1. THE LEGESLATIVE
PROCESS
AND ITS RELATION TO HEALTH POLICY
By: Jessica Melnik and Chrysanne Marquez

2. Part 1:
LEGISLATION WITHIN THE UNITED STATES OF AMERICA
The legislative process can be long, tedious, complex and
frustrating. It is much more difficult to pass a bill than it is to kill one.
There are numerous times and places during the legislative process at
which a bill can die. Only a very few survive to become law.

3. BRANCHES OF GOVERNMENT
• United States Congress
The United States Congress is the chief legislative or law-
making body in the land. Through the laws it passes, it defines crimes
and punishments, establishes levels of taxation and spending and
creates the programs and policies that shape American government and
politics.
By introducing a piece of legislation, a member of Congress
proposes a solution to a public policy problem. Before a public policy
problem can be addressed through the legislative process, however, it
must first be recognized as a problem. When a member of Congress
proposes a bill, he or she is essentially claiming to have found the best
solution to the public policy problem in question.

4. Branches of Government (cont’d)
• The House of Representatives and the Senate
There are nineteen permanent committees in the House and
seventeen in the Senate. Each of these committees has a specific area
of legislative jurisdiction. Each house is guided by its own set of complex
procedural rules which define the structure of the debate. The rules of
both the House and Senate are sufficiently complex that each body
employs a full time "parliamentarian," an expert in the rules and
procedures of each house.
In both the House and the Senate, the allotted time for debate
on each piece of legislation is divided equally between the two parties. In
both the House and the Senate, once all allowable amendments have
been offered and voted on and the time set aside for debate has expired,
the full membership of each body votes on the legislation. In order for a
piece of legislation to move on in the legislative process, it must be
passed by the House and the Senate.

5. Branches of government (Cont’d)
• The President
The President of the United States of America plays a
significant role in the legislative process. After a piece of legislation is
passed by both the House of Representatives and the Senate, it is
forwarded to the President. Bills are then sent to the President to be
signed or vetoed. If the President signs a bill, it becomes law. However, if
the President vetoes a bill, it is rejected, but the Congress may attempt
to override the veto.

6. How a Bill Becomes a Law
1. Recognizing a Problem
While the formal legislative process begins when a bill is introduced in
the House or the Senate, a bill is "born" long before that. A problem must first be
recognized and solutions must be proposed.
2. Choosing the Best Solution
In the American political process, there are generally more than enough
proposed solutions to the problems the nation faces. The difficulty lies in sorting
through the proposed solution to find the one that will work best.
3. Drafting a Bill
Before a member of Congress introduces a bill in the House or Senate,
the bill must be drafted. Writing legislation requires precision, attention to detail,
an intimate understanding of existing laws and a clear understanding of the
proposed policy solution. Members of Congress often rely on staff, experts in the
area the proposed legislation will effect, and Congressional legal staff to assist
them in drafting legislation.

7. How a Bill Becomes a Law (Cont’d)
4. Building Support for a Bill
Members of Congress must successfully compete for congressional and
public attention or the legislation they introduce is bound to fail. To build support and
momentum for a bill, members of Congress generally hold press conferences to
announce the introduction of legislation. They will also secure as many co-sponsors
as possible for their legislation to provide evidence of broad congressional support
for the bill.
5. The Congressional Committee
Once a bill has been formally introduced, it is referred to a congressional
committee for further consideration. Each of these committees has a specific area of
legislative jurisdiction and bills are generally referred to committees accordingly. In
many cases, however, bills address topics that fall under the jurisdiction of more
than one committee. If a bill is assigned to a committee with a Chair that supports
the legislation, the bill is likely to be scheduled for a timely public hearing, full
committee consideration and a vote. If a committee votes to keep a bill, instead of
sending it on for further consideration, the bill is dead.

8. How a Bill becomes a law (cont’d)
6. The House of Representatives and the Senate
Once a bill has been reported out of the committee or committees to
which it was assigned, it must be considered by all of the members of the body
in which it was introduced--either the House or the Senate. In the House, a
Committee on Rules establishes the time and duration of debate on each bill
that comes to the floor. In addition to the timing and extent of the bill's floor
consideration, the rule also specifies what, if any, amendments may be made to
the bill on the floor.
In both the House and the Senate, once all allowable amendments
have been offered and voted on and the time set aside for debate has expired,
the full membership of each body votes on the legislation. If the two houses
cannot reconcile their differences on a bill, it cannot be considered further and it
dies.

