. Employer Reporting Improvement Act (H.R. 3801): Supported full House passage and Senate action. Small Business Flexibility Act (H.R. 3798): Support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799): Support full House passage. SMART Prices Act (S. 1264): Continue to oppose the legislation. Property Rights and IP March-In and the Bayh Dole Act: Continue to express opposition to a regulatory guidance proposal via the National Institutes of Health (NIST) that considers price as a basis for invalidating the patents of research and innovations seeded with federal government dollars. Trade and Global Market Access Digital Trade Principles: Continue to express concern about the U.S. pulling away from these global principles and the need for President Biden to revisit the United State Trade Representatives action to withdraw from for foundational positions on digital trade policy within the World Trade Organization (WTO). Global Trade Agreements and Access to Global Markets: Continue to advocate to the Administration the need to advance a positive and proactive U.S. trade policy that benefits all U.S. enterprises and citizens. Supporting Business Competitiveness and Startup Activity Comprehensive Resources for Entrepreneurs in the Arts to Transform the Economy (CREATE) Act: Support the legislation. Access to Broadband and Next Gen Technology BEAD Program Implementation: Continues to voice concern about the National Telecommunications and Information Administrations rate regulation provisions for broadband internet service that was specifically prohibited by Congress as part of the Infrastructure Investment and Jobs Act. Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216): Continue to support the legislation. Development of a National Spectrum Strategy (NSS): Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G. Nominations NLRB Chair Lauren McFerran: Urge the Senate Health, Education, Labor, and Pensions (HELP) Committee to reject Chair Lauren McFerrans re-nomination to the National Labor Relations Board (NLRB), and expressed concern about the fact that there was no confirmation hearing.

