The Legislative Branch Role in Health Policy

2. The Legislative Branch Role in Health Policy 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 March 8, 2016

3. 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. • The importance of policy advocacy and your role

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

5. 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

6. Key Health-Related Committees • House and Senate Budget Committees (no Subcommittees) • House and Senate Appropriations Committees • Subcommittees on Labor, HHS & Education Approps • Authorizing Committees • Energy & Commerce (House) – PHS Act programs, Medicaid, Medicare Part B, ACA Act Subsidies), CHIP • Ways & Means (House) – Medicare A & B & C & D, tax policy • Finance (Senate) Medicare & Medicaid (all), ACA Act, CHIP • Health, Education, Labor, and Pensions aka HELP (Senate) – PHS Act programs

7. How a Bill Becomes a Law

8. 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

9. 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 last year (‘doc fix’), but dangers still lurk around every corner (national elections, annual funding in era of abortion wars, etc.). . .

10. Health Centers: A Policy (and Political) History • Unique Public-Private Partnership: Resources Directly to Community-Owned Organizations • O.E.O./War On Poverty: A Way Around Entrenched Political/Medical Powers to Address Needs Of Poor/Minorities • Health Centers: Two-Fold Purpose - • Be Agents of Care in Communities With Too Little of the Same • Be Agents of Change, Giving Communities Control of their Health Care System

11. Health Centers: A Policy (and Political) History (Cont’d) • How Health Centers Succeeded Where Others Had Failed • Founded Outside of ‘Mainstream’ Health Policy and Politics • Focused on Forgotten People and Places (Poor, Uninsured, Farmworkers, Homeless, Rural) • Accepted Slow Growth, Low Visibility to Stay in Realm of Distributive Politics • Today, those characteristics are no longer true

12. Policy Analysis and Policy Advocacy • All Public Policy flows from Policy Analysis • Analysis Can Stand Alone, but Effective Advocacy Requires Good Policy Analysis • Advocacy is Analysis PLUS Strategy (Game Plan) and Tactics (Players & Plays) • Advocacy is a Form of Lobbying, but Advocacy is Different • Advocacy is an Active, not a Passive Process

13. Keys to Successful Advocacy • Know What You Want (Be Specific) • Know Who Can Give It To You (Which People Have the Real Power) • Know What They Want (Positive Press, Public Recognition, Votes) • Know What You Can and Cannot Offer Them (Recognition vs Contributions) • Know Who Will Be Your Allies and Your Opponents • Know What It Will Take to WIN

14. YOGI BERRA’S RULES FOR SUCCESS • When You Come to a Fork in the Road, Take It (choose objectives wisely, don’t over/under-shoot) • You’ve Got to be Careful if You Don’t Know Where You’re Going, Because You Might Not Get There (know the system & players – what it will take to win) • It Ain’t Like Football -- You Can’t Make Up No Trick Plays (find a shepherd, get firm commitment, build support among players, mobilize effective grass-roots) • You Can Observe a Lot by Just Watching (anticipate and counter your opposition & their points) • It Ain’t Over ‘til It’s Over (never let up, learn to win & lose gracefully, thank supporters regardless of outcome)

15. WHY SHOULD YOU BE AN ADVOCATE? • You can make a difference • People can change laws (think: Child labor, public education, clean air or water, etc.) • It helps find real solutions (but only when people with ‘front-line’ knowledge & experience are involved) • It’s easy (especially when many are involved together) • It helps people (group vs individual intervention) • It advances your work and builds public trust • It’s a democratic tradition (at heart of system, helps people feel connected and avid alienation)

16. Thank You! Questions?