Geiger Gibson Capstone in Community Health Policy & Leadership

Webinar Series 1. Judicial Branch Role 2. Executive Branch Role 3. Legislative Branch Role 4. Advocacy Role

Merle Cunningham MD MPH - Program Director

Geiger Gibson Program in Partnership with NACHC GWU School Public Health & Health Services

The Legislative Branch Role in Health Policy

Webinar Presentation to:

Geiger Gibson Capstone Program in Community Health Policy & Leadership George Washington University – School of Public Health & Health Services

Presented by:

Kaitlin M. McColgan Director of Federal Affairs National Association of Community Health Centers April 4, 2013

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.

How It Is Supposed to Work: The Committee System

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

Key Health-Related Committees

• • • House and Senate Budget Committees House and Senate Appropriations Committees Authorizing Committees –Energy & Commerce (House) –Ways & Means (House) –Finance (Senate) –Health, Education, Labor, and Pensions aka HELP (Senate)

House and Senate Budget Committees

• • Hearings on fiscal year (FY) federal budget – department heads and OMB Director (President’s Administration) testify on funding levels for federal programs contained in the President’s Budget.

Budget Resolution – Not sent to President –What does “budget” mean in Congressional parlance?

–Broad outline –Draft and mark-up House Budget Resolution – Chairman’s “mark”, alternative view from the President (sometimes. . .) –Chairman manages budget resolution on House/Senate floor • Budget ≠ Appropriations in Congress-speak

House and Senate Appropriations Committees

• Responsibility for deciding annual fiscal year (FY) allocations for each individual

discretionary

program in government • Broad authority, within discretionary limits -historically flows from Budget Resolution or “deeming resolution” - now Budget Control Act (BCA) caps as well • Health-related Subcommittees –Labor HHS –Public Health, including funding for 330 grants

House Energy & Commerce Committee

• Public Health Service Act (CDC, NIH, HRSA, SAMHSA,) Section 330 grants, including Health Center mandatory funding from ACA, and Teaching Health Center GME program • Medicaid and Child Health Insurance Program – FQHC payments • Medicare – FQHC Payments – Part B (physician and outpatient hospital, home health, etc.) – Part C (Medicare Advantage – private insurers offering all Medicare benefits) – Part D (private insurers offering prescription drug coverage)

House Ways & Means Committee

• • Internal Revenue Code (All taxing issues, including insurance deductibility, exclusion and tax credits) Medicare (shares and splits jurisdiction with Energy and Commerce) –Part A (hospitals and other inpatient providers) –Parts of Part B (outpatient hospital, home health, not physicians) –Part C (Medicare Advantage – private insurers offering all Medicare benefits) –Part D (Private insurers offering prescription drug coverage)

Senate Finance Committee

• Tax Code (all revenue issues, deductibility and tax credits) • Medicaid and Child Health Insurance Program – incl. FQHC payments • Medicare (parts A, B, C and D) – incl. FQHC payments, Medicare GME

Senate Health, Education, Labor & Pensions (HELP) Committee

• Public Health Service Act (Section 330 grants, Health Center mandatory ACA funding, NHSC, Teaching Health Center GME) • Food and Drug Administration • Essential Community Provider, private insurance and Exchanges.

How a Bill Becomes a Law

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

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 this year. . .

Acknowledgments

Content from select slides adapted from the work of Katherine Hayes, J.D.

Questions?

Thank You!