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 2872 - Further Additional Continuing Appropriations and Other Extensions Act, 2024 - Rep. Graves, Garret - extends FY24 funding and program authorities through March 8, 2024 H.R. 2882 - Further Consolidated Appropriations Act, 2024 - Rep. Ciscomani, Juan - provides annual funding through September 30, 2024, for the Departments of Labor, Health and Human Services, and Education, and Related Agencies H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements H.R. 6956 - Opioid Settlement Accountability Act - Rep. Kaptur, Marcy - funding for opioid prevention and treatment services, training, equipment, and social support services H.R. 6960 - Emergency Medical Services for Children Reauthorization Act of 2024 - Rep. Carter, Earl L. Buddy - funding for emergency medical services for children program H.R. 7513 - Protecting Americas Seniors Access to Care Act - Rep. Fischbach, Michelle - regarding minimum staffing for nursing facilities H.R. 7623 - Telehealth Modernization Act of 2024- Rep. Carter, Buddy - including requirements for Part D plan contracts with PBMs including transparency and delinking provisions H.R. 7858 - Telehealth Enhancement for Mental Health Act of 2024 - Rep. James, John - Medicare, behavioral health, telehealth H.R. 7899 - To direct the Attorney General, in consultation with the Secretary of Health and Human Services, to promulgate the final regulations relating to special registration for telemedicine. - Rep. Ezell, Mike - telehealth H.R. 7907 - Welcome Back to the Health Care Workforce Act - Rep. Krishnamoorthi, Raja- grants/funding, health care workforce H.R. 7929 - Nursing Home Workforce Support and Expansion Act of 2024 - Rep. Horsford, Steven - grants/funding, health care workforce H.R. 7994 - Long-Term Care Workforce Support Act - Rep. Dingell, Debbie - health care workforce H.R. 8444 - Mental Health in Schools Act - Rep. Napolitano, Grace - grant to promote mental health S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act. - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce S. 3612 - Access to Family Building Act- Sen. Duckworth, Tammy- right to access reproductive technology (ex. IVF) S. 3756 - At HOME Services Act of 2024- Sen. Rubio, Marco- pilot program for outpatient observation, acute care at home S. 3775 - BOLD Infrastructure for Alzheimers Reauthorization Act of 2024- Sen. Collins, Susan - healthcare infrastructure, Alzheimers S. 3805 - A bill to amend title XI of the Social Security Act to prohibit health plans from imposing fees on health care providers for electronic funds transfers and health care payment and remittance advice transactions, and for other purposes. - Sen. Cassidy, Bill - SSA, healthcare, electronic funds, payments, remittance S. 3847 - Improving Social Determinants of Health Act of 2024- Sen. Smith, Tina- CDC authorization S. 4088 - Welcome Back to the Health Care Workforce Act - Sen. Kaine, Tim - grants/funding, health care workforce S. 4120 - Long-Term Care Workforce Support Act - Sen. Casey, Robert P., Jr. - health care workforce S. 4195 - Childhood Diabetes Reduction Act of 2024 - Sen. Sanders, Bernie - nutrition labeling S. 4357 - Comprehensive Dental Reform Act of 2024- Sen. Sanders, Bernie - promotes access to oral health care S. 4358 - Preventing and Treating Substance Use Disorders Among Older Adults Act- Sen. Casey, Robert - SAMHSA grant program for SUDs S. 4554 - Reproductive Freedom for Women Act- Sen. Murray, Patty - protecting abortion and reproductive rights Issues related to broadband and public health infrastructure; mental health and telehealth; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; artificial intelligence and privacy; insurance industry response to and support for providers regarding the Change Healthcare cyberattack and broader cyber security issues; ACA Marketplace; and Mental Health Parity Proposed Rule.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; H.R.824, Telehealth Benefit Expansion for Works Act of 2023; H.R.1264, Commonsense Reporting Act; H.R.1843, Telehealth Expansion Act of 2023; H.R.2813, Self Insurance Protection Act; H.R.2868, Association Health Plan Act; H.R.3797, Paperwork Burden Reduction Act; H.R.3798, Small Business Flexibility Act; H.R.3799, CHOICE Arrangement Act; H.R.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption; Issues related to employer sponsored health coverage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to insurance coverage, employer sponsored insurance, prescription drugs, and telemedicine; H.R. 3801/S.3204 - Employer Reporting Improvement Act, issues related to employer reporting requirements; H.R. 5378 - Lower Cost, More Transparency Act.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Tax Relief and Reform Tax Relief for American Families and Workers Act of 2024 - SBE Council continues to support U.S. Senate passage. R&D Tax Credit-Immediate Expensing: Continue to support restoring and making permanent full expensing for R&D expenditures for small businesses. Support "American Innovation and Jobs Act" (S. 866) in the Senate and "American Innovation and R&D Competitiveness Act" (H.R. 2673) in the House. Main Street Tax Certainty Act of 2023 (S. 1706, H.R. 4721) - Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small-and individually-owned businesses (Section 199A). Death Tax Repeal Act of 2023 (S. 1108): Support House and Senate bills to permanent repeal the death tax and continue to support action by Congress. Regulation Basel III Endgame Implementation - SBE Council has expressed concern and opposition to the proposal by the U.S. Federal Reserve and Federal Deposit and Insurance Corporation in regard to the impact on small business capital access and affordability. Regulation II as Proposed by the Federal Reserve: Opposed the notice of proposed rulemaking to amend Regulation II, which sets standards for debit card fee regulation. Urged the Federal Reserve to withdraw the proposal. Expressed opposition to further lower the cap on debit card interchange fees from 21 cents to 14.4 cents per transaction, which would harm small financial institutions and small business consumers. Congressional Review Act (CRA) Resolution to Overturn the Department of Labors Independent Contractor Rule: SBE Council supported H.J. Res 116 and S.J. Res 63 to nullify the rule. Continue to