Chapter 2 Policy and the Policymaking Process Chapter Overview • Chapter 2 provides a basic overview of policy and the policymaking process • Chapter 2 focuses on: – Defining policy – Public policymaking structure – Federal and State health bureaucracy – Interest groups Defining Policy • Who makes policy? – Private actors – Government (federal, state, local) – Authoritative decision makers • Public policy problems – Beyond individual concerns • Structuring policy options – Mandatory/voluntary – Take action/refrain from acting Federal Policymaking Structure • Legislative branch – House – Senate • Executive branch – White House – Administrative agencies • Judicial branch discussed in chapter 3 Federal Legislative Branch • Congress is lawmaking body of federal government • Congress consists of Senate and House – Senate is statewide, and there are two senators from each state – House is elected by district, proportional to population, and at least on representative per state Legislative Branch: Committees • Workhouse of Congress • Examples of key health committees: – Senate Finance, subcommittee on health care – Senate Health, Education, Labor and Pension – House Ways and Means – House Appropriations committee, subcommittee on Labor, Health and Human Services, Education, and Related Agencies Legislative Branch • Constituents – Voters in state or district – Voters in nation if have leadership role or national aspirations – Political party – President Federal Executive Branch • White House – President – Executive offices assist and advise president • 15 cabinet departments – Interpret and implement laws passed by Congress Federal Executive Branch • Presidential powers/duties – Sets the agenda – Budget proposals – Persuasion – Sign/veto bills – Executive Orders Federal Executive Branch • Presidential Constituents – Nation (all voters) – Public who voted for president – Political party – Other nations – International organizations Federal Executive Branch • Administrative Agencies – Duties/powers: implement statutes through rulemaking – Constituents • President • Congress • Individuals and entities regulated by agency • No one? Federal Health Bureaucracy • Key agencies – Department of Health and Human Services (HHS) – Department of Veterans Affairs (VA) – Department of Defense (DOD) Federal Health Bureaucracy – HHS: Key agencies • Administration for Children and Families • Administration on Aging • Agency for Healthcare Research and Quality • Agency for Toxic Substances and Disease Registry • Centers for Disease Control and Prevention Federal Health Bureaucracy – HHS: Key agencies • Center for Medicare and Medicaid Services • Food and Drug Administration • Health Resources Services Administration • Indian Health Services • National Institutes of Health • Substance Abuse and Mental Health Services Admin. Federal.

1. Chapter 2
Policy and the Policymaking
Process
Chapter Overview
• Chapter 2 provides a basic overview of policy
and the policymaking process
• Chapter 2 focuses on:
– Defining policy
– Public policymaking structure
– Federal and State health bureaucracy
– Interest groups
Defining Policy
• Who makes policy?

2. – Private actors
– Government (federal, state, local)
– Authoritative decision makers
• Public policy problems
– Beyond individual concerns
• Structuring policy options
– Mandatory/voluntary
– Take action/refrain from acting
Federal Policymaking Structure
• Legislative branch
– House
– Senate
• Executive branch
– White House
– Administrative agencies
• Judicial branch discussed in chapter 3

3. Federal Legislative Branch
• Congress is lawmaking body of federal
government
• Congress consists of Senate and House
– Senate is statewide, and there are two
senators from each state
– House is elected by district, proportional to
population, and at least on representative per
state
Legislative Branch: Committees
• Workhouse of Congress
• Examples of key health committees:
– Senate Finance, subcommittee on health care
– Senate Health, Education, Labor and Pension
– House Ways and Means
– House Appropriations committee, subcommittee
on Labor, Health and Human Services, Education,
and Related Agencies

4. Legislative Branch
• Constituents
– Voters in state or district
– Voters in nation if have leadership role or national
aspirations
– Political party
– President
Federal Executive Branch
• White House
– President
– Executive offices assist and advise president
• 15 cabinet departments
– Interpret and implement laws passed by Congress
Federal Executive Branch
• Presidential powers/duties
– Sets the agenda

