Health Policy to Health Policy to LegislationLegislation

Robert G. FrankRobert G. Frank

Lecture 2Lecture 2

Health Services, Research, Health Services, Research, Management and PolicyManagement and Policy

61526152

Who is this man?Who is this man?

Who is this lady?Who is this lady?

Who is this man?Who is this man?

Sonny Hoyer Majority Leader of Sonny Hoyer Majority Leader of the House of Representativesthe House of Representatives

Congressman Steny H. Hoyer of Maryland's Fifth Congressman Steny H. Hoyer of Maryland's Fifth Congressional District was elected in November 2006 to Congressional District was elected in November 2006 to serve as House Majority Leader in the 110th Congress by serve as House Majority Leader in the 110th Congress by his colleagues in the Democratic Caucus, after serving as his colleagues in the Democratic Caucus, after serving as the Democratic Whip in the previous two Congresses.the Democratic Whip in the previous two Congresses.

As the Majority Leader, Congressman Hoyer is charged As the Majority Leader, Congressman Hoyer is charged with scheduling legislation for consideration on the House with scheduling legislation for consideration on the House Floor, as well as building unity among House Democrats Floor, as well as building unity among House Democrats and delivering the Democratic Party's message.and delivering the Democratic Party's message.

Now serving his 14th term in Congress, he also is the Now serving his 14th term in Congress, he also is the longest-serving Member of the U.S. House of longest-serving Member of the U.S. House of Representatives from Southern Maryland in history.Representatives from Southern Maryland in history.

Prior to serving as the Whip in the 108th and 109th Prior to serving as the Whip in the 108th and 109th Congresses, he served as Chair of the Democratic Caucus Congresses, he served as Chair of the Democratic Caucus B the fourth-ranking position among House Democrats B B the fourth-ranking position among House Democrats B from 1989 to 1995.  He is the former Co-Chair (and a from 1989 to 1995.  He is the former Co-Chair (and a current member) of the Democratic Steering Committee, current member) of the Democratic Steering Committee, and served as the chief candidate recruiter for House and served as the chief candidate recruiter for House Democrats from 1995 to 2000.  He also served as Deputy Democrats from 1995 to 2000.  He also served as Deputy Majority Whip from 1987 to 1989.Majority Whip from 1987 to 1989.

Congress and Health ReformCongress and Health Reform

We’ve Got Goldwater to We’ve Got Goldwater to Thank for ThisThank for This

165 more Democrats than Republicans165 more Democrats than Republicans Lyndon JohnsonLyndon Johnson

MedicareMedicare MedicaidMedicaid Maternal and Child Health ProgramMaternal and Child Health Program Health PlanningHealth Planning Regional Medical ProgramsRegional Medical Programs Physician Training ProgramsPhysician Training Programs

1964 Landslide Brought 42 New 1964 Landslide Brought 42 New Northern Democrats to the Northern Democrats to the

HouseHouse

Ways and Means Committee Ways and Means Committee transformed allowing development of transformed allowing development of payroll tax to finance Medicarepayroll tax to finance Medicare

1981 Presidential Landslide1981 Presidential Landslide

Republican SenateRepublican Senate Party leaders now controlled Party leaders now controlled

powerful chairmanpowerful chairman Post Watergate reforms enactedPost Watergate reforms enacted

1993 Bill Clinton - 43% Majority1993 Bill Clinton - 43% Majority

Largest first year class since 1949 in Largest first year class since 1949 in HouseHouse Many experienced in State legislaturesMany experienced in State legislatures Whip weekly meetings to enhance Whip weekly meetings to enhance

common agendacommon agenda Speaker Foley refused to strip Speaker Foley refused to strip

dissident chairsdissident chairs

U.S. Operated under Articles of U.S. Operated under Articles of Confederation for 13 YearsConfederation for 13 Years

Strong StatesStrong States Weak federal governmentWeak federal government Convention to modify Articles of Convention to modify Articles of

Confederation became the Confederation became the Constitutional ConventionConstitutional Convention

Constitutional ConventionConstitutional Convention

Popularly elected HousePopularly elected House Elitist Senate elected by State Elitist Senate elected by State

legislatureslegislatures Strong executive with veto powerStrong executive with veto power

