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The U.S. Congress and Health Policy

Congress and Health. Congress plays a major role in development of health policyMedicareMedicaidNational Institutes of HealthHealth policy is a bi-partisan priorityAuthority spread across several committeesInvolvement includes regulatory, programmatic, financing, and oversight. . Figure 1. Health Care Priorities for Policymakers.

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The U.S. Congress and Health Policy

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    1. The U.S. Congress and Health Policy Sheila Burke, RN, MPA January 2007

    3. Health Care Priorities for Policymakers

    4. Examples of Congressional Legislation in Health Policy Enactment of Medicare and Medicaid (1965) Employee Retirement Income Security Act (1974) Americans with Disabilities Act (1990) Family Medical Leave Act (1993) Temporary Assistance for Needy Families (1996) Health Insurance Portability and Accountability Act (1996) State Children’s Health Insurance Program (1997) Medicare Modernization Act (2003)

    5. Congressional Basics

    7. U.S. House: 110th Congress 202 Republicans 233 Democrats

    8. Critical Differences between House and Senate House is more than four times size of the Senate Senators represent a broader constituency than House members Senators serve longer terms (6 yrs) while House members run every two years Floor debate in House has more limits and is more expeditious than Senate Senate filibuster can block action on legislation Power less evenly distributed in the House Majority more powerful force in the House

    9. Majority vs. Minority Party Majority controls Committee chairs, number of committee members and votes Staff and funding allocations to committees Majority has more control over agenda, floor debate, and committees Can call for hearings and investigations Use of procedural tools (i.e. veto override, filibuster, Constitutional amendment)

    10. Key Congressional Committees

    11. Chief Health Responsibilities: Aging policy Biomedical research and development Domestic activities of the American National Red Cross Individuals with disabilities Occupational safety and health, including the welfare of miners Public Health Senate Health, Education, Labor and Pension (HELP) Committee

    12. House Committee on Energy and Commerce Chief health responsibilities: Medicaid Medicare Public health programs Food and drug safety Hospital construction; mental health and research; biomedical programs and health protection in general

    13. House Committee on Ways and Means

    14. Senate Committee on Finance Chief Health Responsibilities: Health programs under the Social Security Act and health programs financed by a specific tax or trust fund, including: Medicaid Medicare SCHIP Welfare (TANF) Maternal and Child Health block grant SSI ERISA (w/HELP Committee) Revenue measures generally, except as provided in the Congressional Budget Act of 1974

    15. 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)

    16. Senate and House Committees on Appropriations Allocates funding to federal agencies, departments, and programs Sub-committees prepares funding allocations for programs within jurisdiction Subject to spending levels established in budget resolution Mid-year supplemental spending bills for emergency funding

    17. Federal Budget Timeline… Wishful thinking

    18. Federal Budget Process

    19. Legislative Process

    20. Legislative Timing Idea Phase Drafting of Bill Hearings Committee Mark-up Floor Action Amendments Conference Implementation

    21. Influencing the Process

    22. RULES OF THE ROAD: Working with Members Legislation should be last resort Compromise There is little that is black or white Can you gain by taking step forward? Be a resource Members can’t do exhaustive search on every issue. Know facts but admit what you don’t know

    23. RULES OF THE ROAD: 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

    24. RULES OF THE ROAD: 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

    25. Conclusions Congress plays an integral role in the development, financing and oversight of public and private sector health policies Congressional health policy agenda driven by range of forces, including President’s budget, political agenda, lobbying and advocacy. Developing relationships early with staff and members provides opportunity to be a resource and equip them with information.

    26. 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 KaiserEDU.org Tutorial: Health Policy and the Federal Budget KaiserEDU.org Reference Library: Federalism and the Role of States in Health Policy

    27. Return to KaiserEdu Tutorial Page

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