express concern about the effects of the final rule on entrepreneurship and the economy, and support general efforts in the House and Senate to promote and strengthen independent work and self-employment. DOL's Proposed Overtime Rule: Expressed concern about the final rule, support of the CRA to overturn the rule, and communicated to the Department of Labor Wage and Hour Division about the need to delay implementation due to sudden and painful impact on small businesses and legal challenges to the rule. OSHA Walkaround Rule - Oppose the final rule, and efforts in the Congress to implement the rule. Save Local Businesses Act (S.1261, HR 2826) - Support the legislation. Protecting the Right to Organize (PRO) Act (S. 567) - Continue to oppose the legislation. The Protect Small Business and Prevent Illicit Financial Activity Act - SBE Council supports S. 3625 to delay implementation of the Corporate Transparency Act, and continue to communicate concerns about widespread non-compliance due to lack of knowledge in the small business community. Federal Acquisition Regulation: Use of Project Labor Agreements for Federal Construction Projects - SBE Council opposed the final rule. SBE Council continues to educate lawmakers about the effects of PLA's on small business competition, to taxpayers and the efficacy of completing federal construction and infrastructure projects. Federal Trade Commission (FTC) Hart-Scott-Rodino (HSR) Pre-Merger Reporting Requirement Proposed Rule - SBE Council continue to oppose the rule and to point out that the FTC mistakenly certified that small businesses will not be affected by the significant changes being proposed, therefore the rule needs to be pulled. National Labor Relation Board (NLRB) Funding - SBE Council supports efforts by House and Senate appropriators to hold the line on increased funding for the NLRB. Voiced support for language that would disallow funds to be used for implementation of the final "joint employer" rule. Consumer Financial Protection Bureaus (CFPBs) Rule Capping Credit-Card Late Fees - SBE Council continues to voice concern about the rules unintended consequences for small businesses. Prove-It Act (H.R. 7198) - SBE Council continues to support House passage of the legislation, which gives small businesses a more effectual voice in federal rulemakings and strengthens federal government accountability when proposed regulations impact small businesses. Federal Communications Commission (FCC) Safeguarding and Securing the Open Internet Rule - SBE Council continues to express concerns about intrusive government control of the internet as proposed by the rule and Section 214 regulations under the proposal. The Credit Card Competition Act - SBE Council continues to oppose the legislation. Railway Safety Act (S. 576) - SBE Council continues to express concern about the legislation as well as proposals to further regulate the railroad industry, which is dominated by small businesses. The Small Business Regulatory Reduction Act - Continue to support full House passage. The Fishery Improvement to Streamline Untimely Regulatory Hurdles post Emergency Situation Act (FISHES Act) - Support the legislation in the House and Senate. Privacy Policy - Continue to express the need for a national regulatory framework, but for Congress to consider a framework that avoids adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. SBE Council expressed opposition to H.R. 8818, the American Rights Privacy Act. Access to Capital Expanding Access to Capital Act (H.R. 2799) - SBE Council supported House passage and action by the U.S. Senate. Affordable Health Coverage and Health Care Innovation Voiced ongoing concerns about the rising costs of health coverage, lack of choices, and dwindling choices in many markets against the backdrop of challenging economic conditions. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. CHOICE Arrangement Act (H.R. 2799) - Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. HSA Modernization Act (H.R. 5687) and Bipartisan HSA Improvement Act (H.R. 5688) - Continue to support full House passage. Telehealth Expansion Act of 2023 (H.R. 1843) (S. 1001)- Continue to support full House and Senate passage. Telehealth Coverage: Urged the Drug Enforcement Administration to expedite the release of a revised proposed rule to permit and regulate the prescribing of controlled substances through telehealth, which is crucial for access to mental health, substance use disorder, and other telehealth care. Chronic Disease Flexible Coverage Act (H.R. 3800) - Support full House passage. Paperwork Burden Reduction Act (H.R. 3797) - Supported full House passage. Employer Reporting Improvement Act (H.R. 3801) - Support full House passage. Small Business Flexibility Act (H.R. 3798) - Support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799) - Support full House passage. SMART Prices Act (S. 1264) - Continue to oppose the legislation. Property Rights and IP Commented on U.S. Patent and Trademark Office (USPTO) Notice of Proposed Rulemaking concerning proposed modifications to the rules of practice for inter partes review (IPR) and post-grant review (PGR) proceedings before the Patent Trial and Appeal Board (PTAB). Urged USPTO to consider the input of small inventors and innovative entrepreneurial firms. Trade and Global Market Access Digital Trade Principles - Continue to express concern about the U.S. pulling away from the principles and the need for President Biden to revisit the United State Trade Representatives action to withdraw from for foundational positions on digital trade policy within the World Trade Organization (WTO). Supporting Business Competitiveness and Startup Activity Comprehensive Resources for Entrepreneurs in the Arts to Transform the Economy (CREATE) Act - SBE Council supports the legislation. Access to Broadband and Next Gen Technology BEAD Program Implementation - SBE Council continues to voice concern about the National Telecommunications and Information Administrations rate regulation provisions for broadband internet service that was specifically prohibited by Congress as part of the Infrastructure Investment and Jobs Act. Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216) - Continue to support the legislation. Development of a National Spectrum Strategy (NSS) - Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G.

