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THE LEGESLATIVE PROCESSAND ITS RELATION TO HEALTH POLICY By: Jessica Melnik and Chrysanne Marquez
Part 1:LEGISLATION WITHIN THE UNITED STATES OF AMERICA The legislative process can be long, tedious, complex andfrustrating. 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 atwhich a bill can die. Only a very few survive to become law.
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 crimesand punishments, establishes levels of taxation and spending andcreates the programs and policies that shape American government andpolitics. By introducing a piece of legislation, a member of Congressproposes a solution to a public policy problem. Before a public policyproblem can be addressed through the legislative process, however, itmust first be recognized as a problem. When a member of Congressproposes a bill, he or she is essentially claiming to have found the bestsolution to the public policy problem in question.
Branches of Government (cont’d)• The House of Representatives and the Senate There are nineteen permanent committees in the House andseventeen in the Senate. Each of these committees has a specific areaof legislative jurisdiction. Each house is guided by its own set of complexprocedural rules which define the structure of the debate. The rules ofboth the House and Senate are sufficiently complex that each bodyemploys a full time "parliamentarian," an expert in the rules andprocedures of each house. In both the House and the Senate, the allotted time for debateon each piece of legislation is divided equally between the two parties. Inboth the House and the Senate, once all allowable amendments havebeen 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 apiece of legislation to move on in the legislative process, it must bepassed by the House and the Senate.
Branches of government (Cont’d)• The President The President of the United States of America plays asignificant role in the legislative process. After a piece of legislation ispassed by both the House of Representatives and the Senate, it isforwarded to the President. Bills are then sent to the President to besigned or vetoed. If the President signs a bill, it becomes law. However, ifthe President vetoes a bill, it is rejected, but the Congress may attemptto override the veto.
How a Bill Becomes a Law1. Recognizing a Problem While the formal legislative process begins when a bill is introduced inthe House or the Senate, a bill is "born" long before that. A problem must first berecognized and solutions must be proposed.2. Choosing the Best Solution In the American political process, there are generally more than enoughproposed solutions to the problems the nation faces. The difficulty lies in sortingthrough 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 theproposed policy solution. Members of Congress often rely on staff, experts in thearea the proposed legislation will effect, and Congressional legal staff to assistthem in drafting legislation.
How a Bill Becomes a Law (Cont’d)4. Building Support for a Bill Members of Congress must successfully compete for congressional andpublic attention or the legislation they introduce is bound to fail. To build support andmomentum for a bill, members of Congress generally hold press conferences toannounce the introduction of legislation. They will also secure as many co-sponsorsas possible for their legislation to provide evidence of broad congressional supportfor the bill.5. The Congressional Committee Once a bill has been formally introduced, it is referred to a congressionalcommittee for further consideration. Each of these committees has a specific area oflegislative jurisdiction and bills are generally referred to committees accordingly. Inmany cases, however, bills address topics that fall under the jurisdiction of morethan one committee. If a bill is assigned to a committee with a Chair that supportsthe legislation, the bill is likely to be scheduled for a timely public hearing, fullcommittee consideration and a vote. If a committee votes to keep a bill, instead ofsending it on for further consideration, the bill is dead.
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 towhich it was assigned, it must be considered by all of the members of the bodyin which it was introduced--either the House or the Senate. In the House, aCommittee on Rules establishes the time and duration of debate on each billthat comes to the floor. In addition to the timing and extent of the bills floorconsideration, the rule also specifies what, if any, amendments may be made tothe bill on the floor. In both the House and the Senate, once all allowable amendmentshave 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 housescannot reconcile their differences on a bill, it cannot be considered further and itdies.
How a Bill Becomes a Law (cont’d)7. The Conference Committee When similar bills are passed by both houses, they are referred to aspecial, temporary "Conference Committee," comprised of members of bothhouses and of both parties. Members on Conference Committees are chargedwith working out the differences between the two versions of the bill and creatinga compromise version which is then sent back to each house. At this stage in theprocess, no amendments are allowed. The full membership of the House andSenate must simply choose to accept or reject the Conference Committees"Report," which details the compromise version of the bill.8. The President If the Report is accepted, the bill is forwarded to the President. Billssent to the President must be signed or vetoed. If the President signs the bill, itbecomes law. However, if the President vetoes the bill, it is rejected. ThePresident has 10 days to sign or veto the enrolled bill.
How to Veto a bill While the President is the only individual that has thepower to sign or veto a bill, Congress has the power to overridethe veto. Congress may attempt to override the veto if they feelthe bill was mistakenly overlooked by the President. A veto canbe overridden if a two-thirds majority in both houses votes to doso.
• 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?
Part 2: Health Policy In the United States of America, federal, state, and localgovernments have played a role in developing and delivering healthpolicy. Issues associated with health policy stem from individual health,the overall health of the country, and economic problems associated withhealth care. There is an ongoing argument, however, over how muchinvolvement the government should have in developing health policy. In other nations, health care is considered a right, and thusmost agree that the government should play a leading role in developingand delivering health care. In the United States of America, however,health care is not seen as a right, but more as a privilege. Other thannational programs such as Medicare and Medicaid, our health caresystem is controlled by private sectors. Problems associated with thistype of health care system have led to the need for health care reform,and thus new ideas for health policy have been proposed.
