Patient Freedom Act of 2017

H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.1628-American Health Care Act of 2017 H.R.3258-Marketplace Certainty Act H.R.6143-Patient Right to Know Drug Prices Act H.R.6144-Know the Lowest Price Act of 2018 H.R.6733-Know the Cost Act of 2018 S.191-Patient Freedom Act of 2017 S.1462-Marketplace Certainty Act S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2544-Patient Right to Know Drug Prices Act S.2553-Know the Lowest Price Act of 2018

Client expense: $402,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Essential emergency medication shortages Mental health services for emergency psychiatric patients Price transparency, out-of-network reimbursement of emergency medical services H.Res.906-Congratulating the American College of Emergency Physicians on its 50th anniversary H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.767-Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2410-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.5678-Rural Emergency Medical Center Act of 2018 H.R.5734-Resident Education Deferred Interest Act H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act H.R.6143-Patient Right to Know Drug Prices Act H.R.6144-Know the Lowest Price Act of 2018 H.R.6372-To require the Secretary of Health and Human Services issue regulations to ensure due process rights for physicians furnishing emergency medical services H.R.6502-Reducing Unnecessary Senior Hospitalizations Act of 2018 H.R.6733-Know the Cost Act of 2018 Senate resolution congratulating the American College of Emergency Physicians on its 50th anniversary S.191-Patient Freedom Act of 2017 S.256-SOAR to Health and Wellness Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1130-Rural Emergency Acute Care Hospital (REACH) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1553-Stopping Overdoses of Fentanyl Analogues Act S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2465-Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2018 S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2544-Patient Right to Know Drug Prices Act S.2553-Know the Lowest Price Act of 2018 S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018 S.2680-Opioid Crisis Response Act of 2018 S.3531-Emergency Care Improvement Act

Client expense: $402,721 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4575/S.2303, the Access to Independent Health Insurance Advisors Act; H.R. 173/S. 58 the Middle Class Americans' Health Plans Act; H.R. 372, the Competitive Health Insurance Reform Act of 2017; H.R. 1628, American Health Care Act of 2017; Issues related to the Federally-facilitated marketplaces;S. 191, the Patient Freedom Act of 2017; H.R. 1626, the Better Care Reconciliation Act of 2017; H.R. 3798, the Save American Workers Act of 2018; H.R.4616, the Employer Relief Act of 2018; Comments on the Cooperative Agreement to Support Navigators in Federally Facilitated Exchanges, Funding Opportunity Number: CA-NAV-18-001

Client expense: $90,632 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Risk Management Agency, SENATE, Treasury, Dept of

Discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs trough Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S191 Patient Freedom Act of 2017 Monitored S761 Health Care Options Act of 2017 Monitored HR1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act of 2017 (proposed Alexander-Murray legislation) Monitored S 2312 Helping Ensure Low-income patients have Access to Care and Treatment (HELP) Act Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored HR 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. Monitored HR6 SUPPORT for Patients and Communities Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 620, ADA Education and Reform Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1892, Bipartisan Budget Act of 2018 H.R. 3331, To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 3798, Save American Workers Act of 2017 H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 H.R. 5892, To establish an Advisory Committee on Opioids and the Workplace to advise the Secretary of Labor on actions the Department of Labor can take to address the impact of opioid abuse on the workplace H.R. 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2004, Combating the Opioid Epidemic Act S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings S. 3057, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 Draft legislation to stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulation on health reimbursement arrangements and other account-based group health plans (83 Fed. Reg. 54,420-54,477, October 29, 2018) Final Regulation, definition of employer under Section 3(5) of ERISA - association health plans (83 Fed. Reg. 28912-28964, June 21, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); medical device tax; protect Medicare Part D's Non-Interference Clause from repeal Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report; A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioids crisis, including end-stage renal disease; balance or surprise billing; single-payer health care options; aligning 42 CFR Part 2 with the Health Insurance Portability and Accountability Act (P.L. 104-191) for the purposes of treatment, payment, and health car operation (TPO); inclusion of prescription drug pricing on 2019 congressional agenda; general advocacy for Congress to reach a working quorum for the board of the Export-Import Bank; section 301 of the Trade Act of 1974; U.N. Convention on the Assignment of Receivables in Int'l Trade

Client expense: $15,950,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Natl Telecommunications & Information Administration (NTIA), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Social Security Administration (SSA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

Discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs through Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S 191 Patient Freedom Act of 2017 Monitored S 761 Health Care Options Act of 2017 Monitored HR 1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act 2018 (proposed Alexander-Murray legislation) Monitored S 2312 Helping Ensure Low-income Patients have Access to Care and Treatment (HELP) Act Monitored politically appointed Senate-confirmed positions Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored H.R.4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes Monitored HR 6 SUPPORT for Patients and Communities Act

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 3702/HR 7223 - Tax legislation, provisions regarding generic drugs S 3738/HR 7251 - Patent legislation regarding inter partes review HR 302 - FAA Re-authorization (provisions related to air ambulance services HR 7217 - IMPROVE Act Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR) HR - 6082 Overdose Prevention and Patient Safety Act S 2554 Patient Right to Know Drug Prices Act