David BroderDavid Broder

Majority of Senators come from Majority of Senators come from states that elect 20% of the Housestates that elect 20% of the House 1995 1995

the two Senators from Oregon, which is the the two Senators from Oregon, which is the population of greater Atlantapopulation of greater Atlanta

chaired Appropriations and Financechaired Appropriations and Finance Senate Majority Leader from KansasSenate Majority Leader from Kansas Minority Leader from South DakotaMinority Leader from South Dakota

U.S. SenateU.S. Senate

6 year terms6 year terms Statewide electionsStatewide elections 2 from each state2 from each state

Composition of the US SenateComposition of the US Senate 110th Congress (2007-110th Congress (2007-

2009)2009)

Majority Party: Democrat (49 seats)Majority Party: Democrat (49 seats) Minority Party:  Republican (49 seats)Minority Party:  Republican (49 seats) Other Parties: 1Independent; 1 Independent Other Parties: 1Independent; 1 Independent

Democrat Democrat Total Seats: 100Total Seats: 100 Note: Senator Joseph Lieberman of Vermont Note: Senator Joseph Lieberman of Vermont

was reelected in 2006 as an Independent was reelected in 2006 as an Independent Democrat. Senator Bernard Sanders of Democrat. Senator Bernard Sanders of Vermont was elected as an Independent. Vermont was elected as an Independent.

Senate OathSenate Oath

OATH REQUIRED BY THE CONSTITUTION AND OATH REQUIRED BY THE CONSTITUTION AND BY LAW TO BE TAKEN BY SENATORSBY LAW TO BE TAKEN BY SENATORS"I, A__ B__, do solemnly swear (or affirm) that I "I, A__ B__, do solemnly swear (or affirm) that I will support and defend the Constitution of the will support and defend the Constitution of the United States against all enemies, foreign and United States against all enemies, foreign and domestic; that I will bear true faith and domestic; that I will bear true faith and allegiance to the same; that I take this allegiance to the same; that I take this obligation freely, without any mental obligation freely, without any mental reservation or purpose of evasion; and that I reservation or purpose of evasion; and that I will well and faithfully discharge the duties of will well and faithfully discharge the duties of the office on which I am about to enter: So help the office on which I am about to enter: So help me God." (5 U.S.C. 3331.) me God." (5 U.S.C. 3331.)

Standing Rules Standing Rules Standing Rules of The Senate Standing Rules of The Senate RULE XXIIIRULE XXIII

PRIVILEGE OF THE FLOORPRIVILEGE OF THE FLOOR Other than the Vice President and Senators, no person shall be admitted to the floor of the Senate while in session, Other than the Vice President and Senators, no person shall be admitted to the floor of the Senate while in session, except as follows: except as follows: The President of the United States and his private secretary. The President of the United States and his private secretary. The President elect and Vice President elect of the United States. The President elect and Vice President elect of the United States. ExPresidents and exVice Presidents of the United States. ExPresidents and exVice Presidents of the United States. Judges of the Supreme Court. Judges of the Supreme Court. ExSenators and Senators elect. ExSenators and Senators elect. The officers and employees of the Senate in the discharge of their official duties. The officers and employees of the Senate in the discharge of their official duties. ExSecretaries and exSergeants at Arms of the Senate. ExSecretaries and exSergeants at Arms of the Senate. Members of the House of Representatives and Members elect. Members of the House of Representatives and Members elect. ExSpeakers of the House of Representatives. ExSpeakers of the House of Representatives. The Sergeant at Arms of the House and his chief deputy and the Clerk of the House and his deputy. The Sergeant at Arms of the House and his chief deputy and the Clerk of the House and his deputy. Heads of the Executive Departments. Heads of the Executive Departments. Ambassadors and Ministers of the United States. Ambassadors and Ministers of the United States. Governors of States and Territories. Governors of States and Territories. Members of the Joint Chiefs of Staff. Members of the Joint Chiefs of Staff. The General Commanding the Army. The General Commanding the Army. The Senior Admiral of the Navy on the active list. The Senior Admiral of the Navy on the active list. Members of National Legislatures of foreign countries and Members of the European Parliament. Members of National Legislatures of foreign countries and Members of the European Parliament. Judges of the Court of Claims. Judges of the Court of Claims. The Mayor of the District of Columbia. The Mayor of the District of Columbia. The Librarian of Congress and the Assistant Librarian in charge of the Law Library. The Librarian of Congress and the Assistant Librarian in charge of the Law Library. The Architect of the Capitol. The Architect of the Capitol. The Chaplain of the House of Representatives. The Chaplain of the House of Representatives. The Secretary of the Smithsonian Institution. The Secretary of the Smithsonian Institution. The Parliamentarian Emeritus of the Senate. The Parliamentarian Emeritus of the Senate. Members of the staffs of committees of the Senate and joint committees of the Congress when in the discharge of Members of the staffs of committees of the Senate and joint committees of the Congress when in the discharge of their official duties and employees in the office of a Senator when inthe discharge of their official duties (but in each their official duties and employees in the office of a Senator when inthe discharge of their official duties (but in each case subject to such rules or regulations as may be prescribed by the Committee on Rules and Administration). case subject to such rules or regulations as may be prescribed by the Committee on Rules and Administration). Senate committee staff members and employees in the office of a Senator must be on the payroll of the Senate and Senate committee staff members and employees in the office of a Senator must be on the payroll of the Senate and members of joint committee staffs must be on the payroll of the Senate or the House of Representatives.members of joint committee staffs must be on the payroll of the Senate or the House of Representatives.f the Senatef the Senate