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; HR.824, Telehealth Benefit Expansion for Works Act of 2023; HR.1264, Commonsense Reporting Act; HR.1843, Telehealth Expansion Act of 2023; HR.2813, Self Insurance Protection Act; HR.2868, Association Health Plan Act; HR.3797, Paperwork Burden Reduction Act; HR.3798, Small Business Flexibility Act; HR.3799, CHOICE Arrangement Act; HR.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption; Issues related to employer sponsored health coverage

Client expense: $101,954 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; HR.824, Telehealth Benefit Expansion for Works Act of 2023; HR.1264, Commonsense Reporting Act; HR.1843, Telehealth Expansion Act of 2023; HR.2813, Self Insurance Protection Act; HR.2868, Association Health Plan Act; HR.3797, Paperwork Burden Reduction Act; HR.3798, Small Business Flexibility Act; HR.3799, CHOICE Arrangement Act; HR.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption; Issues related to employer sponsored health coverage

Client expense: $101,954 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 2872 - Further Additional Continuing Appropriations and Other Extensions Act, 2024 - Rep. Graves, Garret - extends FY24 funding and program authorities through March 8, 2024 H.R. 2882 - Further Consolidated Appropriations Act, 2024 - Rep. Ciscomani, Juan - provides annual funding through September 30, 2024, for the Departments of Labor, Health and Human Services, and Education, and Related Agencies H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements H.R. 6956 - Opioid Settlement Accountability Act - Rep. Kaptur, Marcy - funding for opioid prevention and treatment services, training, equipment, and social support services H.R. 6960 - Emergency Medical Services for Children Reauthorization Act of 2024 - Rep. Carter, Earl L. Buddy - funding for emergency medical services for children program H.R. 7513 - Protecting Americas Seniors Access to Care Act - Rep. Fischbach, Michelle - regarding minimum staffing for nursing facilities H.R. 7858 - Telehealth Enhancement for Mental Health Act of 2024 - Rep. James, John - Medicare, behavioral health, telehealth H.R. 7899 - To direct the Attorney General, in consultation with the Secretary of Health and Human Services, to promulgate the final regulations relating to special registration for telemedicine. - Rep. Ezell, Mike - telehealth H.R. 7907 - Welcome Back to the Health Care Workforce Act - Rep. Krishnamoorthi, Raja- grants/funding, health care workforce H.R. 7929 - Nursing Home Workforce Support and Expansion Act of 2024 - Rep. Horsford, Steven - grants/funding, health care workforce H.R. 7994 - Long-Term Care Workforce Support Act - Rep. Dingell, Debbie - health care workforce H.R. 8444 - Mental Health in Schools Act - Rep. Napolitano, Grace - grant to promote mental health S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act. - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce S. 3612 - Access to Family Building Act- Sen. Duckworth, Tammy- right to access reproductive technology (ex. IVF) S. 3756 - At HOME Services Act of 2024- Sen. Rubio, Marco- pilot program for outpatient observation, acute care at home S. 3775 - BOLD Infrastructure for Alzheimers Reauthorization Act of 2024- Sen. Collins, Susan - healthcare infrastructure, Alzheimers S. 3805 - A bill to amend title XI of the Social Security Act to prohibit health plans from imposing fees on health care providers for electronic funds transfers and health care payment and remittance advice transactions, and for other purposes. - Sen. Cassidy, Bill - SSA, healthcare, electronic funds, payments, remittance S. 3847 - Improving Social Determinants of Health Act of 2024- Sen. Smith, Tina- CDC authorization S. 4088 - Welcome Back to the Health Care Workforce Act - Sen. Kaine, Tim - grants/funding, health care workforce S. 4120 - Long-Term Care Workforce Support Act - Sen. Casey, Robert P., Jr. - health care workforce S. 4195 - Childhood Diabetes Reduction Act of 2024 - Sen. Sanders, Bernie - nutrition labeling S. 4357 - Comprehensive Dental Reform Act of 2024- Sen. Sanders, Bernie - promotes access to oral health care S. 4358 - Preventing and Treating Substance Use Disorders Among Older Adults Act- Sen. Casey, Robert - SAMHSA grant program for SUDs S. 4554 - Reproductive Freedom for Women Act- Sen. Murray, Patty - protecting abortion and reproductive rights Issues related to broadband and public health infrastructure; mental health and telehealth; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; artificial intelligence and privacy; insurance industry response to and support for providers regarding the Change Healthcare cyberattack; ACA Marketplace; and Mental Health Parity Proposed Rule.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to insurance coverage, employer sponsored insurance, prescription drugs, and telemedicine; H.R. 3801 - Employer Reporting Improvement Act, issues related to employer reporting requirements; H.R. 5378 - Lower Cost, More Transparency Act.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform Employer Reporting under ACA (H.R. 3801) Employer-sponsored coverage ERISA Pharmacy Benefit Manager Reform Insulin copay caps End stage renal disease Mental Health Parity HSA Reform Site neutral payments Transparency H.R. 6860, Dialysis

Client expense: Not reported · Firm income: $21,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

Health care reform Employer Reporting under ACA (H.R. 3801) Employer-sponsored coverage ERISA Pharmacy Benefit Manager Reform Insulin copay caps End stage renal disease Mental Health Parity HSA Reform Site neutral payments Transparency H.R. 6860, Dialysis

Client expense: Not reported · Firm income: $21,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - treating benefits for telehealth services offered under a group health plan or group health insurance coverage as excepted benefits H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 2872 - Further Additional Continuing Appropriations and Other Extensions Act, 2024 - Rep. Graves, Garret - extends FY24 funding and program authorities through March 8, 2024 H.R. 2882- Further Consolidated Appropriations Act, 2024 - Rep. Ciscomani, Juan - provides annual funding through September 30, 2024, for the Departments of Labor, Health and Human Services, and Education, and Related Agencies H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements H.R. 6956 - Opioid Settlement Accountability Act - Rep. Kaptur, Marcy - funding for opioid prevention and treatment services, training, equipment, and social support services H.R. 6960 - Emergency Medical Services for Children Reauthorization Act of 2024 - Rep. Carter, Earl L. - funding for emergency medical services for children program H.R. 7513 - Protecting Americas Seniors Access to Care Act - Rep. Fischbach, Michelle - regarding minimum staffing for nursing facilities S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce S. 3612- Access to Family Building Act- Sen. Duckworth, Tammy- right to access reproductive technology (ex. IVF) S. 3756- At HOME Services Act of 2024- Sen. Rubio, Marco- pilot program for outpatient observation, acute care at home S. 3775- BOLD Infrastructure for Alzheimer's Reauthorization Act of 2024- Sen. Collins, Susan - healthcare infrastructure, Alzheimers S. 3805- A bill to amend title XI of the Social Security Act to prohibit health plans from imposing fees on health care providers for electronic funds transfers and health care payment and remittance advice transactions, and for other purposes. - Sen. Cassidy, Bill - SSA, healthcare, electronic funds, payments, remittance S. 3847- Improving Social Determinants of Health Act of 2024- Sen. Smith, Tina- CDC authorization Issues related to broadband and public health infrastructure; mental health and telehealth; COVID-19 testing; public option programs; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; and artificial intelligence and privacy. Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10 and ICD-11), identifiers, enforcement; cybersecurity; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage and reproductive health; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; ACA risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.

