1. The U.S. Congress and Health Policy
Sheila Burke, RN, MPA, FAAN
Harvard Kennedy School of Government
June 2011
kaiserEDU.org
2. Figure 1
Health Care Priorities for Policymakers
Percent saying each of the following should be a top priority for the
President and Congress in 2011:
Strengthening the nation’s economy 87%
Improving the job situation 84%
Improving the educational system 73%
Taking steps to make Social Security system 66%
financially sound
Reducing the budget deficit 66%
Taking steps to make Medicare system financially 64%
sound
Reducing healthcare costs 61%
Revising the health care legislation passed last year 61%
Dealing with the problems of poor and needy people 56%
Source: Pew Research Center for the People & the Press, January 2011 Political Survey kaiserEDU.org
3. Figure 2
Congress and Health
• Congress plays a major role in development of health policy
• Medicare
• Medicaid
• Veterans Affairs
• National Institutes of Health
• Health care reform
• Health policy is a bi-partisan priority
• Authority spread across several committees
• Involvement includes regulatory, programmatic, financing,
and oversight
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4. Figure 3
Examples of Congressional Legislation
in Health Policy
Health Insurance Portability
and Accountability Act (1996)
Enactment of
Medicare and
Children’s Health
Medicaid
Temporary Assistance for Insurance
(1965)
Needy Families (1996) Program (1997)
1960 1970 1980 1990 2000 2010
Employee
Americans with Medicare Patient
Retirement
Disabilities Act Modernization Protection
Income
(1990) Act (2003) and Affordable
Security Act
(1974) Care Act
(2010)
Family Medical
Leave Act (1993)
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5. Figure 4
U.S. Senate: 112th Congress
51 Democrats
47 Republicans
2 Independents
LEADERSHIP
Majority Leader: Harry Reid (D-NV) Minority Leader: Mitch McConnell (R-KY)
Majority Whip: Richard Durbin (D-IL) Minority Whip: Jon Kyl (R-AZ)
KEY COMMITTEES
Finance Health, Education, Labor, Pension
Chairman: Max Baucus (D-MT) Chairman: Tom Harkin (D-IA)
Ranking: Chuck Grassley (R-IA) Ranking: Michael Enzi (R-WY)
Budget Appropriations
Chairman: Kent Conrad (D-ND) Chairman: Daniel Inouye (D-HI)
Ranking: Jeff Sessions (R-AL) Ranking: Thad Cochran (R-MS)
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6. Figure 5
U.S. House: 112th Congress
241 Republicans
192 Democrats
2 vacancies
LEADERSHIP
Speaker: John Boehner (R-OH)
Majority Leader: Eric Cantor (R-VA) Minority Leader: Nancy Pelosi (D-CA)
Majority Whip: Kevin McCarthy (R-CA) Minority Whip: Steny Hoyer (D-MD)
KEY COMMITTEES
Energy & Commerce Ways & Means
Chairman: Fred Upton(R-MI) Chairman: Dave Camp (R-MI)
Ranking: Henry Waxman (D-CA) Ranking: Sander Levin (D-MI)
Budget Appropriations
Chairman: Paul Ryan (R-WI) Chairman: Harold Rogers (R-KY)
Ranking: Chris Van Hollen(D-MD) Ranking: Norman Dicks (D-WA)
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7. Figure 6
Critical Differences between House and Senate
HOUSE SENATE
House is more than four times size of the Senators represent a broader
Senate constituency than House member
Floor debate in House has more limits Senators serve longer terms (6 yrs) while
and is more expeditious than Senate House members run every two years
Power less evenly distributed in the Senate filibuster can block action on
House, but Majority more powerful force legislation with only 41 votes
in the House
House disproportionate share of majority Senate more equity in distribution of staff
seats on Committees funds
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8. Figure 7
Majority vs. Minority Party
• Majority has more control over agenda, floor
debate, and committees
• Majority controls committee chairs, number of
committee members and votes
• Greater staff and funding allocations to Majority
• Use of procedural tools (i.e. veto override, right of first
recognition)
• Can call for hearings and investigations
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10. Figure 9
House Committee on Ways and Means
Chief Health Responsibilities:
• Government payments for programs in Social Security Act:
– Medicare (Part A, Parts B, D joint with E&C)
– Welfare, Temporary Assistance for Needy Families (TANF)
– Supplemental Security Income (SSI)
– Social Services (Title XX)
• Tax credits and related matters in tax code dealing with health
insurance premiums
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11. Figure 10
House Committee on Energy and Commerce
Chief health responsibilities:
• Medicaid and Children’s Health Insurance Program
• Medicare (Part B, Parts C and D shared with Ways & Means)
• Centers for Medicare and Medicaid Services (CMS), including
the Center for Consumer Information and Insurance Oversight
• Aging policy, individuals with disabilities
• National Institutes of Health (NIH)
• Domestic activities of the American National Red Cross
• Occupational safety and health, including the welfare of miners
• Public Health
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12. Figure 11
Senate Health, Education, Labor and
Pension (HELP) Committee
Chief Health Responsibilities:
– Public Health
– Employee Retirement Income Security
Act (ERISA), (shared with Finance
Committee)
– Individuals with disabilities
– Occupational safety and health
– Biomedical research and development
– Aging
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13. Figure 12
Senate Committee on Finance
Chief Health Responsibilities:
– Health programs under the Social Security Act
and including:
