Geiger Gibson Capstone in Community Health Policy & Leadership

1. Geiger Gibson Capstone in Community Health Policy & Leadership Webinar Series – Fall 2013 (3-4 pm) Executive Branch 10/1-Merle Cunningham Legislative Branch 10/8-Dan Hawkins Judicial Branch-10/15-Sara Rosenbaum Advocacy Role-10/22-Amanda Pears Kelly Merle Cunningham MD MPH - Program Director

2. The Legislative Branch Role in Health Policy Webinar Presentation to: Geiger Gibson Capstone Program in Community Health Policy & Leadership George Washington University – School of Public Health & Health Services Presented by: Dan Hawkins, Senior VP for Public Policy & Research National Association of Community Health Centers October 8, 2013

4. Learning Objectives • What are the major committees in Congress with relevance to health policy? • What are the jurisdictions of the major health authorizing committees? • How does the budget process generally work? • How a bill becomes a law: theory and practice. • How to understand Congress in an era of dysfunction.

5. How It Is Supposed to Work: The Committee System

6. A Structure for Legislating Generally a Seniority-Based System • System where committee assignments are given to those with the longest time in Congress • Committee chairperson is usually a committee member in the majority party with the most time in Congress (although not always) • Senior member of the minority party is usually called the ranking minority member or vice chair Legislation-Generation, Consideration, and Oversight • Bills referred, and the select few “marked-up” • Oversight takes many forms

7. Key Health-Related Committees • House and Senate Budget Committees • House and Senate Appropriations Committees • Authorizing Committees • Energy & Commerce (House) • Ways & Means (House) • Finance (Senate) • Health, Education, Labor, and Pensions aka HELP (Senate)

8. House and Senate Budget Committees • Hearings on fiscal year (FY) federal budget – department heads and OMB Director (President’s Administration) testify on funding levels for federal programs contained in the President’s Budget. • Budget Resolution – Not sent to President • What does “budget” mean in Congressional parlance? • Broad outline • Draft and mark-up House Budget Resolution –Chairman’s “mark”, alternative view from the President (sometimes. . .) • Chairman manages budget resolution on House/Senate floor • Budget ≠ Appropriations in Congress-speak

9. House and Senate Appropriations Committees • Responsibility for deciding annual fiscal year (FY) allocations for each individual discretionary program in government • Broad authority, within discretionary limits -historically flows from Budget Resolution or “deeming resolution” - now Budget Control Act (BCA) caps as well • Health-related Subcommittees • Labor HHS –Public Health, including funding for 330 grants

10. House Energy & Commerce Committee • Public Health Service Act (CDC, NIH, HRSA, SAMHSA,) Section 330 grants, including Health Center mandatory funding from ACA, and Teaching Health Center GME program • Medicaid and Child Health Insurance Program – FQHC payments • Medicare • FQHC Payments • Part B (physician and outpatient hospital, home health, etc.) • Part C (Medicare Advantage – private insurers offering all Medicare benefits) • Part D (private insurers offering prescription drug coverage)

11. House Ways & Means Committee • Internal Revenue Code (All taxing issues, including insurance deductibility, exclusion and tax credits) • Medicare (shares and splits jurisdiction with Energy and Commerce) • Part A (hospitals and other inpatient providers) • Parts of Part B (outpatient hospital, home health, not physicians) • Part C (Medicare Advantage – private insurers offering all Medicare benefits) • Part D (Private insurers offering prescription drug coverage)

12. Senate Finance Committee • Tax Code (all revenue issues, deductibility and tax credits) • Medicaid and Child Health Insurance Program – incl. FQHC payments • Medicare (parts A, B, C and D) – incl. FQHC payments, Medicare GME

13. Senate Health, Education, Labor & Pensions (HELP) Committee • Public Health Service Act (Section 330 grants, Health Center mandatory ACA funding, NHSC, Teaching Health Center GME) • Food and Drug Administration • Essential Community Provider, private insurance and Exchanges.

14. How a Bill Becomes a Law

15. The Schoolhouse Rock Version aka the Exception to the Rule • Problem/Goal • Member drafts bill (House or Senate) • Committee consideration • Committee mark-up • Committee vote • To the floor- Yea or Nay • Other chamber passes their version • Conference committee • Conference Report • Final Passage on the Floor of each chamber. • To the President for Signature

16. How It Really Works: Congress in an Era of Dysfunction • Legislating crisis to crisis • Last minute, big packages, no committee consideration. • Few people “in the room” diminishes democratic (small “d”) process Signs of hope this year. . .

17. Acknowledgments Content of select slides adapted from the work of Katherine Hayes, J.D., Faculty, Department of Health Policy, GWU School of Public Health & Health Services

18. Thank You! Questions?

19. Next Week’s Topic Judicial Branch Role in Health Policy Sara Rosenbaum, J.D.