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

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

S.445/H.R.1825 - Home Health Care Planning Improvement Act of 2017 H.R.1617/S.3067 - Promoting Access to Diabetic Shoes Act S.1109/H.R.959 - Title VIII Nursing Workforce Reauthorization Act of 2017 H.R.1160 - ACO Assignment Improvement Act of 2017 H.R. 1155 - To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. S.1361 - Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017 S.783/H.R.315 [P.L. No: 115-320] - Improving Access to Maternity Care Act H.R.3692 - Addiction Treatment Access Improvement Act of 2017 S. 2317 - Addiction Treatment Access Improvement Act of 2018 S.2004 / H.R. 4501- Combating the Opioid Epidemic Act S. 2456/H.R. 5311 - CARA 2.0 Act of 2018 S.2524/H.R. 5102 - Substance Use Disorder Workforce Loan Repayment Act of 2018 H.R. 3922 - CHAMPIONING HEALTHY KIDS Act S. 1827: KIDS Act of 2017 Alexander-Murray Bipartisan Health Care Stabilization Act of 2017 S.1835 - Lower Premiums Through Reinsurance Act of 2017 H.R. 1478 - Gun Violence Research Act Graham-Cassidy-Heller-Johnson Amendment in the nature of a substitute to H.R. 1628 - American Health Care Act of 2017 H.R. 1628 - American Health Care Act of 2017 Better Care Reconciliation Act Discussion Draft S. 222 - Obamacare Replacement Act H.R. 372 - Competitive Health Insurance Reform Act of 2017 S. 934 - FDA Reauthorization Act of 2017 S. 870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 H.R. 449 - The Synthetic Drug Awareness Act of 2017 S. 191 - Patient Freedom Act of 2017 S. 403 - Health Savings Act of 2017 H.R. 1136 - FDA Deeming Authority Clarification Act of 2017 S.2680 - Opioid Crisis Response Act of 2018 S. 2891 - Fighting the Opioid Epidemic with Sunshine Act of 2018 H.R. 6 [P.L. No: 115-271] - SUPPORT for Patients and Communities Act H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act H.R. 3331/S.1732 - To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 5002/S.2406 - Advancing Cutting-Edge (ACE) Research Act H.R. 5796 - Responsible Education Achieves Care and Healthy Outcomes for Users Treatment Act H.R. 5798 - Opioid Screening and Chronic Pain Management Alternatives for Seniors Act S.3120 - Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 H.Res 1099 - Providing for the concurrence by the House in the Senate amendment to H.R. 6, with an amendment H.R. 6310/H.R. 6317 - Primary Care Enhancement Act of 2018 H.R. 6199 - Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 H.R. 6502 - Reducing Unnecessary Senior Hospitalizations Act of 2018 Medical Record Documentation Medicare Extenders Home Infusion Therapy Medication-Assisted Therapies (MATs) Opioid Abuse Epidemic Medicare Carrier Advisory Committees Reducing Regulatory Burdens

Client expense: $206,455 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), SENATE, Veterans Affairs, Dept of (VA), White House Office

Discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs trough Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S191 Patient Freedom Act of 2017 Monitored S761 Health Care Options Act of 2017 Monitored HR1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act of 2017 (proposed Alexander-Murray legislation) Monitored S 2312 Helping Ensure Low-income patients have Access to Care and Treatment (HELP) Act Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored HR 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. Monitored HR6 SUPPORT for Patients and Communities Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs through Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S 191 Patient Freedom Act of 2017 Monitored S 761 Health Care Options Act of 2017 Monitored HR 1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act 2018 (proposed Alexander-Murray legislation) Monitored S 2312 Helping Ensure Low-income Patients have Access to Care and Treatment (HELP) Act Monitored politically appointed Senate-confirmed positions Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored H.R.4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes Monitored HR 6 SUPPORT for Patients and Communities Act

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4575/S.2303, the Access to Independent Health Insurance Advisors Act; H.R. 173/S. 58 the Middle Class Americans' Health Plans Act; H.R. 372, the Competitive Health Insurance Reform Act of 2017; H.R. 1628, American Health Care Act of 2017; Issues related to the Federally-facilitated marketplaces;S. 191, the Patient Freedom Act of 2017; H.R. 1626, the Better Care Reconciliation Act of 2017; H.R. 3798, the Save American Workers Act of 2018; H.R.4616, the Employer Relief Act of 2018; Comments on the Cooperative Agreement to Support Navigators in Federally Facilitated Exchanges, Funding Opportunity Number: CA-NAV-18-001

Client expense: $87,356 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Risk Management Agency, SENATE, Treasury, Dept of

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 620, ADA Education and Reform Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1892, Bipartisan Budget Act of 2018 H.R. 3331, To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 3798, Save American Workers Act of 2017 H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 H.R. 5892, To establish an Advisory Committee on Opioids and the Workplace to advise the Secretary of Labor on actions the Department of Labor can take to address the impact of opioid abuse on the workplace H.R. 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2004, Combating the Opioid Epidemic Act S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings S. 3057, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 Draft legislation to stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioids crisis, including end-stage renal disease; balance or surprise billing; single-payer health care options

Client expense: $17,560,000 · Firm income: Not reported

Government targets: Agency for Toxic Substances & Disease Registry, Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Natl Telecommunications & Information Administration (NTIA), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Social Security Administration (SSA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Fish & Wildlife Service (USFWS), U.S. Trade Representative (USTR), White House Office

Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act HR 4666 - Relief Act of 2017. Costello (R-PA) S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR) HR - 6082 Overdose Prevention and Patient Safety Act S 2554 Patient Right to Know Drug Prices Act