• Medicaid- including ACA expansions, Center for
Consumer Information, and Insurance Oversight
• Medicare
• CHIP
• Welfare (TANF)
• Maternal and Child Health block grant
• Supplemental Security Income (SSI)
• ERISA (w/HELP Committee)
– Revenue measures
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14. Figure 13
Senate and House Committees on Budget
• Review and evaluate President’s budget proposal
• Formulate budget resolution establishing
Congressional spending and revenue levels
• Submit resolution to full chambers for vote and
negotiations in conference
• Monitoring budget “reconciliation” process
• Oversight of Congressional Budget Office (CBO)
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15. Figure 14
Senate and House Committees on
Appropriations
• Allocates discretionary funding to federal
agencies, departments, and programs
• Sub-committees prepares funding allocations for
programs within jurisdiction
• Subject to spending levels established in budget
resolution
• Major authority over discretionary, non-entitlement
programs
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16. Figure 15
Federal Budget Process
February - President’s budget released
- Congress holds hearings on President’s budget
request
March - CBO baseline and re-estimate of President’s
budget released
- House and Senate develop a Budget Resolution
April Budget Resolution completed
May-Dec - “Reconciliation bill” to make changes in tax policy or
entitlements if required in budget resolution
- Action on Appropriations bills
- Bill signed by President
October 1 Beginning of new fiscal year
SOURCES: Congressional Budget Act of 1974, as amended; Oleszek, kaiserEDU.org
Congressional Procedures and the Policy Process, 2001
17. Figure 16
Legislative Timing
Drafting Committee
Idea Phase Hearings
of Bill Mark-Up
Floor Action House/Senate
- Amendments Conference
President Implementation by
signs bill Administration
0
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19. Figure 18
Lobbyists and Interest Groups
• To conduct activities aimed at influencing public
officials and government at all levels.
• A group of persons working on behalf of or
strongly supporting a cause, such as an item of
legislation.
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20. Figure 19
Communication
• Know the staff
• Put a human face on the issue
• Provide expert testimony at congressional hearings
• Avoid jargon and acronyms
• Use action statements, pros and cons
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21. Figure 20
Partnerships
• Work collectively when possible
• Find common ground with unlikely bedfellows
• Never burn bridges – an enemy today is a friend
tomorrow
• Know your opposition – never leave an ally unprepared
or unprotected
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22. Figure 21
Conclusions
• Congress plays an integral role in the
development, financing and oversight of public and
private sector health policies
• Work with Congress members to identify issues and
strategies
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23. Figure 22
Additional Resources
• U.S. Senate Committee Websites
– Budget Committee (www.budget.senate.gov)
– Finance Committee (www.finance.senate.gov)
– Health, Education, Labor and Pensions Committee (www.help.senate.gov)
– Appropriations Committee (www.appropriations.senate.gov)
• U.S. House of Representatives Committee Websites
– Energy and Commerce Committee (www.energycommerce.house.gov)
– Ways and Means Committee (www.waysandmeans.house.gov)
– Budget Committee (www.budget.house.gov)
– Appropriations Committee (www.appropriations.house.gov)
• KaiserEDU.org Tutorial: Health Policy and the Federal Budget
• KaiserEDU.org Tutorial: The Process of Health Reform
• KaiserEDU.org Issue Module: The Role of States in Health Policy
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Notes de l'éditeur
Size is not the only difference between the two bodies. As noted here, lengths of terms, two versus six years, the rules governing the two bodies are radically different. In the House, the majority party has a greater opportunity to control the agenda and in the Senate, the minority retain considerable rights. The ability to filibuster in the Senate and talk at length is quite unique, rarely fully employed, but that threat alone can force opponents to negotiate.
For both individual citizens and advocacy groups or lobbyists, knowing their staff, putting a human face on the issue so they understand the implications of what it is that you propose is critical. You could potentially provide expert testimony at Congressional hearings because of this knowledge. If you have an opportunity to do so or to talk with members or their staff, remember to avoid jargon and acronyms. Speak in language that they will understand that will clearly articulate the problem that you seek to solve. You can make it easier for a member or their staff by offering to provide information in the form of statements or pros and cons helping them to do the kind of analysis that’s necessary to fully understand the issue before them.
Remember as well that working collectively when possible can often work to your advantage. Find other groups or individuals with whom you have a common interest and work with them to find a common solution. Remember as well to never burn bridges. An enemy today may well be your friend tomorrow in trying to solve a problem. It’s also important for you to anticipate your opposition so that you can prepare those who have offered to support your cause with the necessary arguments.