5. – Budget proposals
– Persuasion
– Sign/veto bills
– Executive Orders
Federal Executive Branch
• Presidential Constituents
– Nation (all voters)
– Public who voted for president
– Political party
– Other nations
– International organizations
Federal Executive Branch
• Administrative Agencies
– Duties/powers: implement statutes through
rulemaking
– Constituents

6. • President
• Congress
• Individuals and entities regulated by agency
• No one?
Federal Health Bureaucracy
• Key agencies
– Department of Health and Human Services (HHS)
– Department of Veterans Affairs (VA)
– Department of Defense (DOD)
Federal Health Bureaucracy – HHS:
Key agencies
• Administration for Children and Families
• Administration on Aging
• Agency for Healthcare Research and Quality
• Agency for Toxic Substances and Disease
Registry
• Centers for Disease Control and Prevention

7. Federal Health Bureaucracy – HHS:
Key agencies
• Center for Medicare and Medicaid Services
• Food and Drug Administration
• Health Resources Services Administration
• Indian Health Services
• National Institutes of Health
• Substance Abuse and Mental Health Services
Admin.
Federal Health Bureaucracy –
VA & DOD
• VA
– Provides comprehensive care to veterans who were
not dishonorably discharged
• DOD
– TriCare Provides health insurance to current and

8. retired military personnel and their families
State and Local Policymaking and
Health Bureaucracy
• State-level policymaking is important
– Key decisions made on state level
– Variation among states in how policymaking
process is structured
• State/local health bureaucracy
– State level agencies (ex: Medicaid, public health)
– Local public health agencies
Interest Groups
• Interest group is the general term used to
describe a variety of organizations that focus
on a particular issue or issues and have the
goal of influencing and educating
policymakers and the general public

9. • Interest groups do not make policy
Chapter 1
Introduction: Understanding
the Role of and
Conceptualizing Health
Policy and Law
Chapter Overview
• Describes why it is important to include policy
and law in the study of health care and public
health
• Describes three ways to conceptualize health
policy and law
The Role of Policy and Law in Health
Care/Public Health
• Federal and state policy and law shape virtually all

10. aspects of the health care system, from structure and
organization, to service delivery, to financing, and to
administrative and judicial oversight
• Topics include: advertising and marketing of health
services and products, health care contracting,
employment issues, patents, taxation, health care
discrimination and disparities, consumer protection,
bioterrorism, health insurance, prescription drug
regulation, and more.
The Role of Policy and Law in Health
Care/Public Health
• Policy and law have also long played a seminal role
in everyday public health activities as well as in many
historic public health accomplishments
• One main focus of policy and law in the realm of
public health is on locating the appropriate balance
between public regulation of private individuals and

11. corporations, and the ability of those same parties to
exercise rights that allow them to function free of
overly intrusive government intervention
Conceptualizing Health Policy
and Law
• There are multiple ways to conceptualize the many
important topics that fall under the umbrella of health
policy and law
• Three conceptual frameworks: one premised on the
broad topical domains of health policy and law, one
based on prevailing historical factors, and one
focused on the individuals and entities impacted by a
particular policy or legal determination
Conceptualizing Health Policy
and Law
• The first domain is reserved for policy and law

12. concerns in the area of health care, another for
issues arising in the public health arena, and
the last for controversies in the field of
bioethics.
Conceptualizing Health Policy
and Law
• A second way to consider health policy and
law is in historical terms, based on the social,
political, and economic views that dominate a
particular era
• Considered this way, health policy and law
have been influenced over time by three
perspectives: professional autonomy, social
contract, and free market
Conceptualizing Health Policy
and Law

13. • A third way to conceptualize health policy and law
issues is in terms of the stakeholders whose interests
are impacted by certain policy choices or by the
passage or interpretation of a law
• Patients, health care providers, governments, the
public, managed care and traditional insurance
companies, employers, the pharmaceutical industry,
the medical device industry, the research community,
interest groups, and others all may have a strong
interest in various policies or laws under debate.