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

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

S.445/H.R.1825 - Home Health Care Planning Improvement Act of 2017 H.R.1617/S.3067 - Promoting Access to Diabetic Shoes Act S.1109/H.R.959 - Title VIII Nursing Workforce Reauthorization Act of 2017 H.R.1160 - ACO Assignment Improvement Act of 2017 H.R. 1155 - To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. S.1361 - Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017 S.783/H.R.315 - Improving Access to Maternity Care Act H.R.3692 - Addiction Treatment Access Improvement Act of 2017 S. 2317 - Addiction Treatment Access Improvement Act of 2018 S.2004 / H.R. 4501- Combating the Opioid Epidemic Act S. 2456/H.R. 5311 - CARA 2.0 Act of 2018 S.2524/H.R. 5102 - Substance Use Disorder Workforce Loan Repayment Act of 2018 H.R. 3922 - CHAMPIONING HEALTHY KIDS Act S. 1827: KIDS Act of 2017 Alexander-Murray Bipartisan Health Care Stabilization Act of 2017 S.1835 - Lower Premiums Through Reinsurance Act of 2017 H.R. 1478 - Gun Violence Research Act Graham-Cassidy-Heller-Johnson Amendment in the nature of a substitute to H.R. 1628 - American Health Care Act of 2017 H.R. 1628 - American Health Care Act of 2017 Better Care Reconciliation Act Discussion Draft S. 222 - Obamacare Replacement Act H.R. 372 - Competitive Health Insurance Reform Act of 2017 S. 934 - FDA Reauthorization Act of 2017 S. 870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 H.R. 449 - The Synthetic Drug Awareness Act of 2017 S. 191 - Patient Freedom Act of 2017 S. 403 - Health Savings Act of 2017 H.R. 1136 - FDA Deeming Authority Clarification Act of 2017 S.2680 - Opioid Crisis Response Act of 2018 S. 2891 - Fighting the Opioid Epidemic with Sunshine Act of 2018 H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act H.R. 3331/S.1732 - To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 5002/S.2406 - Advancing Cutting-Edge (ACE) Research Act H.R. 5796 - Responsible Education Achieves Care and Healthy Outcomes for Users Treatment Act H.R. 5798 - Opioid Screening and Chronic Pain Management Alternatives for Seniors Act S.3120 - Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 H.Res 1099 - Providing for the concurrence by the House in the Senate amendment to H.R. 6, with an amendment H.R. 6310/H.R. 6317 - Primary Care Enhancement Act of 2018 H.R. 6199 - Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 Medical Record Documentation Medicare Extenders Home Infusion Therapy Medication-Assisted Therapies (MATs) Opioid Abuse Epidemic Medicare Carrier Advisory Committees Reducing Regulatory Burdens

Client expense: $167,141 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), SENATE, Veterans Affairs, Dept of (VA), White House Office

S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1038/S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1072/S. 222 Obamacare Replacement Act H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1628 American Health Care Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 2824 Increasing Opportunity and Success for Children and Parents Through Evidence-Based Home Visiting Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3358/S. 1771 Fiscal Year 2018 Labor-Health and Human Services-Education Appropriations Bill H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 741/S. 243 Rural Hospital Regulatory Relief Act H.R. 766 Amend Title XVII of the Social Security Act to expand telehealth in Medicare H.R. 849/S. 260 Protecting Seniors' Access to Medicare Act H.R. 908 Medicare Advantage Quality Payment Relief Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act Introduction of the Healthcare Cybersecurity Improvement Act Introduction of the Stark Law Modernization Act of 2017 Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub L. 115-31 Fiscal Year 2017 Consolidated Appropriations Act Pub L. 115-80 National Clinical Care Commission Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255, 21st Century Cures Act Pub. L. 114-270 Expanding Capacity for Health Outcomes Act (ECHO) Pub L. 115-63 Disaster Relief and Airway Extension Act Pub. L. 115-96 2018 Continuing Resolution Reintroduction of TELE-MED Act of 2015 S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1829 Strong Families Act S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 1967 Mandate Relief Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act

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

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

H. Res. 142/S. Res. 63 National Obesity Care Week Resolution S. Res. 325 National Obesity Care Week Resolution S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1004 Regulatory Integrity Act H.R. 1009/S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038/S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1072/S. 222 Obamacare Replacement Act H.R. 1101 Small Business Health Fairness Act H.R. 1121 Pre-Existing Conditions Protection Act H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1267/S. 482 Personal Health Investment Today Act H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554 Jessie's Law H.R. 1565 Saving Lives, Saving Costs Act H.R. 1628 American Health Care Act H.R. 1703 Medical Product Communications Act H.R. 184 Protect Medical Innovation Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 246/S. 183 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 2824 Increasing Opportunity and Success for Children and Parents Through Evidence-Based Home Visiting Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3120 to reduce the volume of future electronic health record-related significant hardship requests H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3358/S. 1771 Fiscal Year 2018 Labor-Health and Human Services-Education Appropriations Bill H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3545 Overdoes Prevention and Patient Safety Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4616 to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617 to provide for a temporary moratorium on the medical device excise tax H.R. 4618 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4200/S. 2052 Healthcare Market Certainty and Mandate Relief Act H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 706 Plan Verification and Fairness Act H.R. 741/S. 243 Rural Hospital Regulatory Relief Act H.R. 749 Lower Drug Costs Through Competition Act H.R. 766 Amend Title XVII of the Social Security Act to expand telehealth in Medicare H.R. 849/S. 260 Protecting Seniors' Access to Medicare Act H.R. 908 Medicare Advantage Quality Payment Relief Act H.R. 998 Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act H.R.3545 Overdose Prevention and Patient Safety Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act Introduction of the Healthcare Cybersecurity Improvement Act Introduction of the Stark Law Modernization Act of 2017 Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub L. 115-31 Fiscal Year 2017 Consolidated Appropriations Act Pub L. 115-80 National Clinical Care Commission Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255, 21st Century Cures Act Pub. L. 114-270 Expanding Capacity for Health Outcomes Act (ECHO) Pub. L. 114-328 National Defense Authorization Act for Fiscal Year Pub. L. 114-329 American Innovation and Competitiveness Act Pub L. 115-63 Disaster Relief and Airway Extension Act Pub. L. 115-96 2018 Continuing Resolution Pub. L. 115-97 Tax Cuts and Jobs Act Reintroduction of TELE-MED Act of 2015 S. 108 Medical Device Access and Innovation Protection Act S. 297 Increasing Competition in Pharmaceuticals Act S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1829 Strong Families Act S. 1850 Protecting Jessica Grubbs Legacy Act (The Legacy Act) S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 1967 Mandate Relief Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act H .R. 1933/S. 761 Health Care Options Act of 2017 S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act S. Con. Res. 3 Budget Resolution