U.S. HouseU.S. House

2 year terms2 year terms District electionsDistrict elections 435 members435 members Reallocated every 10 yearsReallocated every 10 years

Composition U.S. House of Composition U.S. House of RepresentativesRepresentatives110110thth Congress Congress

MembershipMembership 435 Members 435 Members 4 Delegates 4 Delegates 1 Resident 1 Resident

Commissioner Commissioner Party Divisions Party Divisions 233 Democrats 233 Democrats 202 Republicans 202 Republicans 0 Independent 0 Independent 0 Vacancies 0 Vacancies

SenateSenate

Fewer procedure rulesFewer procedure rules Amendments do not have to be Amendments do not have to be

germane to the topic of the billgermane to the topic of the bill 1 Senator can filibuster1 Senator can filibuster

filibuster used 22 times per year since filibuster used 22 times per year since 1990 vs. 12 times per year 1968 - 19891990 vs. 12 times per year 1968 - 1989

LeadershipLeadership

LeadershipLeadership Both houses organized by partiesBoth houses organized by parties Majority party selects leaderMajority party selects leader

SchedulesSchedules Committee membershipsCommittee memberships Bill referralBill referral Conference committeesConference committees

Party strength inversely correlated with Party strength inversely correlated with chairman powerchairman power

Legislative CalendarLegislative Calendar A A legislative daylegislative day

begins when a house of Congress meets and begins when a house of Congress meets and ends when it adjourns. ends when it adjourns.

The House almost always adjourns at the The House almost always adjourns at the end of a daily session, so its calendar day end of a daily session, so its calendar day and legislative day coincide. and legislative day coincide.

The Senate often does not adjourn at the The Senate often does not adjourn at the end of a daily session, but instead end of a daily session, but instead "recesses," so when the Senate next meets, "recesses," so when the Senate next meets, it continues in the same legislative day. As a it continues in the same legislative day. As a result, a legislative day in the Senate may result, a legislative day in the Senate may extend over days, weeks, or even months. extend over days, weeks, or even months.

Legislative CalendarLegislative Calendar

““Day certain” or “a day not yet Day certain” or “a day not yet determined” (as in a unanimous determined” (as in a unanimous consent request)consent request)

Refers to calendar dateRefers to calendar date

Legislative DayLegislative Day

Period of time following an Period of time following an adjournment of Senate until another adjournment of Senate until another adjournmentadjournment No senator may speak twice upon one No senator may speak twice upon one

issue on the same legislative dayissue on the same legislative day

Legislative CalendarLegislative Calendar

Senators refer to bill or nominations Senators refer to bill or nominations “on the calendar”…these are on the “on the calendar”…these are on the legislative calendarlegislative calendar