The role of the State Individual states do play a significant role in the development anddelivery of health policy. In fact, many of the policies we know today haveoriginated in state governments. Examples of implemented health policy thatoriginated 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
Problems associated with state involvement in health policy While state governments have made great strides in developinghealth policy to protect and provide for it’s citizens, some can argue thatstate involvement has prevented our nation from effectively addressingissues associated with current health policy. The more control stateshave, the more difficult it becomes to establish a national health strategy.Also, because each state plays a role in developing health care, manyfeel that inequalities in health care exist among the states. Somepoliticians, therefore, have suggested that the federal government shouldplay more of a role in developing health policy, and that individual statesshould have less involvement.
The role of congress As discussed earlier, Congress has the power to make laws, thusmaking this legislative branch extremely influential in developing andimplementing health policy. Congress also has the ability to spend, allowingfunding (or lack there of) for national programs such as Medicaid andMedicare. The House of Representatives and the Senate control most of thelegislative activity in Congress. Examples of federal involvement in healthpolicy 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.
Problems associated with federal involvement in health policy While this topic is highly debatable, some feel that governmentinvolvement in health policy has caused the high cost of health care today, andthat this problem will progress with increased government involvement. Thosethat endorse government involvement in health care reform, feel that governmentinvolvement would decrease the cost of health care and would help to providehealth insurance to all American citizens. Finally, there are those that believe thata balance between state and government involvement will lead to a moreefficient, less expensive, health care system.
Problems associated with health policy As Americans we live in a nation in which many citizens arewithout health insurance, yet health care expenditure is amongst thehighest in the world. In order to reform such an ineffective system,government commitment (whether on a state or federal level) isimperative. Issues associated with current health policy are related toaccess to care, cost of care, and quality of care.
Access to care Many citizens feel that health care should be a right, and thus allcitizens should have access to health care. The debatable topic, however,is which health care services should be included in basic care. Currentnational programs, such as Medicaid and Medicare focus on providingcare to the most needy, which are the elderly, disabled, and povertystricken. There are many bills that have been passed by state and federalgovernments 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 PresidentObama. The health care law seeks to extend health care to over 30million Americans, primarily by expanding access to Medicaid andreducing expenditure on Medicare. While there were challenges faced onmany of the law’s provisions, it was recently upheld in the Supreme Court,and will continue to roll forward.
Cost of care While America is home to thelatest developments in medicaltechnology and well-trainedspecialists, we are also home to themost expensive health care system inthe world. Cost containment hasbecome one of the primary concernsassociated with developing new healthpolicy. Government involvementtowards a solution includes theimplementation of federal programs suchas: Medicaid, Medicare, VeteransAffairs, and federal employee benefitprograms. States have also played arole in reducing health care costs, suchas regulating how much hospitals andnursing homes are reimbursed.
Quality of care Quality of care is also a concern of policy makers. Newtreatment methods, new diagnostic tools, and new research must beused to enhance the quality of care available to American citizens. Inresponse to this concern, Congress created a new agency in 1989, nowcalled the Agency for Healthcare Research and Quality (AHRQ). Thisagency conducts and supports research that measures the outcomesand effectiveness of health care services and procedures. Manyprograms have been established on the state level as well. State fundedprograms, such as smoking cessation programs, focus on health carepromotion and disease prevention.
• 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 associatedQuestions 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?
Conclusion It is important to understand that all laws begin as ideas. A problemmust be identified before a solution is proposed. While the legislative process iscomplex, we can all play an essential role in the decision-making process.Americans have proven this by communicating directly with localrepresentatives. Legislators may respond by proposing a bill that addresses anindividual or group concern. As American citizens we can also make a changeby voting for politicians that support our beliefs. While great strides have been made in attempt to rectify issues inhealth 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 indirectmanner, will allow each person to promote a health policy that will support theneeds of our citizens. Regardless of our varying opinions about healthpolicy, we can all agree that the cost of care, quality of care, and access to careare issues that need to be addressed in health care reform. The hope is thatone day we can say that the United States provides superior patient care, to allcitizens, at an affordable price.
Answers to questionsPart 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
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.
ReferencesCrowly, S. (2012). Health care reform and the Supreme Court (Affordable Care Act). The New York Times. Retrievedfrom:http://topics.nytimes.com/top/reference/timestopics/organizations/s/supreme_court/affordable_care_act/index.htmlLongley, R. (2012). The legislative process: How bills become laws, or not. About.com Guide. Retrieved from:http://usgovinfo.about.com/od/uscongress/a/legprocess.htmShi, L., & Singh, D. (2008). Delivering health care in America: A systems approach.(4th ed.). Sudbury, Massachusetts: Jones and Bartlett Publishers.
References (cont’d)Texiera, R. (2012). Public opinion snapshot: Public still backs government role in health care. TheCenter 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/