Tax Relief and Reform Tax Relief for American Families and Workers Act of 2024 - SBE Council supported U.S. House passage of the legislation and advocated for passage by the U.S. Senate. R&D Tax Credit: Continue to support extending and making permanent full expensing for R&D expenditures for small businesses. Voiced Support for "American Innovation and Jobs Act" (S. 866) in the Senate and "American Innovation and R&D Competitiveness Act" (H.R. 2673) in the House. Main Street Tax Certainty Act of 2023 (S. 1706, H.R. 4721) - Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small-and individually-owned businesses (Section 199A). Death Tax Repeal Act of 2023 (S. 1108): Support House and Senate bills to permanent repeal the death tax and continue to support action by Congress. Capital Gains Tax Indexing - Voiced support for this reform measure and continue to support action by Congress. Regulation Resolution of Disapproval to Overturn NLRBs Joint Employer Rule (HJ. Res 98) - SBE Council supported U.S. House passage and for the U.S. Senate to quickly follow suit. Basel III Endgame Implementation - SBE Council expressed concern and opposition to the proposal to the U.S. Federal Reserve and Federal Deposit and Insurance Corporation regarding the impact on small business capital access and affordability. Congressional Review Act (CRA) Resolution to Overturn the Department of Labors Independent Contractor Rule: SBE Council supported H.J. Res 116 and S.J. Res 63 to nullify the rule. DOL's Proposed Overtime Rule: Continue to express concern about the proposed rule. Save Local Businesses Act (S.1261, HR 2826) - Continue to support the legislation. Protecting the Right to Organize (PRO) Act (S. 567) - Continue to oppose the legislation. The Protect Small Business and Prevent Illicit Financial Activity Act - SBE Council supports S. 3625 to delay implementation of the Corporate Transparency Act. Federal Acquisition Regulation: Use of Project Labor Agreements for Federal Construction Projects - SBE Council opposed the final rule. Federal Trade Commission (FTC) Hart-Scott-Rodino (HSR) Pre-Merger Reporting Requirement Proposed Rule - SBE Council opposes the rule and pointed out that the FTC mistakenly certified that small businesses will not be affected by the significant changes being proposed, therefore the rule needs to be pulled. National Labor Relation Board (NLRB) Funding - SBE Council urged House and Senate appropriators to hold the line on increased funding for the NLRB. Consumer Financial Protection Bureaus (CFPBs) Rule Capping Credit-Card Late Fees - SBE Council voiced concern about the rules unintended consequences. That is, backfiring on small business consumers who use credit responsibly and make their payments on time. Prove-It Act (H.R. 7198) - SBE Council supported House Judiciary Committee action that advanced the legislation, which gives small businesses a more effectual voice in federal rulemakings and strengthens federal government accountability when proposed regulations impact small businesses. Federal Communications Commission (FCC) Safeguarding and Securing the Open Internet Rule - SBE Council continues to express concerns about intrusive government control of the internet as proposed by the rule and Section 214 regulations under the proposal. The Credit Card Competition Act - SBE Council continues to oppose the legislation. Railway Safety Act (S. 576) - SBE Council continues to express concern about the heavy-handedness of the legislation as well as proposals to further regulate the railroad industry, which is dominated by small businesses. Centers for Medicare and Medicaid Services (CMS) Proposal on Medicare Advantage Plans - SBE Council expressed concerns about the proposal that would significantly alter the marketing and broker compensation structures of the plans. The Small Business Regulatory Reduction Act - Continue to supported full House passage. Privacy Policy - Continue to express the need for a national regulatory framework, but for Congress to consider a framework that avoids adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. Access to Capital Expanding Access to Capital Act (H.R. 2799) - SBE Council supported House passage. The Budget Further Consolidated Appropriations Act for 2024 - SBE Council supported House passage. Republican FY 2025 Budget Resolution - SBE Council supported the budget resolution framework. President Bidens Budget Proposal - SBE Council voiced concern about the excessive spending in the proposal as well as the various tax increases that would fall on small businesses, investors and the business community. Affordable Health Coverage and Health Care Innovation Voiced ongoing concerns about the rising costs of health coverage, lack of choices, and dwindling choices in many markets against the backdrop of challenging economic conditions. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. CHOICE Arrangement Act (H.R. 2799) - Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. HSA Modernization Act (H.R. 5687) and Bipartisan HSA Improvement Act (H.R. 5688) - Continue to support full House passage. Telehealth Expansion Act of 2023 (H.R. 1843) (S. 1001)- Continue to support full House and Senate passage. Chronic Disease Flexible Coverage Act (H.R. 3800) - Support full House passage. Paperwork Burden Reduction Act (H.R. 3797) - Support full House passage. Employer Reporting Improvement Act (H.R. 3801) - Support full House passage. Small Business Flexibility Act (H.R. 3798) - Support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799) - Support full House passage. SMART Prices Act (S. 1264) - Continue to oppose the legislation. Property Rights and IP Submitted Comments to the National Institutes of Standards and Technology (NIST) Regarding the Draft Interagency Guidance Framework for Considering the Exercise of March-in Rights-SBE Council urged NIST to withdraw the proposed guidance. Submitted Comments to United States Patent and Trademark Office (USPTO) on WIPO IGC Negotiations on Genetic Resources and Associated Traditional Knowledge - SBE Council expressed concern regarding the IGCs proposed mandatory patent disclosure requirements (PDRs) for the origin of genetic resources and traditional knowledge, which would irreparably harm the startup and small business ecosystems that drive innovation. Trade and Global Market Access Digital Trade - The Moratorium on Customs Duties on Electronic Transmissions permanent during the 13th WTO Ministerial Conference (MC13) - SBE Council urged World Trade Organization members to support an extension of the moratorium. Digital Trade Principles - Continue to express concern about the U.S. pulling away from the principles and the need for President Biden to revisit the United State Trade Representatives action to withdraw from for foundational positions on digital trade policy within the World Trade Organization (WTO). Supporting Business Competitiveness and Startup Activity Comprehensive Resources for Entrepreneurs in the Arts to Transform the Economy (CREATE) Act - SBE Council supported Senate introduction of the bill. Paid Leave Policy in U.S. House: Continue to express support for bipartisan exploration in identifying paid leave policy solutions that help support business owners and working families. Access to Broadband and Next Gen Technology BEAD Program Implementation - SBE Council expressed concern about the National Telecommunications and Information Administrations rate regulation provisions for broadband internet service that was specifically prohibited by Congress as part of the Infrastructure Investment and Jobs Act. Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216) - Continue to support the legislation. Development of a National Spectrum Strategy (NSS) - Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; HR.824, Telehealth Benefit Expansion for Works Act of 2023; HR.1264, Commonsense Reporting Act; HR.1843, Telehealth Expansion Act of 2023; HR.2813, Self Insurance Protection Act; HR.2868, Association Health Plan Act; HR.3797, Paperwork Burden Reduction Act; HR.3798, Small Business Flexibity Act; HR.3799, CHOICE Arrangement Act; HR.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption

