The Process of Health Reform Legislation
The Process of Health Reform Legislation
Alan SchlobohmSenior Program Administrator
Kaiser Family Foundation
July 2009
Chart 1
The Process of Health Reform Legislation
The Congressional budget and health reform
Health reform: some key players in the Administration
House and Senate Committees with health jurisdiction
Committee procedures
Senate floor procedures
House-Senate conference; final passage
Signed into law or vetoed
Health reform on the agenda
House floor procedures
Chart 2
Health Reform and the National Agenda
President Obama at the White House Forum on Health Care Reform, March 5, 2009
Health reform is unlikely to be adopted if it is not at or near the top of the national political agenda
Chart 3
Health Reform: Some Key Players in the Administration
HHS Secretary - Kathleen Sebelius
Nancy-Ann Min DeParle, DirectorWhite House Office for Health Reform
Peter Orszag, DirectorWhite House Office of Management and Budget
Rahm EmanuelWhite House Chief of Staff
Melody BarnesDirector of the White HouseDomestic Policy Council
Lawrence SummersDirector of National EconomicCouncil
Chart 4
House and Senate Committees with Jurisdiction Over Health Reform
Energy & CommerceRep. Henry Waxman (D-Calif.)chairman
Ways & MeansRep. Charles Rangel (D-N.Y.)chairman
Education & Labor
Rep. George Miller (D-Calif.)chairman
HouseCommittees
SenateCommittees
Health, Education, Labor & PensionsSen. Edward Kennedy (D-Mass.)chairman
FinanceSen. Max Baucus (D-Mont.)chairman
Chart 5
House and Senate Committees with Jurisdiction Over Health Reform
Energy and Commerce has primary oversight over health issues, specifically public health and health programs that are funded by general revenue (as opposed to specific taxes)
Health jurisdiction:
National health insuranceMedicaidMedicare (Part B only)*Children’s Health Insurance Program (CHIP)
Public Health and Quarantine
Hospital constructionMental health and research
Biomedical research and development
House Committees
Chart 6
* Jurisdiction over Medicare Part B shared with the Ways & Means Committee
Chair: Rep. Henry Waxman (D-Calif.)Ranking: Rep. Joe Barton (R-Tex.)
Health Subcommittee
Chair: Rep. Frank Pallone (D-N.J.)Ranking: Rep. Nathan Deal (R-Ga.)
House and Senate Committees with Jurisdiction Over Health Reform
Ways and Means has primary oversight over tax policy in general, and specifically health programs that are supported by payroll deductions
Health jurisdiction:
Medicare*
Chair: Rep. Charles Rangel (D-N.Y.)
Tax policy
Ranking: Rep. Dave Camp (R-Mich.)
Health Subcommittee
Chair: Rep. Pete Stark (D-Calif.)Ranking: Rep. Wally Herger (R-Calif.)
House Committees
Chart 7
* Jurisdiction over Medicare Part B shared with the Energy & Commerce Committee
House and Senate Committees with Jurisdiction Over Health Reform
Education and Labor has primary oversight over pension, health, and other employee benefits, including the Employee Retirement Security Act (ERISA)
House Committees
Chart 8
Chair: Rep. George Miller (D-Calif.)Ranking: Rep. John Kline (R-Minn.)
House and Senate Committees with Jurisdiction Over Health Reform
Finance has primary oversight over tax policy in general, as well as federal health programs financed by a specific tax or trust fund, and other programs under the Social Security Act
Health jurisdiction:
Medicare
Chair: Sen. Max Baucus (D-Mont.)
Children’s Health Insurance Program (CHIP)
Medicaid
Senate Committees
Ranking: Sen. Charles Grassley (R-Iowa)
Health Subcommittee
Chair: Sen. Jay Rockefeller (D-W.Va.)Ranking: Sen. Orrin Hatch (R-Utah)
Chart 9
House and Senate Committees with Jurisdiction Over Health Reform
Health, Education, Labor and Pensions (HELP) has primary oversight over pension, health, and other employee benefits, including the Employee Retirement Security Act (ERISA); HELP also has oversight over public health and biomedical research and development
Chair: Sen. Edward Kennedy (D-Mass.)
Senate Committees
Ranking: Sen. Mike Enzi (R-Wyo.)
Sen. Chris Dodd (D-Conn.) – in Senator Kennedy’s absence
Chart 10
Working Groups:Insurance CoveragePreventionQuality
Committee Procedures
Formal hearings
Informal meetings (“Walk-Throughs”)
Drafting legislation
Formal meetings to consider, debate, amend and approve or disapprove legislation (“Mark-Ups”)
CBO cost estimate
Committee Report
Chart 11
House Floor Procedures
Rule
Debate
Amendments
Passage
Chart 12
Senate Floor Procedures
Debate
Amendments
Filibuster
Cloture
Passage
Regular Order
Budget Reconciliation
Chart 13
Budget Reconciliation
Adopted by Congress in April 2009
Authorizes (but does not require) health reform legislation to be protected from Senate filibuster through the use of “budget reconciliation”
Budget Reconciliation
Limited Debate
Amendments
Passage
Chart 14
The Congressional Budget Resolution
House-Senate Conference
Conference appointed to resolve differences between House and Senate
Informal negotiations
Formal meeting
Conference report
Final bill voted on separately by the full House and Senate
Chart 15
Bill Signed Into Law or Vetoed
Bill approved and signed into law by the President
Bill vetoed by the President
or
Chart 16
Overview – Committees and Floor Debate
HOUSE SENATE
COMMITTEEPROCEDINGS
FLOORCONSIDERATION
Debate
Full House vote on Bill(simple majority to pass)
Three Bills combined into One
Rules Committee sets terms for debate; confirmed by full House
House-SenateConference Committee
Energy & Commerce
Ways & Means
Education& Labor
Finance HELP
Full Senate vote on Bill(simple majority to pass)
DebateFilibuster
Cloture
Debate
Debate terms negotiated Limited debate; no filibuster
Regular Order Reconciliation
Two Bills combined into One
Hearings
Legislation
Cost estimate
Mark-Up
Hearings
Legislation
Cost estimate
Mark-Up
Chart 17
Overview – Conference
House-SenateConference Committee
Conference Report
Debate
Full House vote on Bill(simple majority to pass)
Rules Committee sets terms for debate; confirmed by full House
Full Senate vote on Bill(simple majority to pass)
DebateFilibuster
Cloture
Debate
Debate terms negotiated Limited debate; no filibuster
Regular Order Reconciliation
HOUSE SENATE
President signs or vetoes the bill
Chart 18
Resources
Oleszek, W.J., “Congressional Procedures and the Policy Process” (Fifth Edition), CQ Press, Washington, 2001
Schick, A., “The Federal Budget: Politics, Policy, Process”, Brookings Institution Press, Washington, 2000
Beth, R.S., and Bach, S., ‘Filibusters and Cloture in the Senate’, Report for Congress, Congressional Research Service, Updated March 28, 2003
House Energy and Commerce Committeehttp://energycommerce.house.gov/
House Ways and Means Committeehttp://waysandmeans.house.gov/
House Education and Labor Committeehttp://edworkforce.house.gov/
Senate Finance Committeehttp://finance.senate.gov/
Senate Health, Education, Labor and Pensions Committeehttp://help.senate.gov/
White House – health reform websitehttp://www.healthreform.gov/
Chart 19