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

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

H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.1628-American Health Care Act of 2017 H.R.3258-Marketplace Certainty Act S.191-Patient Freedom Act of 2017 S.1462-Marketplace Certainty Act S.1835-Lower Premiums Through Reinsurance Act of 2017

Client expense: $702,392 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Essential emergency medication shortages Mental health services for emergency psychiatric patients Price transparency of emergency medical services Due process rights for physicians furnishing emergency medical services H.Res.906-Congratulating the American College of Emergency Physicians on its 50th anniversary H.R.6-Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.767-Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.4922-Stopping Overdoses of Fentanyl Analogues Act H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act H.R.5531-Opioid Emergency Response Act H.R.5558-Alternatives to Opioids Prescribing Act H.R.5678-Rural Emergency Medical Center Act of 2018 H.R.6082-Overdose Prevention and Patient Safety (OPPS) Act S.191-Patient Freedom Act of 2017 S.256-SOAR to Health and Wellness Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1130-Rural Emergency Acute Care Hospital (REACH) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1553-Stopping Overdoses of Fentanyl Analogues Act S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018

Client expense: $702,392 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Blueprint on Drug Pricing State Reinsurance Program H.R. 6 - The Support for Patients and Communities Act HR 4666 - Relief Act of 2017. Costello (R-PA) S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR)

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

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

HR 1156 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) S 1133 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs trough Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S191 Patient Freedom Act of 2017 Monitored S761 Health Care Options Act of 2017 Monitored HR1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act of 2017 (proposed Alexander-Murray legislation) Monitored S 1835 The Lower Premiums Through Reinsurance Act of 2017 Monitored S 2312 Helping Ensure Low-income patients have Access to Care and Treatment (HELP) Act Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored HR 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1628, American Health Care Act of 2017 H.R. 1892, Bipartisan Budget Act of 2018 H.R. 3331, To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioid crisis

Client expense: $15,190,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Natl Telecommunications & Information Administration (NTIA), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), Vice President of the U.S., White House Office

H.R. 4575/S.2303, the Access to Independent Health Insurance Advisors Act; H.R. 173/S. 58 the Middle Class Americans' Health Plans Act; H.R. 372, the Competitive Health Insurance Reform Act of 2017; H.R. 1628, American Health Care Act of 2017; Issues related to the Federally-facilitated marketplaces;S. 191, the Patient Freedom Act of 2017; H.R. 1626, the Better Care Reconciliation Act of 2017

Client expense: $122,737 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Risk Management Agency, SENATE, Treasury, Dept of

HR 1156 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) S 1133 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) Monitored HR 277 American Health Care Reform Act of 2017 Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs through Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S 191 Patient Freedom Act of 2017 Monitored S 761 Health Care Options Act of 2017 Monitored HR 1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act 2017 (proposed Alexander-Murray legislation) Monitored S 1835 The Lower Premiums Through Reinsurance Act of 2017 Monitored S 2312 Helping Ensure Low-income Patients have Access to Care and Treatment (HELP) Act Monitored politically appointed Senate-confirmed positions Monitored S 3158 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2019 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored S 2453 Ensuring the Value of the 340B Program Act of 2018 Monitored H.R.4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.445/H.R.1825 - Home Health Care Planning Improvement Act of 2017 H.R.1617/S.3067 - Promoting Access to Diabetic Shoes Act S.1109/H.R.959 - Title VIII Nursing Workforce Reauthorization Act of 2017 H.R.1160 - ACO Assignment Improvement Act of 2017 H.R. 1155 - To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. S.1361 - Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017 S.783/H.R.315 - Improving Access to Maternity Care Act H.R.3692 - Addiction Treatment Access Improvement Act of 2017 S. 2317 - Addiction Treatment Access Improvement Act of 2018 S.2004 / H.R. 4501- Combating the Opioid Epidemic Act S. 2456/H.R. 5311 - CARA 2.0 Act of 2018 S.2524/H.R. 5102 - Substance Use Disorder Workforce Loan Repayment Act of 2018 H.R. 3922 - CHAMPIONING HEALTHY KIDS Act S. 1827: KIDS Act of 2017 Alexander-Murray Bipartisan Health Care Stabilization Act of 2017 S.1835 - Lower Premiums Through Reinsurance Act of 2017 H.R. 1478 - Gun Violence Research Act Graham-Cassidy-Heller-Johnson Amendment in the nature of a substitute to H.R. 1628 - American Health Care Act of 2017 H.R. 1628 - American Health Care Act of 2017 Better Care Reconciliation Act Discussion Draft S. 222 - Obamacare Replacement Act H.R. 372 - Competitive Health Insurance Reform Act of 2017 S. 934 - FDA Reauthorization Act of 2017 S. 870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 H.R. 449 - The Synthetic Drug Awareness Act of 2017 S. 191 - Patient Freedom Act of 2017 S. 403 - Health Savings Act of 2017 H.R. 1136 - FDA Deeming Authority Clarification Act of 2017 S.2680 - Opioid Crisis Response Act of 2018 S. 2891 - Fighting the Opioid Epidemic with Sunshine Act of 2018 H.R. 6 - SUPPORT for Patients and Communities Act H.R. 5605 - Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act H.R. 3331/S.1732 - To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 5002/S.2406 - Advancing Cutting-Edge (ACE) Research Act H.R. 5796 - Responsible Education Achieves Care and Healthy Outcomes for Users Treatment Act H.R. 5798 - Opioid Screening and Chronic Pain Management Alternatives for Seniors Act S.3120 - Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 Medicare Extenders Home Infusion Therapy Medication-Assisted Therapies (MATs) Opioid Abuse Epidemic Medicare Carrier Advisory Committees Reducing Regulatory Burdens