Client expense: $126,007 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to insurance coverage, prescription drugs, and telemedicine; H.R. 3801 - Employer Reporting Improvement Act, issues related to employer reporting requirements; H.R. 5378 - Lower Cost, More Transparency Act; Issues related to pharmacy, prescription drugs, and health insurance in H.R. 4366 - the Consolidated Appropriations Act, 2024.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. McMorris Rodgers, Cathy - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 1613 - Drug Price Transparency in Medicaid Act of 2023 - Rep. Carter, Earl -spread-pricing by PBMs for Medicaid H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. McMorris Rodgers, Cathy - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. McMorris Rodgers, Cathy - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements S. 113 - Prescription Pricing for the People Act of 2023 - Sen. Grassley, Chuck - preventing anti-competitive tactics for prescription drugs S. 127 - Pharmacy Benefit Manager Transparency Act of 2023 - Sen. Cantwell, Maria - pharmacy benefit manager transparency S. 652 - Safe Step Act - Sen. Murkowski, Lisa - medication step therapy protocol S. 954 - Affordable Insulin Now Act of 2023 - Sen. Warnock, Raphael - cost-sharing for insulin products S. 1038 - Drug Price Transparency in Medicaid Act of 2023 - Sen. Welch, Peter - prohibits spread-pricing by PBMs in Medicaid S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality S. 3393 - SUPPORT for Patients and Communities Reauthorization Act. - Sen. Sanders, Bernie - SUD treatment S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 - Sen. Wyden, Ron - mental health, telehealth, health workforce Issues related to broadband and public health infrastructure; mental health and telehealth; COVID-19 testing; public option programs; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; provider directories; and artificial intelligence and privacy. Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10 and ICD-11), identifiers, enforcement; cybersecurity; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage and reproductive health; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; ACA risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Taxes and Tax Reform R&D Tax Credit: Continue to support extending and making permanent full expensing for R&D expenditures for small businesses. Voiced Support for "American Innovation and Jobs Act" (S. 866) in the Senate and "American Innovation and R&D Competitiveness Act" (H.R. 2673) in the House. Main Street Tax Certainty Act of 2023 (S. 1706, H.R. 4721) - Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small-and individually-owned businesses (Section 199A). "Small Business Jobs Act" (HR 3937) - Continue to support House passage of the legislation. "Build It in America Act" (HR 3938) - Continue to support House passage of the legislation. "Small Business Investment Act" (H.R. 2767) - Continue to support full House Action. "Death Tax Repeal Act of 2023" (S. 1108): Support House and Senate bills to permanent repeal the death tax and continue to support action by Congress. Capital Gains Tax Indexing - Voiced support for this reform measure and continue to support action by Congress. Affordable Health Coverage and Health Care Innovation "CHOICE Arrangement Act" (H.R. 2799) - Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. Voiced ongoing concerns about the rising costs of health coverage, lack of choices, and dwindling choices in many markets against the backdrop of challenging economic conditions. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. "HSA Modernization Act" (H.R. 5687) and "Bipartisan HSA Improvement Act" (H.R. 5688) - Continue to support full House passage. "Telehealth Expansion Act of 2023" (H.R. 1843) (S. 1001) - Voiced support for Ways and Means Committee passage and continue to support full House and Senate passage. Chronic Disease Flexible Coverage Act (H.R. 3800) - Continue to support full House passage. Paperwork Burden Reduction Act (H.R. 3797) - Continue to support full House passage. Employer Reporting Improvement Act (H.R. 3801) - Continue to support full House passage. Small Business Flexibility Act (H.R. 3798) - Continue to support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799) - Continue to support full House passage. Preserving Telehealth: Joined coalition comments to the Centers for Medicare and Medicaid Services (CMS) take action on preserving the benefits of telehealth by ensuring telehealth practitioners working from a home-based (or other) location do not need to report that private residence to the federal government for purposes of either enrollment or billing. "Inflation Reduction Act": Continue to express concern about the impact of price controls on drug innovation, especially for small bio-pharmaceutical firms, urging congressional oversight. "SMART Prices Act" (S. 1264) - Continue to oppose the legislation. Access to Broadband and Digital Policy Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216) - Continue to support the legislation. Development of a National Spectrum Strategy (NSS) - Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G. Broadband Infrastructure: Continue to support efforts in the Congress to provide oversight and track Broadband Equity, Access and Deployment (BEAD) Program funding to ensure the tens of billions of taxpayer dollars being allocated will be used efficiently to connect those lacking access with high-speed broadband. Also expressed concern to U.S. Commerce about possible price controls for broadband. Access to Capital "Small Business Technological Advancement Act" (S.2330): Support the legislation which would help end the digital gap for many small businesses by allowing SBA Loans to be used for investments in eligible technologies. Basel III Endgame Rule: Provided written testimony to Senate Finance Committee on the downstream negative effects regarding the cost and availability of capital and credit of this proposed Federal Reserve rule. Proposed CFPB Rule on Credit Card Price Caps: Urged the Consumer Financial Protection Bureau and President Biden to pull back on this proposed rule given the negative impact on small business access to credit and small financial institutions. Regulation "Providing Opportunities to Show Transparency via Information Technology Act" (POST IT Act): Supported full House passage of the bill. "The Small Business Regulatory Reduction Act": Continue to supported full House passage. "Regulations from the Executive in Need of Scrutiny (REINS) Act" (H.R. 277) - Supported House passage and continue to support Senate action. Privacy Policy in General: Continue to express the need for a national framework, but for Congress to consider a framework that avoid adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. PLA Mandates for Clean Energy Credits: Joined comments to U.S. Treasury/IRS expressing opposition and concern about the mandated use of Project Labor Agreements (PLAs) in order to qualify for the clean energy tax credit used in conjunction with Inflation Reduction Act projects. "Prove It Act" (S. 1411) - Continue to voice support and passage of this bill requiring agencies to conduct due diligence on how proposed regulations impact small businesses. Filed comments with the North American Securities Administrators Associations (NASAA) on proposed revisions to its model rule on Dishonest or Unethical Business Practices of Broker-Dealers and Agents, expressing concern about impact on small businesses in the sector and the impact on retail investors. Filed comments with the Federal Communications Commission (FCC) opposing the Proposed Rulemaking (NPRM), Safeguarding and Securing the Open Internet, given its negative impact on small providers, costs, investment, innovation and access to affordable broadband. Trade and Globa Market Access EU and Digital Trade: Urged President Biden, ahead of the October 20 U.S.-EU Summit, to push back against regulatory overreach and protectionist actions in Europe that threaten to restrict trade, undermine U.S. competitiveness, and stifle innovation. These actions include one that undermine intellectual property rights and regulatory initiatives that discriminate against U.S. companies. Digital Trade Principles: Urged President Biden to revisit the United State Trade Representatives action to withdraw from for foundational positions on digital trade policy within the World Trade Organization (WTO). Labor and Workforce Policy DOL's Proposed Overtime Rule: Continue to express concern about the proposed rule. "Save Local Businesses Act" (S.1261, HR 2826) - Continue to support the legislation. Paid Leave Policy in U.S. House: Continue to express support for bipartisan exploration in identifying paid leave policy solutions that help support business owners and working families. Proposed Independent Contractor Rules: Continued to express opposition to independent contractor rules being proposed and advanced by the Department of Labor that would disrupt this critical model for entrepreneurship. "Protecting the Right to Organize (PRO) Act" (S. 567) - Continue to oppose the legislation. "Railway Safety Act" (S. 576): Expressed concern about the legislation to all members of Congress.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. .R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R.5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3797 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. S. 3204 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). S. 3207 (Paperwork Burden Reduction Act): This bill modifies provisions under the Patient Protection and Affordable Care Act so that employers and health insurance providers are no longer required to send tax forms to covered individuals showing proof of minimum essential coverage (1095-B and 1095-C tax forms) unless a form is requested. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R.5138 (Improving Access to Medicare Coverage Act of 2023): To amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital stay requirement for coverage of skilled nursing facility services under Medicare, and for other purposes. H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.

