I’ll be honest, I used to watch the VHS of Schoolhouse Rock: America about once a week as a kid. It might be more than a few decades old, but it’s still perfectly accurate thanks to Article I of the U.S. Constitution, which grants all legislative powers to Congress, including the authority for each chamber to make its own rules for processing legislation. Before we dive in to the nitty, gritty of drafting, considering, amending, reconciling, and voting on legislation, let’s (re)familiarize ourselves with some vital stats about Congress.
There are 541 seats in Congress: 435 voting members of the House of Representatives, 6 non-voting members of the House*, and 100 members of the Senate. Members of the House are elected to a two-year term to represent districts determined by population. Each state (regardless of population) elects two Senators, each for a six year term.
Now that we have those stats out of the way, let’s take a peek at how 541 elected officials and their staff keep up with thousands of legislative proposals–from the massive task of overhauling our healthcare system to the simple exercise of naming post offices.
In general, proposed legislation will be referred to a committee that holds jurisdiction (a fancy word for responsibility) over the issue at hand. A committee does not have to hold a hearing on every piece of legislation referred to it–honestly, there simply isn’t time. During the 114th Congress alone (2015-2017), over 12,000 pieces of legislationwere introduced!
A committee can hold informational hearings to learn from experts and stakeholders and mark-up hearings for members to debate and amend legislation. If a majority of the committee agrees to the text of the bill, it can be voted out of committee and sent to the full chamber for consideration. This simplistic look at committee process is, of course, made more complicated when a legislative proposal addresses a wide range of issues–this is often the case for health-related bills.
So, let’s take a tour around the Hill and meet the committees that have jurisdiction over most health-related legislation. (Some policy issues, like portions of the military healthcare apparatus or food and nutrition policy, can fall outside the boundaries of the committees listed below).
- The Senate Committee on Finance (Subcommittee on Health Care) has jurisdiction over Medicare and Medicaid.
- The Senate Committee on Health, Education, Labor, and Pensions (HELP) has jurisdiction over measures related to health, aging, biomedical research and development, occupational safety and health, and public health.
- The Senate Committee on Appropriations (Subcommittee on Labor, Health and Human Services, Education, and Related Agencies) has jurisdiction over nearly every agency involved in healthcare you can think of except the Food and Drug Administration and the Indian Health Service.
- The House of Representatives Committee on Ways and Means (Subcommittee on Health) has jurisdiction over healthcare programs in the Social Security Act and taxation related to insurance premiums and health care costs.
- The House of Representatives Committee on Energy and Commerce (Subcommittee on Health) has jurisdiction over public health, hospital construction, biomedical research and development, Medicare and Medicaid, health information technology, medical malpractice, the Department of Health and Human Services, the National Institutes of Health, the Centers for Disease Control, and the Indian Health Service.
- The House of Representatives Committee on Appropriations (Subcommittee on Labor, Health and Human Services, Education, and Related Agencies) has jurisdiction over the budget for the Department of Health and Human Services.
- The House of Representatives Committee on the Budget has jurisdiction over the federal budget process.
If your eyes haven’t glazed over yet from this complicated puzzle of responsibility, you might have noticed that multiple committees are responsible for the same health-related legislation. For example, Medicare is the responsibility of no fewer than four committees–the Senate Finance Committee, the Senate HELP Committee, the House Energy and Commerce Committee, and the House Ways and Means Committee. If that doesn’t make your head spin, keep in mind that the Department of Health and Human Services (HHS) is tasked with implementing and enforcing the Medicare-related laws passed by Congress. But that’s another post for another day.
For a bill to end up on the President’s desk, it must go through the committee process of each chamber and receive a vote of approval from a majority of the House and the Senate. (Because nothing is simple, there are some cases where more than a simple majority of Senators voting in the affirmative is required or where each chamber passes similar but not identical legislation, necessitating a conference committee to reconcile the bills). If the House and Senate pass a bill that is identical down to the last comma, it will be sent to the President.
And that is everything you should have learned in high school civics!
No, I kid. There is much more to civics than the general outline of how a bill becomes a law. And it seriously influences the creation, implementation, and enforcement of health policy. So, buckle up policy nerds.
Molly, mph to md 