Morning HoursMorning Hours

Through unanimous consent, Through unanimous consent, majority leader provides a brief majority leader provides a brief period (about 10 minutes each) two period (about 10 minutes each) two leaders leaders Provide direct observations current Provide direct observations current

events or pending legislationevents or pending legislation Also receive reports, communications, Also receive reports, communications,

messages from the Housemessages from the House

Senate ProcedureSenate Procedure

Senate rules promote comprehensive Senate rules promote comprehensive debatesdebates A simple majority may end debateA simple majority may end debate Filibuster can be ended by invoking Filibuster can be ended by invoking

cloturecloture Usually by a 3/5 vote Usually by a 3/5 vote Even with cloture, debate can continue for Even with cloture, debate can continue for

30 hours30 hours

FilibusterFilibuster

Encourages consensus in SenateEncourages consensus in Senate Unanimous consent agreements limit Unanimous consent agreements limit

time available for debatetime available for debate

Not Germane AmendmentsNot Germane Amendments

Except when debating appropriations, Except when debating appropriations, budget, and certain other measuresbudget, and certain other measures Senators may propose amendments not Senators may propose amendments not

related to the topic, that have not been related to the topic, that have not been reviewed by committees.reviewed by committees.

Senators can also place business directly Senators can also place business directly on the Calendar of Business without on the Calendar of Business without committee referralcommittee referral

makes Senate schedule less predictable.makes Senate schedule less predictable.

Senate Majority LeaderSenate Majority Leader

Proposes proposes bills or resolutions Proposes proposes bills or resolutions for the Senate to consider. for the Senate to consider.

CommitteesCommittees

Woodrow Wilson (1885)Woodrow Wilson (1885) ““Congress in its committee rooms is Congress in its committee rooms is

Congress at work”Congress at work” Roughly 20 standing committees in each Roughly 20 standing committees in each

househouse Conference committees are temporary Conference committees are temporary

to reconcile differences between the to reconcile differences between the houseshouses

Standing CommitteesStanding Committees

35 standing committees35 standing committees 19 in House, 16 in Senate19 in House, 16 in Senate 8,000 bills introduced in a 2-year 8,000 bills introduced in a 2-year

session@80 Passsession@80 Pass Committee that drafts legislation also Committee that drafts legislation also

handles on floorhandles on floor every health bill moved by the Senate every health bill moved by the Senate

Labor Committee passed in 99th CongressLabor Committee passed in 99th Congress

CommitteesCommittees

Extends beyond CongressExtends beyond Congress affects bureaucracy, agencies and affects bureaucracy, agencies and

commissionscommissions Cabinet offices spend 1/3 of their time Cabinet offices spend 1/3 of their time

on Capitol Hillon Capitol Hill

Appropriating vs. Appropriating vs. Authorizing CommitteesAuthorizing Committees

AppropriatingAppropriating House Ways and MeansHouse Ways and Means Senate FinanceSenate Finance AppropriationsAppropriations BudgetBudget

Forms of Legislative Forms of Legislative BusinessBusiness

BillBill Public --- most commonPublic --- most common Private – designed to affect or benefit Private – designed to affect or benefit

specific individuals or groupspecific individuals or group

BillsBills

Senate numbers bills in sequenceSenate numbers bills in sequence Starting with 1Starting with 1 Designation SDesignation S

Joint resolutions --same effect as a Joint resolutions --same effect as a bill unless amendment to the bill unless amendment to the ConstitutionConstitution

““S Con. Res.___”S Con. Res.___” For Senate concurrent resolution --- express sense For Senate concurrent resolution --- express sense

of Congress to President or others. of Congress to President or others.

House BillsHouse Bills

H.R. ___H.R. ___ H.R. Res.____ for House joint H.R. Res.____ for House joint

resolutionsresolutions H.R. Con. Res. ___ for House H.R. Con. Res. ___ for House

Concurrent resolutionsConcurrent resolutions

Bills and Joint ResolutionsBills and Joint Resolutions

Identical bills and joint resolutions, Identical bills and joint resolutions, passed by both Houses and approved passed by both Houses and approved by President become lawby President become law

Public laws affect the NationPublic laws affect the Nation Private laws affect only a class or Private laws affect only a class or

group of individualsgroup of individuals

Constitutional AmendmentConstitutional Amendment

Requires 2/3 vote with a quorum Requires 2/3 vote with a quorum presentpresent

Not sent to PresidentNot sent to President Instead sent to GSA who transmits to Instead sent to GSA who transmits to

the various statesthe various states Must be ratified by ¾ of statesMust be ratified by ¾ of states