S.127, Pharmacy Benefit Manager Transparency Act of 2023; S.954, Affordable Insulin Now Act; S.1339, Pharmacy Benefit Manager Reform Act; S.1664, Healthy Families Act; S.1869, SITE Act; HR.824, Telehealth Benefit Expansion for Works Act of 2023; HR.1264, Commonsense Reporting Act; HR.1843, Telehealth Expansion Act of 2023; HR.2813, Self Insurance Protection Act; HR.2868, Association Health Plan Act; HR.3797, Paperwork Burden Reduction Act; HR.3798, Small Business Flexibity Act; HR.3799, CHOICE Arrangement Act; HR.3801, Employer Reporting Improvement Act; Issues related to dialysis coverage; Issues related to health sector consolidation; Issues related to ERISA pre-emption

Client expense: $64,788 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to insurance coverage, prescription drugs, and telemedicine; H.R. 3801 - Employer Reporting Improvement Act, issues related to employer reporting requirements.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform Employer Reporting under ACA (H.R. 3801) Employer-sponsored coverage ERISA Pharmacy Benefit Manager Reform Insulin copay caps End stage renal disease Mental Health Parity HSA Reform Site neutral payments Transparency

Client expense: Not reported · Firm income: $21,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

H.R. 485 - Protecting Health Care For All Patients Act of 2023 - Rep. Rodgers, Cathy McMorris - federal programs using prices based on quality-adjusted life years H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 - Rep. Walberg, Tim - telehealth and ERISA amendments H.R. 830 - HELP Copays Act - Rep. Carter, Earl - health insurers responsibility for payments made by or on behalf of a plan enrollee toward a plans cost-sharing requirements H.R. 1488 - Affordable Insulin Now Act of 2023 - Rep. Craig, Angie - cost-sharing for insulin products H.R. 1613 - Drug Price Transparency in Medicaid Act of 2023 - Rep. Carter, Buddy - prohibits spread-pricing by PBMs in Medicaid H.R. 2666 - MVP Act - Rep. Guthrie, Brett - value-based purchasing arrangements under Medicaid program and reforms to price reporting H.R. 2691 - Transparent Price Act - Rep. Rodgers, Cathy McMorris - health insurer price transparency H.R. 2813 - Self-Insurance Protection Act - Rep. Good, Bob - ERISA amendments H.R. 2868 - Association Health Plans Act - Rep. Walberg, Tim - ERISA amendments H.R. 3305 - Black Maternal Health Momnibus Act - Rep. Underwood, Lauren - maternal health including in Medicaid and CHIP H.R. 3561 - PATIENT Act - Rep. Rodgers, Cathy McMorris - PBM transparency, PBM contract design, health insurance transparency, hospital transparency H.R. 3797 - Paperwork Burden Reduction Act - Rep. Smith, Jason - employers mailing 1095 physical tax forms H.R. 3798 - Small Business Flexibility Act - Rep. Tenney, Claudia - small business coverage notifications H.R. 3799 - Custom Health Option and Individual Care Expense Arrangement Act- Rep. Hern, Kevin - health reimbursement arrangements H.R. 3801 - Employer Reporting Improvement Act - Rep. Smith, Adrian - ACA reporting requirements S. 113 - Prescription Pricing for the People Act of 2023 - Sen. Grassley, Chuck - preventing anti-competitive tactics for prescription drugs S. 127 - Pharmacy Benefit Manager Transparency Act of 2023 - Sen. Cantwell, Maria - pharmacy benefit manager transparency S. 652 - Safe Step Act - Sen. Murkowski, Lisa - medication step therapy protocol S. 954 - Affordable Insulin Now Act of 2023 - Sen. Warnock, Raphael - cost-sharing for insulin products S. 1038 - Drug Price Transparency in Medicaid Act of 2023 - Sen. Welch, Peter - prohibits spread-pricing by PBMs in Medicaid S. 1606 - A bill to end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. - Sen. Booker, Cory - maternal mortality Accessible, Affordable Internet for All Act (no bill number) - broadband Advancing Integration in Medicare and Medicaid (AIM) Act (no bill number) - coordinating full-benefits for dual eligible individuals Advancing Telehealth Beyond COVID-19 Act (no bill number) - telehealth American Data Privacy and Protection Act (no bill number) - data privacy American Rescue Plan Act (no bill number) - COVID-19 relief Behavioral Health Integration Awareness Act (no bill number) - mental health and Medicare Better Health Care Directories Act (no bill number) - commercial plans Building COVID-19 Vaccine Confidence Act (no bill number) - COVID-19 CHOICE Act (no bill number) - public option CONNECT for Health Act (no bill number) - expansion of telehealth for Medicare Consolidated Appropriations Act (no bill number) - continued Medicaid and Medicare provisions and funding for FY2023 Consumer Online Privacy Rights Act (no bill number) - data privacy Continuing Appropriations and Ukraine Supplemental Appropriations Act (no bill number) - continued funding for Medicare and Medicaid Improving Seniors Timely Access to Care Act (no bill number) - prior authorization in Medicare Advantage Medicaid Saves Lives Act (no bill number) - Medicaid expansion Medicare for All Act (no bill number) - public option Medicare Multi-Cancer Early Detection Screening Coverage Act (no bill number) - Cancer screening in Medicare Mental Health Matters Act (no bill number) - changes to the procedure around MHPEA litigation MOMMAs Act (no bill number) - maternal health Moms Matter Act (no bill number) - maternal mental health conditions and SUD MORE Health Education Act (no bill number) - Federal Exchange outreach and educational activities NO PAIN Act (no bill number) - non-opioid treatment No Surprises for Survivors Act (no bill number) - requirements for group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for forensic medical exams with no cost sharing Nursing Home Reform Modernization Act (no bill number) - nursing home quality and transparency Parity Enforcement Act (no bill number) - mental health and SUD Parity Implementation Assistance Act (no bill number) - mental health parity PATCH Act (no bill number) - privacy and cybersecurity Patients Before Middlemen Act (no bill number) - pharmacy benefit managers Physician Wellness Program Act (no bill number) - mental health and Medicare Prevent Pandemics Act (no bill number) - pandemic preparedness Preventing Mental Health and Substance Use Crises During Emergencies Act (no bill number) - mental health and SUD national strategy Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act (no bill number) - commercial plans Protecting Americans with Pre-Existing Conditions Act (no bill number) - state innovation waivers Protecting Patients from Deceptive Health Plans Act (no bill number) - excepted benefits coverage Protecting Personal Health Data Act (no bill number) - privacy Public Health Infrastructure Saves Lives Act (no bill number) - public health infrastructure Public Option Deficit Reduction Act (no bill number) - public option Restore Protections for Dialysis Patients Act (no bill number) - reform of MSP Secondary Payer Act Restoring Hope for Mental Health and Well-Being Act (no bill number) - reauthorization of several behavioral health programs RICE Act (no bill number) - commercial plans SAFE DATA Act (no bill number) - consumer data privacy and data transparency and security Safe Step Act (no bill number) -commercial plans and medication step-therapy requirements Secure Data and Privacy for Contact Tracing Act (no bill number) - digital contact tracing for COVID-19 Social Determinants for Moms Act (no bill number) - SDOH and maternal health Strengthen Kids Mental Health Now Act (no bill number) - mental health and Medicaid Supporting Best Practices for Healthy Moms Act (no bill number) - maternal health Tech to Save Moms Act (no bill number) - maternal health The Jackie Walorski Maternal and Child Home Visiting Reauthorization Act (no bill number) - funding for maternal and early childhood health programs To amend the Consolidated Appropriations Act, 2021 to authorize additional funds for the Emergency Broadband Connectivity Fund, to provide grants to States and Tribal Entities to strengthen the National Lifeline Eligibility Verifier, to provide for Federal coordination between the National Lifeline Eligibility Verifier and the National Accuracy Clearinghouse (no bill number) - Broadband To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes. (no bill number) - commercial plans To amend title XI of the Social Security Act to require CMI testing of incentive payments for behavioral health providers and certain other providers for adoption and use of certified electronic health record technology, and for other purposes. (no bill number) - behavioral health and electronic health records To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program. (no bill number) - mental health and Medicare To direct the Secretary of Health and Human Services to conduct a public outreach campaign to inform individuals covered under a group health plan or group or individual health insurance coverage of Federal requirements relating to mental health and substance use disorder crisis services, and for other purposes. (no bill number) - commercial plans To direct the Secretary of Health and Human Services to provide outreach and reporting on opioid use disorder treatment services furnished by opioid treatment programs under the Medicare program. (no bill number) - mental health and Medicare TREATS Act (no bill number) - increase use of telehealth for SUD treatment Turn the Tide Act (no bill number) - Substance Use Disorder Virtual Community Support Act (no bill number) - mental health and SUD grants for community peer support Issues related to benefits, design, or structure of HIPAA-excepted benefits and supplemental benefits; mental health parity; surprise billing; broadband and public health infrastructure; mental health and telehealth; COVID-19 testing; public option programs; behavioral health; rural health; substance use disorder treatments; Health Savings Accounts; and provider directories. Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10 and ICD-11), identifiers, enforcement; cybersecurity; issues related to Medicare Secondary Payer requirements; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; issues related to health equity; issues related to vaccination; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; prescription drug pricing; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; rural health; issues related to behavioral health benefits; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage and reproductive health; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues related to health insurance tax; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; ACA risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan and enhancements included in the American Rescue Plan Act (ARPA); issues related to Medicaid coverage gap; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.