9. How a Bill Becomes a Law (cont’d)
7. The Conference Committee
When similar bills are passed by both houses, they are referred to a
special, temporary "Conference Committee," comprised of members of both
houses and of both parties. Members on Conference Committees are charged
with working out the differences between the two versions of the bill and creating
a compromise version which is then sent back to each house. At this stage in the
process, no amendments are allowed. The full membership of the House and
Senate must simply choose to accept or reject the Conference Committee's
"Report," which details the compromise version of the bill.
8. The President
If the Report is accepted, the bill is forwarded to the President. Bills
sent to the President must be signed or vetoed. If the President signs the bill, it
becomes law. However, if the President vetoes the bill, it is rejected. The
President has 10 days to sign or veto the enrolled bill.

10. How to Veto a bill
While the President is the only individual that has the
power to sign or veto a bill, Congress has the power to override
the veto. Congress may attempt to override the veto if they feel
the bill was mistakenly overlooked by the President. A veto can
be overridden if a two-thirds majority in both houses votes to do
so.

11. • How does congress build
momentum for a bill?
• What happens once a bill has been
Questions about the formally introduced?
Legislative process
• How many days does the president
(Answers listed at the end of the have to sign or veto a bill?
presentation)
• In order for a bill to move on in the
legislative process, what has to
happen?

12. Part 2:
Health Policy
In the United States of America, federal, state, and local
governments have played a role in developing and delivering health
policy. Issues associated with health policy stem from individual health,
the overall health of the country, and economic problems associated with
health care. There is an ongoing argument, however, over how much
involvement the government should have in developing health policy.
In other nations, health care is considered a right, and thus
most agree that the government should play a leading role in developing
and delivering health care. In the United States of America, however,
health care is not seen as a right, but more as a privilege. Other than
national programs such as Medicare and Medicaid, our health care
system is controlled by private sectors. Problems associated with this
type of health care system have led to the need for health care reform,
and thus new ideas for health policy have been proposed.

13. The role of the State
Individual states do play a significant role in the development and
delivery of health policy. In fact, many of the policies we know today have
originated in state governments. Examples of implemented health policy that
originated on the state level are as follows:
• Administration of federal/state Medicaid and SCHIP programs
• Programs that address vulnerable populations such as the poor and disabled
• Programs that address the needs of specific populations such as children and
pregnant women
• State licensure and regulation
• Regulation of health care costs and insurance companies
• Authorization of local health service
• Health personal training and education

14. Problems associated with state involvement in health
policy
While state governments have made great strides in developing
health policy to protect and provide for it’s citizens, some can argue that
state involvement has prevented our nation from effectively addressing
issues associated with current health policy. The more control states
have, the more difficult it becomes to establish a national health strategy.
Also, because each state plays a role in developing health care, many
feel that inequalities in health care exist among the states. Some
politicians, therefore, have suggested that the federal government should
play more of a role in developing health policy, and that individual states
should have less involvement.

15. The role of congress
As discussed earlier, Congress has the power to make laws, thus
making this legislative branch extremely influential in developing and
implementing health policy. Congress also has the ability to spend, allowing
funding (or lack there of) for national programs such as Medicaid and
Medicare. The House of Representatives and the Senate control most of the
legislative activity in Congress. Examples of federal involvement in health
policy are listed below:
• Financing and jurisdiction over public programs such as: Medicare,
Medicaid, Social Security, unemployment compensation, and public
welfare.
• Jurisdiction over health bills including: the Public Health Service Act, the
Affordable Health Care for America Act, the Federal Drug and Cosmetic
Act, HMO plans, Community Mental Health Centers Act, and many more.
• The establishment of federal agencies designed to protect the public, such
as the Federal Drug and Food Administration, and the Untied States
Public Health Service.

16. Problems associated with federal involvement in
health policy
While this topic is highly debatable, some feel that government
involvement in health policy has caused the high cost of health care today, and
that this problem will progress with increased government involvement. Those
that endorse government involvement in health care reform, feel that government
involvement would decrease the cost of health care and would help to provide
health insurance to all American citizens. Finally, there are those that believe that
a balance between state and government involvement will lead to a more
efficient, less expensive, health care system.

17. Problems associated with health policy
As Americans we live in a nation in which many citizens are
without health insurance, yet health care expenditure is amongst the
highest in the world. In order to reform such an ineffective system,
government commitment (whether on a state or federal level) is
imperative. Issues associated with current health policy are related to
access to care, cost of care, and quality of care.

18. Access to care
Many citizens feel that health care should be a right, and thus all
citizens should have access to health care. The debatable topic, however,
is which health care services should be included in basic care. Current
national programs, such as Medicaid and Medicare focus on providing
care to the most needy, which are the elderly, disabled, and poverty
stricken.
There are many bills that have been passed by state and federal
governments in attempt to rectify this obvious problem in health policy.
One primary example of this is the Affordable Care Act. In March, 2010,
Congress passed the Affordable Care Act that was supported by President
Obama. The health care law seeks to extend health care to over 30
million Americans, primarily by expanding access to Medicaid and
reducing expenditure on Medicare. While there were challenges faced on
many of the law’s provisions, it was recently upheld in the Supreme Court,
and will continue to roll forward.