Concurrent ResolutionsConcurrent Resolutions

Must be approved in identical form by Must be approved in identical form by both Housesboth Houses

Do not become law; not sent to Do not become law; not sent to PresidentPresident

Attested by Secretary of Senate and Attested by Secretary of Senate and Clerk of HouseClerk of House

Transmitted to Administrator of GSA Transmitted to Administrator of GSA for publication in Statutes at Largefor publication in Statutes at Large

House vs. SenateHouse vs. Senate

Senate order of business simpler Senate order of business simpler than Housethan House

Procedure for both bodies founded Procedure for both bodies founded on Jefferson’s Manual of on Jefferson’s Manual of Parliamentary PracticeParliamentary Practice

Primary differences in method of Primary differences in method of calling up businesscalling up business

House vs. SenateHouse vs. Senate

Senate business is not divided into classes nor Senate business is not divided into classes nor are calendar days set aside for specific are calendar days set aside for specific businessbusiness

Senate is a continuing body (2/3 of Senate Senate is a continuing body (2/3 of Senate returns after each election)returns after each election)

House readopts old rules inception of each House readopts old rules inception of each CongressCongress

Senate has not reaffirmed rules since 1789 – Senate has not reaffirmed rules since 1789 – rules adopted since first Congress remain in rules adopted since first Congress remain in forceforce

Bill IntroductionBill Introduction

Any member may introduce a billAny member may introduce a bill Blank forms are kept at Clerk (House) Blank forms are kept at Clerk (House) Introducing member is the sponsorIntroducing member is the sponsor Must sign the billMust sign the bill

BillsBills

Co-sponsors do not have to sign the Co-sponsors do not have to sign the billbill

Co-sponsors may not be added after Co-sponsors may not be added after the bill has been reported from the the bill has been reported from the last committeelast committee

““In no event shall the Speaker In no event shall the Speaker entertain a request to drop the entertain a request to drop the sponsor”sponsor”

Bills in the SenateBills in the Senate

Senator may have Presiding Officer place the Senator may have Presiding Officer place the bill in the record or be recognized to give bill in the record or be recognized to give commentscomments

Senators frequently obtain consent to have Senators frequently obtain consent to have the bill printed in the “Congressional Record”the bill printed in the “Congressional Record”

If a Senator objects to the introduction of a If a Senator objects to the introduction of a bill, it is delayed one day.bill, it is delayed one day.

If there is no objection, the bill is read and If there is no objection, the bill is read and placed in the “Congressional Record”placed in the “Congressional Record”

Bills in the House of Bills in the House of RepresentativesRepresentatives

In the House, bills are not read.In the House, bills are not read. Printed in the Journal and Printed in the Journal and

Congressional Record.Congressional Record. Bills referred according to the “Rules Bills referred according to the “Rules

of the House”.of the House”. Bill Number and committee referral Bill Number and committee referral

appear in the “Congressional Record”appear in the “Congressional Record”

Senate Senate

Maintain decorumMaintain decorum No senator may refer “offensively to No senator may refer “offensively to

any State of the Union”any State of the Union”

Standing CommitteesStanding Committees

19 Standing Committees in the House19 Standing Committees in the House 16 Standing Committees in the Senate16 Standing Committees in the Senate

Several Select CommitteesSeveral Select Committees Four Standing Joint Committee which Four Standing Joint Committee which oversight, but no legislative jurisdictionoversight, but no legislative jurisdiction

House may create select committees or House may create select committees or task forces through formal resolution or task forces through formal resolution or informal agreement among membersinformal agreement among members

Committee ReferralCommittee Referral

““Rules of House” and Rules of Senate Rules of House” and Rules of Senate have 200 classification for billshave 200 classification for bills

Prior to 1975, Speaker could refer to Prior to 1975, Speaker could refer to only one billonly one bill

Now Speaker may make multiple Now Speaker may make multiple referrals; must designate a primary referrals; must designate a primary

committeecommittee

Health Committees SenateHealth Committees Senate

Senate Finance CommitteeSenate Finance Committee Subcommittee on Medicaid and Health-Subcommittee on Medicaid and Health-

Care for Low Income FamiliesCare for Low Income Families Subcommittee on Medicare, Long-Term Subcommittee on Medicare, Long-Term

