Transcript KFF - A Schlobohm - Process of health reform legislation 0709

Chart 1
The Process of Health Reform Legislation
The Process of Health Reform Legislation
Alan Schlobohm
Senior Program Administrator
Kaiser Family Foundation
July 2009
Chart 2
The Process of Health Reform Legislation
Health reform on the agenda
Health reform: some key players in the Administration
The Congressional budget and health reform
House and Senate Committees with health jurisdiction
Committee procedures
House floor procedures
Senate floor procedures
House-Senate conference; final passage
Signed into law or vetoed
Chart 3
Health Reform and the National Agenda
President Obama at the White House Forum on Health Care Reform, March 5, 2009
Heath reform is unlikely to be adopted if it is not at or
near the top of the national political agenda
Chart 4
Health Reform: Some Key Players in the Administration
Nancy-Ann Min DeParle, Director
White House Office for Health Reform
Peter Orszag, Director
White House Office of
Management and Budget
HHS Secretary - Kathleen Sebelius
Rahm Emanuel
White House Chief of Staff
Melody Barnes
Director of the White House
Domestic Policy Council
Lawrence Summers
Director of National Economic
Council
Chart 5
House and Senate Committees with Jurisdiction Over Health Reform
House
Committees
Energy & Commerce
Rep. Henry Waxman (D-Calif.)
chairman
Ways & Means
Rep. Charles Rangel (D-N.Y.)
chairman
Education & Labor
Rep. George Miller (D-Calif.)
chairman
Senate
Committees
Finance
Sen. Max Baucus (D-Mont.)
chairman
Health, Education, Labor & Pensions
Sen. Edward Kennedy (D-Mass.)
chairman
Chart 6
House and Senate Committees with Jurisdiction Over Health Reform
House Committees
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 insurance
Public Health and Quarantine
Medicaid
Medicare (Part B only)*
Children’s Health Insurance
Program (CHIP)
Hospital construction
Mental health and research
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.)
* Jurisdiction over Medicare Part B shared with the Ways & Means Committee
Biomedical research and development
Chart 7
House and Senate Committees with Jurisdiction Over Health Reform
House Committees
Ways and Means has primary oversight over tax policy in general, and
specifically health programs that are supported by payroll deductions
Health jurisdiction:
Medicare*
Tax policy
Chair: Rep. Charles Rangel (D-N.Y.)
Ranking: Rep. Dave Camp (R-Mich.)
Health Subcommittee
Chair: Rep. Pete Stark (D-Calif.)
Ranking: Rep. Wally Herger (R-Calif.)
* Jurisdiction over Medicare Part B shared with the Energy & Commerce Committee
Chart 8
House and Senate Committees with Jurisdiction Over Health Reform
House Committees
Education and Labor has primary oversight over pension, health, and other
employee benefits, including the Employee Retirement Security Act (ERISA)
Chair: Rep. George Miller (D-Calif.)
Ranking: Rep. John Kline (R-Minn.)
Chart 9
House and Senate Committees with Jurisdiction Over Health Reform
Senate Committees
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
Medicaid
Children’s Health Insurance Program (CHIP)
Chair: Sen. Max Baucus (D-Mont.)
Ranking: Sen. Charles Grassley (R-Iowa)
Health Subcommittee
Chair: Sen. Jay Rockefeller (D-W.Va.)
Ranking: Sen. Orrin Hatch (R-Utah)
Chart 10
House and Senate Committees with Jurisdiction Over Health Reform
Senate Committees
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.)
Sen. Chris Dodd (D-Conn.) – in Senator Kennedy’s absence
Ranking: Sen. Mike Enzi (R-Wyo.)
Working Groups:
Insurance Coverage
Prevention
Quality
Chart 11
Committee Procedures
Formal hearings
Informal meetings (“Walk-Throughs”)
Drafting legislation
CBO cost estimate
Formal meetings to consider,
debate, amend and approve or
disapprove legislation (“Mark-Ups”)
Committee Report
Chart 12
House Floor Procedures
Rule
Amendments
Debate
Passage
Chart 13
Senate Floor Procedures
Regular Order
Debate
Amendments
Filibuster
Cloture
Passage
Budget Reconciliation
Chart 14
Budget Reconciliation
The Congressional Budget Resolution
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 15
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 16
Bill Signed Into Law or Vetoed
Bill approved and
signed into law by
the President
or
Bill vetoed by the
President
Chart 17
Overview – Committees and Floor Debate
HOUSE
Energy &
Commerce
Ways &
Means
SENATE
Education
& Labor
COMMITTEE
PROCEDINGS
Finance
HELP
Hearings
Hearings
Legislation
Legislation
Cost estimate
Cost estimate
Mark-Up
Mark-Up
Two Bills combined into One
Three Bills combined into One
Rules Committee sets terms for debate;
confirmed by full House
Debate
FLOOR
CONSIDERATION
Regular Order
Debate terms negotiated
Debate
Filibuster
Reconciliation
Limited debate; no filibuster
Debate
Cloture
Full House vote on Bill
(simple majority to pass)
House-Senate
Conference Committee
Full Senate vote on Bill
(simple majority to pass)
Chart 18
Overview – Conference
House-Senate
Conference Committee
Conference Report
HOUSE
SENATE
Regular Order
Reconciliation
Rules Committee sets terms for debate;
confirmed by full House
Debate terms negotiated
Limited debate; no filibuster
Filibuster
Debate
Debate
Debate
Cloture
Full House vote on Bill
(simple majority to pass)
Full Senate vote on Bill
(simple majority to pass)
President signs or vetoes the bill
Chart 19
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 Committee
http://energycommerce.house.gov/
House Ways and Means Committee
http://waysandmeans.house.gov/
House Education and Labor Committee
http://edworkforce.house.gov/
Senate Health, Education, Labor and
Pensions Committee
http://help.senate.gov/
Senate Finance Committee
http://finance.senate.gov/
White House – health reform website
http://www.healthreform.gov/