The U.S. Congress and Health Policy


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The U.S. Congress and Health PolicySheila P. Burke, RN, MPA, FAAN
Georgetown University Public Policy Institute, June 2011

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  • 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.
  • The U.S. Congress and Health Policy

    1. 1. The U.S. Congress and Health PolicySheila Burke, RN, MPA, FAANHarvard Kennedy School of GovernmentJune 2011
    2. 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
    3. 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
    4. 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)
    5. 5. Figure 4 U.S. Senate: 112th Congress 51 Democrats 47 Republicans 2 Independents LEADERSHIPMajority Leader: Harry Reid (D-NV) Minority Leader: Mitch McConnell (R-KY)Majority Whip: Richard Durbin (D-IL) Minority Whip: Jon Kyl (R-AZ) KEY COMMITTEESFinance Health, Education, Labor, PensionChairman: Max Baucus (D-MT) Chairman: Tom Harkin (D-IA)Ranking: Chuck Grassley (R-IA) Ranking: Michael Enzi (R-WY)Budget AppropriationsChairman: Kent Conrad (D-ND) Chairman: Daniel Inouye (D-HI)Ranking: Jeff Sessions (R-AL) Ranking: Thad Cochran (R-MS)
    6. 6. Figure 5 U.S. House: 112th Congress 241 Republicans 192 Democrats 2 vacancies LEADERSHIPSpeaker: 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 COMMITTEESEnergy & Commerce Ways & MeansChairman: Fred Upton(R-MI) Chairman: Dave Camp (R-MI)Ranking: Henry Waxman (D-CA) Ranking: Sander Levin (D-MI)Budget AppropriationsChairman: Paul Ryan (R-WI) Chairman: Harold Rogers (R-KY)Ranking: Chris Van Hollen(D-MD) Ranking: Norman Dicks (D-WA)
    7. 7. Figure 6 Critical Differences between House and Senate HOUSE SENATEHouse is more than four times size of the Senators represent a broaderSenate constituency than House memberFloor debate in House has more limits Senators serve longer terms (6 yrs) whileand is more expeditious than Senate House members run every two yearsPower less evenly distributed in the Senate filibuster can block action onHouse, but Majority more powerful force legislation with only 41 votesin the HouseHouse disproportionate share of majority Senate more equity in distribution of staffseats on Committees funds
    8. 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
    9. 9. Figure 8Key Congressional Committees
    10. 10. Figure 9 House Committee on Ways and MeansChief 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
    11. 11. Figure 10House Committee on Energy and CommerceChief 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
    12. 12. Figure 11 Senate Health, Education, Labor and Pension (HELP) CommitteeChief 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
    13. 13. Figure 12 Senate Committee on FinanceChief 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
    14. 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)
    15. 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
    16. 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 yearSOURCES: Congressional Budget Act of 1974, as amended; Oleszek, kaiserEDU.orgCongressional Procedures and the Policy Process, 2001
    17. 17. Figure 16 Legislative Timing Drafting CommitteeIdea Phase Hearings of Bill Mark-Up Floor Action House/Senate - Amendments Conference President Implementation by signs bill Administration 0
    18. 18. Figure 17Working With Congress
    19. 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.
    20. 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
    21. 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
    22. 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
    23. 23. Figure 22 Additional Resources• U.S. Senate Committee Websites – Budget Committee ( – Finance Committee ( – Health, Education, Labor and Pensions Committee ( – Appropriations Committee (• U.S. House of Representatives Committee Websites – Energy and Commerce Committee ( – Ways and Means Committee ( – Budget Committee ( – Appropriations Committee (• Tutorial: Health Policy and the Federal Budget• Tutorial: The Process of Health Reform• Issue Module: The Role of States in Health Policy