19. Cost of care
While America is home to the
latest developments in medical
technology and well-trained
specialists, we are also home to the
most expensive health care system in
the world. Cost containment has
become one of the primary concerns
associated with developing new health
policy. Government involvement
towards a solution includes the
implementation of federal programs such
as: Medicaid, Medicare, Veterans
Affairs, and federal employee benefit
programs. States have also played a
role in reducing health care costs, such
as regulating how much hospitals and
nursing homes are reimbursed.

20. Quality of care
Quality of care is also a concern of policy makers. New
treatment methods, new diagnostic tools, and new research must be
used to enhance the quality of care available to American citizens. In
response to this concern, Congress created a new agency in 1989, now
called the Agency for Healthcare Research and Quality (AHRQ). This
agency conducts and supports research that measures the outcomes
and effectiveness of health care services and procedures. Many
programs have been established on the state level as well. State funded
programs, such as smoking cessation programs, focus on health care
promotion and disease prevention.

21. • Can you list examples of health
policy that have been
implemented in order to address
issues associated with the cost of
care?
• What problems are associated
Questions About with state involvement in
developing and implementing
Health PolicY health policy?
(Answers at the end of the • What is the name of the
presentation) government agency that was
created in order to measure the
effectiveness of health care
services and procedures?
• Critical thinking question: Do you
feel that the government should
be more involved in health policy?
Why or why not?

22. Conclusion
It is important to understand that all laws begin as ideas. A problem
must be identified before a solution is proposed. While the legislative process is
complex, we can all play an essential role in the decision-making process.
Americans have proven this by communicating directly with local
representatives. Legislators may respond by proposing a bill that addresses an
individual or group concern. As American citizens we can also make a change
by voting for politicians that support our beliefs.
While great strides have been made in attempt to rectify issues in
health policy today, it is apparent that there is still much that needs to be done.
Involvement in the legislative process, whether in a direct or indirect
manner, will allow each person to promote a health policy that will support the
needs of our citizens. Regardless of our varying opinions about health
policy, we can all agree that the cost of care, quality of care, and access to care
are issues that need to be addressed in health care reform. The hope is that
one day we can say that the United States provides superior patient care, to all
citizens, at an affordable price.

23. Answers to questions
Part 1 Answers:
• Congress generally holds press conferences to announce the introduction of
legislation.
• It is referred to a congressional committee for further consideration.
• The President has 10 days to sign or veto the enrolled bill.
• It must be passed in identical form by both the House and the Senate. If the two
houses cannot reconcile their differences on a bill, it cannot be considered
further and it dies

24. Answers to questions (Cont’d)
Part 2 Answers:
• Federal programs such as: Medicaid, Medicare, Veterans Affairs, and federal
employee benefit programs. States have regulated how much hospitals and
nursing homes are reimbursed.
• Increased state involvement makes it more difficult to establish a national
health strategy. Also, because each state plays a role in developing health
care, many feel that inequalities in health care exist among the states.
• The Agency for Healthcare Research and Quality (AHRQ) was created by
the US Congress in 1989.
• There is no “right” answer to this question. Some feel that government
involvement in health policy has caused the high cost of health care
today, and that this problem will progress with increased government
involvement. Those that endorse government involvement in health care
reform, feel that government involvement would decrease the cost of health
care and would help to provide health insurance to all American citizens.

25. References
Crowly, S. (2012). Health care reform and the Supreme Court (Affordable Care Act). The New York Times. Retrieved
from:
http://topics.nytimes.com/top/reference/timestopics/organizations/s/supreme_court/affordable_care_act/index.html
Longley, R. (2012). The legislative process: How bills become laws, or not. About.com Guide. Retrieved from:
http://usgovinfo.about.com/od/uscongress/a/legprocess.htm
Shi, L., & Singh, D. (2008). Delivering health care in America: A systems approach.
(4th ed.). Sudbury, Massachusetts: Jones and Bartlett Publishers.

26. References (cont’d)
Texiera, R. (2012). Public opinion snapshot: Public still backs government role in health care. The
Center for American Progress. Retrieved from: http://www.americanprogress.org/issues/public-
opinion/news/2012/08/06/11977/public-opinion-snapshot-public-still-backs-government-role-in-health-
care/
The United States House of Representatives (2012). The House explained: The legislative process.
Retrieved from: http://www.house.gov/content/learn/legislative_process/