Client expense: $171,580 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Motor Carrier Safety Administration, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.1628-American Health Care Act of 2017 H.R.3258-Marketplace Certainty Act S.191-Patient Freedom Act of 2017 S.1462-Marketplace Certainty Act S.1835-Lower Premiums Through Reinsurance Act of 2017

Client expense: $520,414 · Firm income: Not reported

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

Essential emergency medication shortages Bipartisan Health Care Stabilization Act of 2017 H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.582-Kari's Law Act of 2017 H.R.767-Stop, Observe, Ask, and Respond (SOAR) to Health and Wellness Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.849-Protecting Seniors' Access to Medicare Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1148-Furthering Access to Stroke Telemedicine (FAST) Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1421-Improving Access to Medicare Coverage Act of 2017 H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1628-American Health Care Act of 2017 H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2392-Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 HR 2843-Medicaid and Chip Quality Improvement Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.3729-Comprehensive Operations, Sustainability, and Transport Act of 2017 H.R.3922-Continuing Community Health And Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (CHAMPIONING HEALTHY KIDS) Act of 2017 H.R.5176-Preventing Overdoses While in Emergency Rooms Act of 2018 H.R.5197-Alternatives to Opioids (ALTO) in the Emergency Department Act P.L.111-148-Patient Protection and Affordable Care Act S.191-Patient Freedom Act of 2017 S.251-Protecting Medicare from Executive Action Act of 2017 S.256-SOAR to Health and Wellness Act of 2017 S.260-Protecting Seniors' Access to Medicare Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1063-Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 S.1130-Rural Emergency Acute Care Hospital (REACH) Act H.R.1148-Furthering Access to Stroke Telemedicine (FAST) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1827-Keep Kids Insurance Dependable and Secure (KIDS) Act of 2017 S.1835-Lower Premiums Through Reinsurance Act of 2017 S.2516-Alternatives to Opioids (ALTO) in the Emergency Department Act S.2609-Recovery Coaches Offer Addiction Counseling and Healing (COACH) Act S.2610-Preventing Overdoses While in Emergency Departments Act of 2018

Client expense: $520,414 · Firm income: Not reported

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

H.R. 4575/S.2303, the Access to Independent Health Insurance Advisors Act; H.R. 173/S. 58 the Middle Class Americans' Health Plans Act; H.R. 372, the Competitive Health Insurance Reform Act of 2017; H.R. 1628, American Health Care Act of 2017; Issues related to the Federally-facilitated marketplaces;S. 191, the Patient Freedom Act of 2017; H.R. 1626, the Better Care Reconciliation Act of 2017

Client expense: $94,334 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Risk Management Agency, SENATE, Treasury, Dept of

HR 1156 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) S 1133 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) HR 277 American Health Care Reform Act of 2017 (all sections of full text) Discussions seeking guidance to minimize supply chain shortages for areas hit by natural disasters Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs trough Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S191 Patient Freedom Act of 2017 Monitored S761 Health Care Options Act of 2017 Monitored HR1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act of 2017 (proposed Alexander-Murray legislation) Monitored The Lower Premiums Through Reinsurance Act of 2017 (proposed Collins-Nelson legislation) Monitored S 2312 Helping Ensure Low-income patients have Access to Care and Treatment (HELP) Act Monitored politically appointed Senate-confirmed positions Monitored PL 115-141 Consolidated Appropriations Act, 2018 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored HR 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 445/ H.R.1825 - Home Health Care Planning Improvement Act of 2017 H.R.1617 - Promoting Access to Diabetic Shoes Act S.1109/H.R.959 - Title VIII Nursing Workforce Reauthorization Act of 2017 H.R.1160 - ACO Assignment Improvement Act of 2017 H.R. 1155 - To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. S.1361 - Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017 S.783/H.R. 315 - Improving Access to Maternity Care Act H.R.3692 - Addiction Treatment Access Improvement Act of 2017 S. 2317 - Addiction Treatment Access Improvement Act of 2018 S.2004 / H.R. 4501- Combating the Opioid Epidemic Act S. 2456/H.R. 5311 - CARA 2.0 Act of 2018 S.2524/H.R. 5102 - Substance Use Disorder Workforce Loan Repayment Act of 2018 H.R. 3922 - CHAMPIONING HEALTHY KIDS Act S. 1827: KIDS Act of 2017 Alexander-Murray Bipartisan Health Care Stabilization Act of 2017 S.1835 - Lower Premiums Through Reinsurance Act of 2017 H.R. 1478 - Gun Violence Research Act Graham-Cassidy-Heller-Johnson Amendment in the nature of a substitute to H.R. 1628 - American Health Care Act of 2017 H.R. 1628 - American Health Care Act of 2017 Better Care Reconciliation Act Discussion Draft S. 222 - Obamacare Replacement Act H.R. 372 - Competitive Health Insurance Reform Act of 2017 S. 934 - FDA Reauthorization Act of 2017 S. 870 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 H.R. 449 - The Synthetic Drug Awareness Act of 2017 S. 191 - Patient Freedom Act of 2017 S. 403 - Health Savings Act of 2017 H.R. 1136 - FDA Deeming Authority Clarification Act of 2017 Medicare Extenders Home Infusion Therapy Medication-Assisted Therapies (MATs) Opioid Abuse Epidemic Medicare Carrier Advisory Committees Reducing Regulatory Burdens

Client expense: $170,734 · Firm income: Not reported

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

H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1628, American Health Care Act of 2017 H.R. 1892, Bipartisan Budget Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5138, Bipartisan HSA Improvement Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including changes to the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition

Client expense: $15,390,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Fish & Wildlife Service (USFWS), U.S. Trade Representative (USTR), White House Office

