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