US Government: A Case Presentation Dana M. Block, OMS-IV SOMA National Director of Political Affairs

US Government: A Case Presentation

Dana M. Block, OMS-IVSOMA National Director of Political Affairs

Introduction

• Purpose: to provide osteopathic medical students with a basic understanding of the structure and function of the US Government and the processes involved in a bill becoming a law

• This presentation is Part I of III in the Student Osteopathic Medical Association (SOMA) Political Action Training Course (PATC), completion of which is recommended for all D.O. Day on the Hill participants

• Completion of the SOMA PATC is one requirement for induction into Omega Beta Iota (ΩΒΙ), the national osteopathic political action honor society (exceptions will be made for 2007 ΩΒΙ inductees, as this is the first SOMA PATC to be given)

Presentation Overview

• “Case” presentation of sample issue

• Topic Review• Structure and functions

of US government branches

• How a bill becomes a law

• Save the Date: D.O. Day on the Hill (4/26/07)

“Case” Presentation

• Disclaimer: the “case” used in this presentation represents a current issue and is a creative adaptation of such; it therefore should not be taken too literally nor is this an official production of the American Osteopathic Association (AOA).

• CC: “We need improved funding for osteopathic graduate medical education (OGME).”

• HPI: The AOA is a 110-year-old membership organization that supports, unifies, and represents osteopathic physicians within the USA, and is currently in need of improved funding for OGME. Although this need has been apparent for several years, it only recently became so severe that it required immediate attention. The need for funding is a deep, constant, 10/10 and worsens as graduating osteopathic medical student numbers increase. It improves slightly if Medicare provides additional funding and if approval for new OGME programs is attained. ROS is (+) for collaboration with other osteopathic organizations, employment of a team of political advocacy experts, and the promotion of osteopathic postdoctoral training institutes (OPTIs). All other ROS are (-).

Pertinent History

• PMHx: the Balanced Budget Act of 1997 established a full-time equivalent resident “cap” on funded residency positions. Additionally, OGME programs are limited by Medicare laws and the restricted utilization of ambulatory sites in teaching hospital-affiliated OGME programs

• PSHx: OGME programs have been restructured in the past to assure compliance with current legislation

• Soc Hx:• Medications: none• NKDA

Pertinent “Physical Exam” Findings(a.k.a. Pertinent Statistics)

• Vital signs, as of June 2006:• Total # of osteopathic medical

students: 13,406 • Estimated # of graduating

osteopathic medical students (13,406/4): 3352

• Total # of AOA-approved OGME internship programs: 229

• Total # of AOA-approved OGME internship positions: 2777

• Osteopathic physicians in self-identified specialties, as of June 2006:• Family Medicine: 46.4%• Internal Medicine: 8.3%• Pediatrics: 4.2%• OB/GYN: 3.9%• OMT: 1.2%• Non-primary care: 36.0%

• Visits to osteopathic physicians account for roughly 20% of annual patient visits to general/family practitioners, according to the National Ambulatory Medical Care Survey 2003-2004

Pertinent Laboratory Data/Imaging

• D.O. internships are offered in only 36 of the 50 states: Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Missouri, North Carolina, North Dakota, New Hampshire, New Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin, and Wyoming

Assessment and Plan

• Assessment: we are in need of additional funding to improve upon existing, and to create additional, OGME programs

• Plan: author a bill to promote funding for the addition and improvement of OGME programs, and lobby to help the bill become a law!!!

Topic Review: US Government

• The United States government is composed of three branches, as delineated in the Constitution:• Executive (President)• Legislative (Congress)• Judicial (Supreme Court)

• These branches were created to provide “checks and balances”• Each branch of government has

the right to amend or void those acts of another branch of government that fall within its purview


• Executive Branch in detail:• Purpose: responsible for enforcing the laws of the US• Membership:

• President (US leader, Commander-in-Chief of the US military, and appoints Department leaders)

• Vice-President (President of the Senate)• Executive Office of the President • Departments:

• Department heads advise the President on policy issues and help put policies into practice

• Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Homeland Security, Housing and Urban Development, Interior, Justice, Labor, State, Transportation, Treasury, Veterans’ Affairs

• Independent Establishments and Government Corporations • Provide special services and help execute policies• CIA, NASA, USPS, etc.


• Judicial Branch in detail:• Purpose: to decide arguments about the meaning of

laws, how they are applied, and whether or not they violate the US Constitution

• Membership:• The Supreme Court is the highest court in the US and is

the only court created by the Constitution• Several other federal courts have since been created by

Congress as allowed by the Constitution • Additional courts included within the judicial branch of

government are: the US Court of Appeals, US district courts, the US sentencing commission, etc


• Legislative Branch in detail: • Purpose: create and establish US laws • Membership:

• Congress = Senate + House of Representatives• Senate: equal representation provided for each state,

regardless of state’s population (2 Senators per state, period)• House of Representatives: representation provided for each

state based upon state’s population (each state may have several representatives, elected from given districts)

• Agencies: provide support services for Congress• Architect of the Capitol, Congressional Budget Office, General

Accounting Office, Government Printing Office, Library of Congress

• This is the branch of government we will work most closely with when we participate in advocacy campaigns, including writing legislation and lobbying!