HR 1156 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) S 1133 Patient Access to Higher Quality Health Care Act of 2017 (all sections of full text) HR 277 American Health Care Reform Act of 2017 (all sections of full text) Discussions seeking guidance to minimize supply chain shortages for areas hit by natural disasters Monitored S 297 Increasing Competition in Pharmaceuticals Act Monitored HR 749 Lower Drug Costs through Competition Act Monitored HR 208 Ensuring Health Care Opportunities Act Monitored S 1115 Making Pharmaceutical Markets More Competitive Act Monitored HR 2562 Making Pharmaceutical Markets More Competitive Act Monitored S 191 Patient Freedom Act of 2017 Monitored S 761 Health Care Options Act of 2017 Monitored HR 1933 Health Care Options Act of 2017 Monitored HR 1628 American Health Care Act of 2017 Monitored Bipartisan Health Care Stabilization Act 2017 (proposed Alexander-Murray legislation) Monitored The Lower Premiums Through Reinsurance Act of 2017 (proposed Collins-Nelson legislation) Monitored S 2312 Helping Ensure Low-income Patients have Access to Care and Treatment (HELP) Act Monitored politically appointed Senate-confirmed positions Monitored PL 115-141 Consolidated Appropriations Act, 2018 Monitored HR 4191 HHS Cybersecurity Modernization Act Monitored HR 4710 340B PAUSE Act Monitored H.R.4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 4666 - Relief Act of 2017. Costello (R-PA) S 1835 - Lower Premiums through Reinsurance Act of 2017. Collins (R-ME) HR 3545 - Overdose Prevention and Patient Safety Act. Murphy (R-PA) S 1850 - Protecting Jessica Grubbs Legacy Act. Manchin (D-WV) HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR)

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

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

HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3120 - To amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests. Burgess (R-TX) HR 3245 - Medicare Civil and Criminal Penalties Update Act: To amend title XI of the Social Security Act to increase civil money penalties and criminal fines for Federal health care program fraud and abuse, and for other purposes. Bilirakis (R-FL). HR 3263 - To amend title XVIII of the Social Security Act to extend the Medicare independence at home medical practice demonstration program. Burgess (R-TX) HR 3921 - Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017: To extend funding for the Children's Health Insurance Program, and for other purposes. Burgess (R-TX) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1827 - Keep Kids' Insurance Dependable and Secure Act of 2017: A bill to extend funding for the Children's Health Insurance Program, and for other purposes. Hatch (R-UT) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). H.R.3120 - To amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests. Burgess (R-TX). S. 934 and H.R. 2430 - FDA Reauthorization Act of 2017: To amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological products, and for other purposes. Alexander (R-TN) & Walden (R-OR). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 314 - Health Care Choice Act of 2017: To repeal title I of the Patient Protection and Affordable Care Act and to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. Blackburn (R-TN). HR 706 - Plan Verification and Fairness Act of 2017: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. Blackburn (R-TN). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1628 - American Health Care Act of 2017: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017. Black (R-TN). HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR)

Client expense: $1,043,000 · Firm income: Not reported

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

H.R. 1628 The American Health Care Act S. 191 The Patient Freedom Act Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Funding for the Children's Health Insurance Program (CHIP) Medicaid Waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Meaningful use Stage 2 and 3 Legislation related to chronic care treatment Legislation related to Medicare reimbursement for telehealth service Medicaid managed care policies rulemaking Medicaid supplemental payments to hospitals Medicare site neutral payments for hospital outpatient departments Legislation related to health care disparities HR 1628:Better Care Reconciliation Act Medicaid- State flexibility Medicaid 1115 & 1332 Waivers Upper Payment Limit payments State Financing of Medicaid HR 3921 Healthy Kids Act HR 3922 CHAMPION Act S. 1827 KIDS Act Graham Cassidy Amendment to HR 1628 Medicare Part B Cuts-OPPS proposed rule to 340 B covered entities

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

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

H.R. 1628 The American Health Care Act S. 191 The Patient Freedom Act Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Funding for the Children's Health Insurance Program (CHIP) Medicaid Waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Meaningful use Stage 2 and 3 Legislation related to chronic care treatment Legislation related to Medicare reimbursement for telehealth service Medicaid managed care policies rulemaking Medicaid supplemental payments to hospitals Medicare site neutral payments for hospital outpatient departments Legislation related to health care disparities HR 1628:Better Care Reconciliation Act Medicaid- State flexibility Medicaid 1115 & 1332 Waivers Upper Payment Limit payments State Financing of Medicaid HR 3921 Healthy Kids Act HR 3922 CHAMPION Act S. 1827 KIDS Act Graham Cassidy Amendment to HR 1628 Medicare Part B Cuts-OPPS proposed rule to 340 B covered entities

Client expense: $260,000 · Firm income: Not reported

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

H.R. 1628 The American Health Care Act S. 191 The Patient Freedom Act Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Funding for the Children's Health Insurance Program (CHIP) Medicaid Waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Meaningful use Stage 2 and 3 Legislation related to chronic care treatment Legislation related to Medicare reimbursement for telehealth service Medicaid managed care policies rulemaking Medicaid supplemental payments to hospitals Medicare site neutral payments for hospital outpatient departments Legislation related to health care disparities HR 1628 Better Care Reconciliation Act Medicaid- State flexibility Medicaid 1115 & 1332 Waivers Upper Payment Limit payments State Financing of Medicaid

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

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

H.R. 1628 The American Health Care Act S. 191 The Patient Freedom Act Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Funding for the Children's Health Insurance Program (CHIPS) Medicaid Waivers Medicaid Expansion Issues Medicaid Disproportionate Share Hospital Payments Medicare Disproportionate Share Hospital Payments Meaningful use Stage 2 and 3 Legislation related to chronic care treatment Legislation related to Medicare reimbursement for telehealth service Medicaid managed care policies rulemaking Medicaid supplemental payments to hospitals Medicare site neutral payments for hospital outpatient departments Legislation related to health care disparities