Taxes and Tax Reform R&D Tax Credit: Continue to support extending and making permanent full expensing for R&D expenditures for small businesses. Voiced Support for "American Innovation and Jobs Act" in the Senate and "American Innovation and R&D Competitiveness Act" in the House. Main Street Tax Certainty Act of 2023 - Support House and Senate versions of the legislation to make permanent the 20-percent deduction for small-and individually-owned businesses (Section 199A). "Small Business Jobs Act" (HR 3937) - Voiced support for Ways and Means passage of the legislation and continue to support House passage of the legislation. "Build It in America Act" (HR 3938) - Voiced support for Ways and Means passage of the legislation and continue to support House passage of the legislation. "Small Business Investment Act" - Voiced support for the bill and reforming Section 1202 of the tax code and continue to advocate for action on the bill. "Death Tax Repeal Act of 2023": Support House and Senate bills to permanent repeal the death tax and continue to support action by Congress. Capital Gains Tax Indexing - Voiced support for this reform measure and continue to support action by Congress. Affordable Health Coverage and Health Care Innovation "CHOICE Arrangement Act" (H.R. 2799) - Supported House passage and continue to support Senate action on the legislation. Tax Credit for Small Businesses: Support making reforms to the restrictive and temporary health care tax credit for small businesses to make it more practical for small businesses. Voiced ongoing concerns about the rising costs of health coverage, lack of choices, and dwindling choices in many markets against the backdrop of challenging economic conditions. Voiced support for these various reforms: enhancing tax credits for small businesses, expanding and making additional fixes to HSAs, reforming QSEHRAs, and making CARESs Act telehealth provisions permanent. "HSA Modernization Act" (H.R. 5687) and "Bipartisan HSA Improvement Act" (H.R. 5688) - supported House Ways and Means passage of the legislation. "Telehealth Expansion Act of 2023" (H.R. 1843) - Voiced support for Ways and Means Committee passage. Chronic Disease Flexible Coverage Act (H.R. 3800) - Voiced support for Ways and Means Committee passage and support full House Action. Paperwork Burden Reduction Act (H.R. 3797) - Voiced support for Ways and Means Committee passage and support full House passage. Employer Reporting Improvement Act (H.R. 3801) - Voiced support for Ways and Means Committee passage and support full House passage. Small Business Flexibility Act (H.R. 3798) - Voiced support for Ways and Means Committee passage and support full House passage. Custom Health Option and Individual Care Expense Arrangement Act (H.R. 3799) - Voiced support for Ways and Means Committee passage and support full House passage. "Inflation Reduction Act": Continue to express concern about the impact of price controls on drug innovation, especially for small bio-pharmaceutical firms. "SMART Prices Act" (S. 1264) - Continue to oppose the legislation. Senate HELP Committee: Provided input on the new draft legislation to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA), urging Committee members to remove the suggested reasonable pricing language from the bill. Provided written comments to CMS on proposed rule on the Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program, and voiced concern about impact on small bio-pharmaceutical companies and not to finalize the proposed rule. Access to Broadband and Digital Policy Rural Internet Improvement Act of 2023 (S.130) (H.R. 3216) - Voiced support for the legislation. Development of a National Spectrum Strategy (NSS) - Continue to express support for such a policy and the need for more spectrum to deploy next Gen technologies and 5G. Broadband Infrastructure: Continue to support efforts in the Congress to provide oversight and track Broadband Equity, Access and Deployment (BEAD) Program funding to ensure the tens of billions of taxpayer dollars being allocated will be used efficiently to connect those lacking access with high-speed broadband. Access to Capital "Small Business Technological Advancement Act" (S.2330): Support the legislation which would help end the digital gap for many small businesses by allowing SBA Loans to be used for investments in eligible technologies. Regulation Comments to Federal Trade Commission (FTC) and Department of Justice (DOJ) on Proposed Merger Guidelines: Voiced concern about the merger guidelines and urged the agencies to pull back on this effort and to not move forward with the proposed guidelines. "Providing Opportunities to Show Transparency via Information Technology Act" (POST IT Act): Supported passage of the bill by House Small Business Committee. "The Small Business Regulatory Reduction Act": Supported passage by House Small Business Committee. "Regulations from the Executive in Need of Scrutiny (REINS) Act" (H.R. 277) - Supported House passage and continue to support Senate action. Privacy Policy in General: Continue to express the need for a national framework, but for Congress to consider a framework that avoid adding to the growing patchwork burden of state privacy laws, and to carefully consider unintended consequences on small businesses. "Prove It Act" (Senate) - Voiced support for the bill to require agencies to conduct due diligence on how proposed regulations impact small businesses. "American Innovation and Choice Online Act" (S.2033): Continue to oppose the legislation that would break up various platforms that serve small businesses in the digital space. Arbitration and Class Action Waivers: Voiced opposition to numerous bills introduced in the Congress that attempt to prohibit arbitration and class action waiver provisions. Labor and Workforce Policy DOL's Proposed Overtime Rule: Continue to express concern about the proposed rule and requested a 60 extension of the comment period to full evaluate the rule's impact on small businesses. "Save Local Businesses Act" (S.1261, HR 2826) - Support the legislation. Paid Leave Policy in U.S. House: Continue to express support for bipartisan exploration in identifying paid leave policy solutions that help support business owners and working families. Nomination of Gwynn Wilcox to serve another term on the National Labor Relations Board: Urged Senate Health, Education, Labor, and Pensions (HELP) Committee members to delay a vote in order to fully explore nominee's record. Proposed Independent Contractor Rules: Continued to express opposition to independent contractor rules being proposed and advanced by the Department of Labor that would disrupt this critical model for entrepreneurship. "Protecting the Right to Organize (PRO) Act" (S. 567) - Continue to oppose the legislation. "Railway Safety Act" (S. 576): Expressed concern about the legislation to all members of Congress.

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1256 Veterans Health Administration Leadership Transformation Act; H.R. 3801 Employer Reporting Improvement Act; H.R. 1264 Commonsense Reporting Act of 2023

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5688 (Bipartisan HSA Improvement Act of 2023): A bill to amend the Internal Revenue Code of 1986 to improve health savings accounts. H.R. 5687 (The HSA Modernization Act of 2023): A bill to amend the Internal Revenue Code of 1986 to modernize health savings accounts. H.R. 5378 (Lower Costs, More Transparency Act): A bill to promote price transparency in the health care sector, and for other purposes. H.R. 3801 (Employer Reporting Improvement Act): This bill modifies provisions under the ACA that require employers and health insurance providers to prepare tax forms showing proof of minimum essential coverage (1095-B and 1095-C tax forms). H.R. 3561 (The PATIENT Act of 2023): This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps. H.R. 1843 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. S. 1001 (Telehealth Expansion Act of 2023): To amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. H.R. 4509 (Transparency in Billing Act): To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. H.R. 1264 (Commonsense Reporting Act): This bill addresses the eligibility verification process for the premium assistance tax credit and cost-sharing subsidy under the Patient Protection and Affordable Care Act.