Care and Health InsuranceCare and Health Insurance Senate Health, Education, Labor and Senate Health, Education, Labor and

PensionsPensions Senate Appropriations CommitteeSenate Appropriations Committee Senate Budget CommitteeSenate Budget Committee

Key Health Committees in Key Health Committees in the Housethe House

House Ways and MeansHouse Ways and Means Subcommittee on Health Subcommittee on Health

House Appropriations CommitteeHouse Appropriations Committee Subcommittee on Labor, HHS, and Subcommittee on Labor, HHS, and

EducationEducation House Commerce CommitteeHouse Commerce Committee

Subcommittee on Health and EnvironmentSubcommittee on Health and Environment House Budget CommitteeHouse Budget Committee

Committees Movement of Committees Movement of Bills to the FloorBills to the Floor

House Committees pass bills to House Committees pass bills to House Rules Committee House Rules Committee determines rules of debate including determines rules of debate including whether amendments allowedwhether amendments allowed

Senate Committees pass bills to floorSenate Committees pass bills to floor

SubcommitteesSubcommittees

1979 Henry Waxman challenged for 1979 Henry Waxman challenged for chair of House Commerce Health and chair of House Commerce Health and Environment SubcommitteeEnvironment Subcommittee shared campaign money with supportersshared campaign money with supporters

House Subcommittees heavily involved House Subcommittees heavily involved legislation development, hearings, mark-legislation development, hearings, mark-upsups

Still variability between committees on Still variability between committees on importanceimportance House full committees mark-ups - hearings House full committees mark-ups - hearings

rarerare

SenateSenate

HELP CommitteeHELP Committee jurisdiction over 26 major health jurisdiction over 26 major health

programsprograms subcommittee under Ted Kennedy in subcommittee under Ted Kennedy in

1970s1970s eliminated by Orin Hatch in 1987eliminated by Orin Hatch in 1987 1987 Democrats regain Senate1987 Democrats regain Senate

still no subcommitteestill no subcommittee

HouseHouse

Healthcare policy - Commerce Health Healthcare policy - Commerce Health and Environment Subcommitteeand Environment Subcommittee Under Dems - subcommittee establish Under Dems - subcommittee establish

its own agenda - picked legislative its own agenda - picked legislative battles - won most battles - won most

lost Clinton billlost Clinton bill Neither subcommittee and full able to agree Neither subcommittee and full able to agree

Bill MovementBill Movement

House House 85% measures on House floor first 85% measures on House floor first

referred to subcommitteereferred to subcommittee Senate Senate

42% measures referred first to 42% measures referred first to subcommitteessubcommittees

80% measures brought to House floor 80% measures brought to House floor referred by subcommitteesreferred by subcommittees

46% in Senate46% in Senate

TurfTurf

Committee chairs guardCommittee chairs guard 1993 House Judiciary chairs would not allow 1993 House Judiciary chairs would not allow

medical malpractice to go to Ways and medical malpractice to go to Ways and MeansMeans

1971 Paul Rogers changed subcommittee 1971 Paul Rogers changed subcommittee name to Public Health and Environment name to Public Health and Environment SubcommitteeSubcommittee argued subcommittee should have argued subcommittee should have

jurisdiction over Medicaid, then under jurisdiction over Medicaid, then under Ways and MeansWays and Means

4 years later, subcommittee gained 4 years later, subcommittee gained MedicaidMedicaid

Subcommittee Jurisdiction Subcommittee Jurisdiction Changed with TimesChanged with Times

1970s - energy committees 1970s - energy committees increasedincreased

1993 - 15 committees claimed health 1993 - 15 committees claimed health jurisdictionjurisdiction previously only 8 subcommittees previously only 8 subcommittees

claimed jurisdictionclaimed jurisdiction

Referral AssignmentReferral Assignment

Clinton billClinton bill Senate Finance Chair Senate Finance Chair Moynihan claimed jurisdiction over entire Moynihan claimed jurisdiction over entire

bill – (though he was known for welfare bill – (though he was known for welfare reform) reform)

Senator Kennedy - chair of Labor and Human Senator Kennedy - chair of Labor and Human ResourcesResources

the traditional authorizing committee claimed the traditional authorizing committee claimed jurisdiction over non-tax issues, including jurisdiction over non-tax issues, including employer mandate, premiums, insurance-buying employer mandate, premiums, insurance-buying cooperatives on insurance reformcooperatives on insurance reform