Topic Review: How a Bill Becomes a Law

• A bill always begins with an idea– ours is to promote funding for the addition and improvement of osteopathic graduate medical education (OGME) programs

• Let’s pretend we already authored our bill and we now are wanting to make it into a law…


• Anyone may write a bill, but a bill may only be introduced to Congress by a Member of Congress when the House is in session

• There are 4 types of legislation:• Bills• Joint Resolutions• Concurrent Resolutions• Simple Resolutions

• There are also different types of bills:• Private: affects a specific

person or organization• Public: affects the population

at large


• The process of introducing a bill depends on if it is being introduced in the House or in the Senate:• In the House of Representatives, a bill is introduced by placing it in

the “hopper,” a receptacle near the Speaker’s podium; it is then assigned a number by a bill clerk

• House bills are abbreviated “H.R.” • The first reading of a bill in the House means its title is read on the

House Floor; it is then referred to committee for markup• In the Senate, a bill is introduced by placing it on the presiding

officer’s desk or by formally introducing it on the Senate Floor• Senate bills are abbreviated “S.”• Once introduced in the Senate, a bill is also referred to committee for

markup• Once a bill is formally introduced in either the House or the

Senate, the Library of Congress receives an electronic copy • The Library of Congress then posts the bill and its status on a

public website named THOMAS, http://thomas.loc.gov/; updates on bills at each step of the process are also included on the THOMAS website


• There are 19 House Standing Committees and 16 Senate Committees, each with jurisdiction over a specific area of public policy

• Committee Actions:• Bill is placed on Committee Calendar• Bill is debated and altered (if deemed

necessary) utilizing parliamentary procedures• Bill may be “tabled” if it is determined to be

unwise or unnecessary• Bill may be referred to subcommittee for

further evaluation• Subcommittee evaluation of a bill mirrors that

of Committee evaluation, but subcommittees may include hearings to obtain views of experts, supporters, and opponents

• Once a subcommittee approves a bill, it is sent back to the full committee for a vote

• Bill is voted upon after it is debated and/or amended

• Approved bill is reported back to the House or Senate Floor


• The bill is termed “reported” once it has passed through Committee; the bill is accompanied by a report outlining all of its provisions, hence the term “reported”


• A reported bill is then placed on a House calendar for “consideration” on the House floor

• Debate ensues according to established parliamentary procedure (which may be special rules for the specific bill)

• After the debate, the second reading of the bill occurs, allowing the opportunity for scrutiny and further amendment

• Following further amendment (if performed), the bill is read a third time in preparation for a vote by the House


• House voting:• The bill is read by title only and put to a vote• Members of the House who are present vote to

pass or not to pass the bill• The House has an electronic voting system• Members may vote to pass the bill (“yea”), not to pass

the bill (“nay”), or abstain (“present”)

• The bill passes with a majority vote of the House• A bill is termed “engrossed” once it (and its

amendments) has passed the House and has been certified by the Clerk

• A bill that passes the House is then referred to the Senate to undergo a similar process again


• Senate voting:• The Senate may decide to vote on a House bill or

to continue its own legislation• The bill may be sent to committee • The bill may be voted upon by Senators• If the bill undergoes revision within and passes

the Senate with language other than what was introduced, the bill must be sent to a conference committee for review

• The conference committee is comprised of members from both the House and the Senate

• Differences must be reconciled before the bill may be sent to the President for signature

• A bill must pass both the House and the Senate in order to become a law


• A bill is termed “enrolled” when it is submitted to the President for signature

• The President may:• Take no action (if Congress is in

session, the bill automatically becomes law in 10 days)

• Pocket veto (if Congress is not in session and the bill is not signed in 10 days, it does NOT become a law)

• Veto the bill• Sign the bill to make it a law

• A bill becomes a law once it has passed both the House and the Senate and has been signed by the President, or if Congress overrides a President’s veto


• If a Presidential veto occurs:• The bill returns to either the House or the Senate,

wherever it originated• Objections to the veto are read and debated• If enough objections to the veto exist, a vote to

override the veto may be obtained• If the vote on the veto override passes, the bill

becomes a law• In order to pass, a 2/3 majority of BOTH the House and

the Senate is required

• If the House or Senate does not vote on a veto override, or if the vote on the veto override fails, the bill does not become a law


• So, WHY did we time-travel back to fifth-grade social sciences to review all of this stuff?• Our brains are currently inundated with medical

jargon• We got free food for coming to the meeting• It’s required for induction into the national

osteopathic political action honor society, Omega Beta Iota (ΩΒΙ)

• It’s important to understand the basics and the processes behind the legislation we will be lobbying to support in DC during D.O. Day on the Hill!

Save the Date

D.O. Day on the Hill

April 26, 2007Register online now! www.do-online.org

THANK YOU FOR YOUR

ATTENTION!

QUESTIONS???

Notes

• Part II of the SOMA Political Action Training Course will be coming to you in the beginning of March!• Topic: The osteopathic medical student

lobbyist how-to guide• Part III of the SOMA Political Action

Training Course will be coming to you in late March or early April!• Topic: Preliminary introduction and review

of 2007 AOA priority issues to be lobbied during D.O. Day on the Hill

References

• Licciardone JC. A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the national ambulatory medical care survey. Osteopathic Medicine and Primary Care, 1:2, January 12, 2007.

• AOA 2006 Report, including data from AACOM, accessed online at https://www.do-online.org/pdf/ost_factsheet.pdf

• www.do-online.org• AOA’s 110th Congress Legislative, Regulatory, and Advocacy

Agenda, accessed online at https://www.do-online.org/pdf/110thCongressReport.pdf

• http://bensguide.gpo.gov/9-12/government/branches.html• http://clerkkids.house.gov/laws/bill_begin.html• Google images search

Documents

US Government: A Case Presentation Dana M. Block, OMS-IV SOMA National Director of Political Affairs