Client expense: $350,000 · Firm income: Not reported

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

Alternatives to Opiates (ALTO) Bipartisan Health Care Stabilization Act of 2017 H.R.304-Protecting Patient Access to Emergency Medications Act of 2017 H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.548-Health Care Safety Net Enhancement Act of 2017 H.R.582-Kari's Law Act of 2017 H.R.817-End Surprise Billing Act of 2017 H.R.849-Protecting Seniors' Access to Medicare Act of 2017 H.R.880-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act H.R.1057-Synthetics Trafficking and Overdose Prevention Act of 2017 H.R.1215-Protecting Access to Care Act of 2017 H.R.1323-Reducing Unnecessary Emergency Room Visits under Medicaid Act H.R.1421-Improving Access to Medicare Coverage Act of 2017 H.R.1492-Medical Controlled Substances Transportation Act of 2017 H.R.1565-Saving Lives, Saving Costs Act H.R.1628-American Health Care Act of 2017 H.R.1822-Good Samaritan Health Professionals Act of 2017 H.R.1876-Good Samaritan Health Professionals Act of 2017 H.R.2200-Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2017 H.R.2392-Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 H.R.2430-FDA Reauthorization Act of 2017 HR 2843-Medicaid and Chip Quality Improvement Act of 2017 H.R.2851-Stop the Importation and Trafficking of Synthetic Analogues (SITSA) Act of 2017 H.R.2957-Save Rural Hospitals Act H.R.3181-Medicare Choices Empowerment and Protection Act H.R.3258-Marketplace Certainty Act H.R.3545-Overdose Prevention and Patient Safety (OPPS) Act H.R.3729-Comprehensive Operations, Sustainability, and Transport Act of 2017 H.R.3922-Continuing Community Health And Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (CHAMPIONING HEALTHY KIDS) Act of 2017 H.J.Res.51-Approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act P.L.111-148-Patient Protection and Affordable Care Act S.191-Patient Freedom Act of 2017 S.222-Obamacare Replacement Act S.251-Protecting Medicare from Executive Action Act of 2017 S.260-Protecting Seniors' Access to Medicare Act of 2017 S.284-End Surprise Billing Act of 2017 S.372- Synthetics Trafficking and Overdose Prevention Act of 2017 S.527-Health Care Safety Net Enhancement Act of 2017 S.568-Improving Access to Medicare Coverage Act of 2017 S.781-Good Samaritan Health Professionals Act of 2017 S.916-Protecting Patient Access to Emergency Medications Act of 2017 S.934-FDA Reauthorization Act of 2017 S.1016-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 S.1022-Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act S.1063-Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 S.1130-Rural Emergency Acute Care Hospital (REACH) Act H.R.1148-Furthering Access to Stroke Telemedicine (FAST) Act S.1462-Marketplace Certainty Act S.1530- Medicare Choices Empowerment and Protection Act S.1827-Keep Kids Insurance Dependable and Secure (KIDS) Act of 2017 S.1835-Lower Premiums Through Reinsurance Act of 2017 S.Amdt.667 to S.Amdt.267 to H.R.1628-Better Care Reconciliation Act S.J.Res.16-A joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act S.J.Res.17-A joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act

Client expense: $672,362 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

H.R.372-Competetive Health Insurance Reform Act of 2017 H.R.1628-American Health Care Act of 2017 H.R.3258-Marketplace Certainty Act S.191-Patient Freedom Act of 2017 S.222-Obamacare Replacement Act S.1462-Marketplace Certainty Act S.1835-Lower Premiums Through Reinsurance Act of 2017

Client expense: $672,362 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

HR 1 - An act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018. HJ Res 123 - Making further continuing appropriations for fiscal year 2018 and for other purposes. HR 4200 & S 2052 - To provide for temporary funding for health insurance cost-sharing reduction payments and provide targeted tax relief, and for other purposes. HR 2212 & S 974 - Creating and Restoring Equal Access To Equivalent Samples Act of 2017: A bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Marino (R-PA) & Leahy (D-VT) HR 3921 - Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017: To extend funding for the Children's Health Insurance Program, and for other purposes. Burgess (R-TX) HR 3922 - Community Health And Medical Professionals Improve Our Nation Act of 2017: To extend funding for certain public health programs, and for other purposes. Walden (R-OR) S 1354 - Individual Health Insurance Marketplace Improvement Act: A bill to establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Carper (D-DE) S 1827 - Keep Kids' Insurance Dependable and Secure Act of 2017: A bill to extend funding for the Children's Health Insurance Program, and for other purposes. Hatch (R-UT) S 1859 - Healthcare Tax Relief Act: A bill to extend the moratorium on the annual fee on health insurance providers. Gardner (R-CO) H.R. 1215 - Protecting Access to Care Act of 2017: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. King (R-IA) H.R.1101 - Small Business Health Fairness Act of 2017: To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Johnson (R-TX). S. 974 and H.R. 2212 - Creates Act of 2017: To promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products. Leahy (D-VT) & Marino (R-PA). HR 173 and S 40 - Middle Class Health Benefits Tax Repeal Act of 2017: To amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. Kelly (R-PA) & Heller (R-NV). HR 706 - Plan Verification and Fairness Act of 2017: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. Blackburn (R-TN). HR 708 - State Age Rating Flexibility Act of 2017: To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. Buschon (R-IN). HR 710 -Health Coverage State Flexibility Act of 2017: To amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. Flores (R-TX). HR 749 - Lower Drug Costs through Competition Act: To increase competition in the pharmaceutical industry. Schrader (D-OR) H.R.1121 - Pre-existing Conditions Protection Act of 2017: To amend the Public Health Service Act to prohibit application of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. Walden (R-OR). HR 1175 and S 403 - Health Savings Act of 2017: To amend the Internal Revenue Code of 1986 to improve access to health care through expanded health savings accounts, and for other purposes. Paulsen (R-MN) & Hatch (R-UT). HR 1304 - Self-Insurance Protection Act: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans. Roe (R-TN) HR 1628 - American Health Care Act of 2017: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017. Black (R-TN). HR 1776 & S 771 Improving Access To Affordable Prescription Drugs Act: To improve access to affordable prescription drugs. Schakowsky (D-IL) & Franken (D-MN) HR 2051 - To amend the Federal Food, Drug, and Cosmetic Act to ensure that eligible product developers have competitive access to approved drugs and licensed biological products, so as to enable eligible product developers to develop and test new products, and for other purposes. McKinley (R-WV) S 191 - Patient Freedom Act of 2017: To improve patient choice by allowing States to adopt market based alternatives to the Affordable Care Act that increase access to affordable health insurance and reduce costs while ensuring important consumer protections and improving patient care. Cassidy (R-LA) S 637 - Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2017: To amend titles XI and XVIII of the Social Security Act to provide greater transparency of discounts provided by drug manufacturers. Wyden (D-OR)

