the u.s. congress and health policy
DESCRIPTION
The U.S. Congress and Health PolicySheila P. Burke, RN, MPA, FAAN Georgetown University Public Policy Institute, June 2011TRANSCRIPT
kaiserEDU.org
The U.S. Congress and Health Policy
Sheila Burke, RN, MPA, FAANHarvard Kennedy School of Government
June 2011
kaiserEDU.org
Health Care Priorities for Policymakers
Series1 56%
61%
61%
64%
66%
66%
73%
84%
87%
Source: Pew Research Center for the People & the Press, January 2011 Political Survey
Percent saying each of the following should be a top priority for the President and Congress in 2011:
Figure 1
Taking steps to make Medicare system financially sound
Reducing healthcare costs
Revising the health care legislation passed last year
Dealing with the problems of poor and needy people
Reducing the budget deficit
Improving the educational system
Strengthening the nation’s economy
Improving the job situation
Taking steps to make Social Security system financially sound
kaiserEDU.org
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
Figure 2
kaiserEDU.org
Temporary Assistance for Needy Families (1996)
Examples of Congressional Legislation in Health Policy
Figure 3
Enactment of Medicare and Medicaid (1965)
Patient Protection and Affordable Care Act (2010)
Medicare Modernization Act (2003)
Children’s Health Insurance Program (1997)
Family Medical Leave Act (1993)
Americans with Disabilities Act (1990)
Employee Retirement Income Security Act (1974)
1960 1970 1980 1990 2000 2010
Health Insurance Portability and Accountability Act (1996)
kaiserEDU.org
U.S. Senate: 112th Congress
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 COMMITTEES
Chairman: Max Baucus (D-MT) Chairman: Tom Harkin (D-IA)Ranking: Chuck Grassley (R-IA) Ranking: Michael Enzi (R-WY)
Chairman: Kent Conrad (D-ND) Chairman: Daniel Inouye (D-HI)Ranking: Jeff Sessions (R-AL) Ranking: Thad Cochran (R-MS)
51 Democrats47 Republicans2 Independents
Figure 4
Finance
Budget
Health, Education, Labor, Pension
Appropriations
kaiserEDU.org
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 COMMITTEES
Chairman: Fred Upton(R-MI) Chairman: Dave Camp (R-MI)Ranking: Henry Waxman (D-CA) Ranking: Sander Levin (D-MI)
Chairman: Paul Ryan (R-WI) Chairman: Harold Rogers (R-KY)Ranking: Chris Van Hollen(D-MD) Ranking: Norman Dicks (D-WA)
Figure 5
Energy & Commerce Ways & Means
Budget Appropriations
kaiserEDU.org
Critical Differences between House and Senate
Figure 6
HOUSE SENATEHouse is more than four times size of the Senate
Senators represent a broader constituency than House member
Floor debate in House has more limits and is more expeditious than Senate
Senators serve longer terms (6 yrs) while House members run every two years
Power less evenly distributed in the House, but Majority more powerful force in the House
Senate filibuster can block action on legislation with only 41 votes
House disproportionate share of majority seats on Committees
Senate more equity in distribution of staff funds
kaiserEDU.org
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
Figure 7
kaiserEDU.org
House Committee on Ways and Means
Chief 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
Figure 9
kaiserEDU.org
House Committee on Energy and Commerce
Chief 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
Figure 10
kaiserEDU.org
Senate Health, Education, Labor and Pension (HELP) Committee
Chief 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
Figure 11
kaiserEDU.org
Senate Committee on Finance
Chief 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
Figure 12
kaiserEDU.org
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)
Figure 13
kaiserEDU.org
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
Figure 14
kaiserEDU.org
Federal Budget Process
SOURCES: Congressional Budget Act of 1974, as amended; Oleszek, Congressional Procedures and the Policy Process, 2001
Figure 15
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
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
April Budget Resolution completed
October 1 Beginning of new fiscal year
kaiserEDU.org
Legislative Timing
Figure 16
Idea Phase Drafting of Bill
Hearings Committee Mark-Up
Floor Action- Amendments
House/Senate Conference
President signs bill
Implementation by Administration 0
kaiserEDU.org
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.
Figure 18
kaiserEDU.org
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
Figure 19
kaiserEDU.org
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
Figure 20
kaiserEDU.org
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
Figure 21
kaiserEDU.org
Additional Resources
• U.S. Senate Committee Websites– Budget Committee (www.budget.senate.gov)– Finance Committee (www.finance.senate.gov) – Health, Education, Labor and Pensions Committee (www.help.senate.gov)– Appropriations Committee (www.appropriations.senate.gov)
• U.S. House of Representatives Committee Websites– Energy and Commerce Committee (www.energycommerce.house.gov)– Ways and Means Committee (www.waysandmeans.house.gov)– Budget Committee (www.budget.house.gov)– Appropriations Committee (www.appropriations.house.gov)
• KaiserEDU.org Tutorial: Health Policy and the Federal Budget• KaiserEDU.org Tutorial: The Process of Health Reform
• KaiserEDU.org Issue Module: The Role of States in Health Policy
Figure 22