Client expense: $155,000 · Firm income: Not reported

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

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment, transitional policies) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies) The American Health Care Act and related amendments (H.R. 1628 and H. Res. 154) The Better Care Reconciliation Act of 2017 The Health Care Options for All Act (S. 1201) The Individual Health Insurance Marketplace Improvement Act (S. 1354) The Marketplace Certainty Act (S. 1462) Lower Premiums Through Reinsurance Act (S. 1835) Patient Freedom Act of 2017 (S. 191) Making further supplemental appropriations for the fiscal year ending September 30, 2018, for disaster assistance for Hurricanes Harvey, Irma, and Maria, and calendar year 2017 wildfires, and for other purposes (H.R. 4667) Championing Healthy Kids Act (H.R. 3922) Keep Kids' Insurance Dependable and Secure Act of 2017 (S. 1827) Mental health and substance use (42 CFR Part 2) 2019 Notice of Benefit and Payment Parameters proposed rule Individual market and exchange stabilization Association health plans Out of network billing ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs)

Client expense: $1,730,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment, transitional policies) ACA reform (reconciliation, individual mandate, cost sharing reduction subsidies) The American Health Care Act and related amendments (H.R. 1628 and H. Res. 154) The Better Care Reconciliation Act of 2017 The Health Care Options for All Act (S. 1201) The Individual Health Insurance Marketplace Improvement Act (S. 1354) The Marketplace Certainty Act (S. 1462) Lower Premiums Through Reinsurance Act (S. 1835) Patient Freedom Act of 2017 (S. 191) Making further supplemental appropriations for the fiscal year ending September 30, 2018, for disaster assistance for Hurricanes Harvey, Irma, and Maria, and calendar year 2017 wildfires, and for other purposes (H.R. 4667) Championing Healthy Kids Act (H.R. 3922) Keep Kids' Insurance Dependable and Secure Act of 2017 (S. 1827) Mental health and substance use (42 CFR Part 2) 2019 Notice of Benefit and Payment Parameters proposed rule Individual market and exchange stabilization Association health plans Out of network billing ACA third party payments Telehealth Price of prescription drugs Opioid addiction issues and response (prescription drug monitoring programs)

Client expense: $1,730,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Legislative monitoring and outreach on issues related to Healthcare Reform Health IT ERISA. H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018. H.R. 277, American Health Care Reform Act of 2017. H.R. 1628, American Healthcare Act of 2017. H.R. 4695, Bipartisan Market Stabilization and Innovation Act of 2017. S. 191, Patient Freedom Act of 2017. S. 1804, Medicare for All Act of 2017.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of

Legislative monitoring and outreach on issues related to Medicare SCHIP Health Care Reform. H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018. H.R. 277, American Health Care Reform Act of 2017. H.R. 1628, American Healthcare Act of 2017. H.R. 4695, Bipartisan Market Stabilization and Innovation Act of 2017. S. 191, Patient Freedom Act of 2017. S. 1804, Medicare for All Act of 2017.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of

H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018, including provisions relating to Senate Amendment 1687 H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 247/S. 28, Health Savings Account Expansion Act of 2017 H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101/S. 1818, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1280, Health Savings Account Act H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1628, American Health Care Act of 2017 H.R. 2430/S. 934, FDA Reauthorization Act of 2017 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 934, FDA Reauthorization Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1852, Solution for Undocumented Children through Careers, Employment, Education, and Defending our Nation (SUCCEED) Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.Con.Res.71 - Establishing the congressional budget for the United States Government for fiscal year 2018 and setting forth the appropriate budgetary levels for fiscal years 2019 through 2027, including provisions relating to Senate Amendment 1227 Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on benefit and payment parameters for 2019 (82 Fed. Reg. 51,052-51,148, November 2, 2017) Request for Information reducing regulatory burdens imposed by the Patient Protection and Affordable Care Act & Improving Health Care Choices to Employer Patients (82 Fed. Reg. 26,885-26,887, June 12, 2017) Request for Information Treasury proposed review of regulations & recommendations to further compliance with Executive Orders 13771 and 13777 (82 Fed. Reg. 27,217-27,218, June 14, 2017) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; IRS Notice application of market reform and other provisions of the Affordable Care Act to HRAs, Health FSAs, and certain other employer healthcare arrangements HRAs (Notice 2013-54, September 13, 2013); IRS Notice on Section 4980I - Excise Tax on High Cost Employer-Sponsored Health Coverage (Notice 2015-16, February 23, 2015); IRS Notice on qualified small employer health reimbursement arrangements (Notice 2017-67, October 31, 2017); House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition

Client expense: $16,830,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Industry and Security (BIS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Fish & Wildlife Service (USFWS), U.S. Trade Representative (USTR), White House Office