Conference CommitteesConference Committees

Penultimate powerPenultimate power Decisions finalDecisions final Voted up or downVoted up or down May differ on representationMay differ on representation

1989 conference savings and loan1989 conference savings and loan 8 Senate, 94 House8 Senate, 94 House

Conference CommitteesConference Committees

PowerfulPowerful 1974 inserted state preemption clause 1974 inserted state preemption clause

in ERISAin ERISA state insurance plans prohibitedstate insurance plans prohibited

added 10 days before final passage without added 10 days before final passage without knowledge most insurers, Department of knowledge most insurers, Department of Labor or state government associationsLabor or state government associations

has not been altered despite almost 30 has not been altered despite almost 30 years of effortsyears of efforts

EntitlementsEntitlements

Combination of authorization and Combination of authorization and appropriationappropriation

Funded automatically - do not Funded automatically - do not require appropriationsrequire appropriations

Spending for entitlements difficult to Spending for entitlements difficult to controlcontrol

EntitlementsEntitlements

Social Security, Medicare, Medicaid, Social Security, Medicare, Medicaid, Food Stamps, AFDCFood Stamps, AFDC

Avoids routine Congressional scrutinyAvoids routine Congressional scrutiny Often indexed for COLAOften indexed for COLA

EntitlementsEntitlements

FY 64FY 64 24% Federal spending24% Federal spending grown 12% per year since 1964grown 12% per year since 1964 Social Security alone now 20% of Social Security alone now 20% of

Federal spendingFederal spending Between 1980 and 1990 Medicare grew Between 1980 and 1990 Medicare grew

200%200%

EntitlementsEntitlements

Social Security grows slower than Social Security grows slower than health entitlements - Medicare, health entitlements - Medicare, MedicaidMedicaid popular programs - difficult to cutpopular programs - difficult to cut the political third railthe political third rail

BudgetingBudgeting AuthorizationsAuthorizations

establish or continue a program or establish or continue a program or agencyagency

AppropriationsAppropriations provides fundingprovides funding

Process designed to separate policy Process designed to separate policy from fiscal decisionsfrom fiscal decisions

Process typically sequentialProcess typically sequential

Budget ProcessBudget Process

First 150 years budget surplusFirst 150 years budget surplus federal spending was quite lowfederal spending was quite low 1930s Federal spending grew1930s Federal spending grew

1939 Bureau of Budget made part of 1939 Bureau of Budget made part of Executive BranchExecutive Branch 1970 became Office of Management and 1970 became Office of Management and

Budget (OMB)Budget (OMB)

Budget ProcessBudget Process Early 1970s presidential budget Early 1970s presidential budget

control peakedcontrol peaked Richard Nixon refused to spend funds Richard Nixon refused to spend funds

appropriated by Congress for programs appropriated by Congress for programs he did not supporthe did not support

Congress passed Congressional Congress passed Congressional Budget Impoundment Control Act of Budget Impoundment Control Act of 19741974 established Senate and House Budget established Senate and House Budget

Committees and CBOCommittees and CBO mandated concurrent budget resolutionmandated concurrent budget resolution

BudgetingBudgeting Balanced Budget and Emergency Balanced Budget and Emergency

Deficit Control Act of 1985Deficit Control Act of 1985 known as Gramm-Rudman-Hollings Actknown as Gramm-Rudman-Hollings Act forced Congress to reduce deficitforced Congress to reduce deficit $36 billion/year reduction$36 billion/year reduction sequestration- across board cuts if sequestration- across board cuts if

Congress fails to make cutsCongress fails to make cuts many entitlements - Social Security, many entitlements - Social Security,

medicaid, AFDC exemptedmedicaid, AFDC exempted

Administrative BudgetingAdministrative Budgeting

CBO Produces Annual Report to CBO Produces Annual Report to House and Senate Committees on House and Senate Committees on budgetbudget

Provides a broad range of optionsProvides a broad range of options Released in FebruaryReleased in February

The Congressional Budget The Congressional Budget CalendarCalendar

DateDate ActionAction

Between first Monday in JanuaryBetween first Monday in January President transmits the budget, including a sequester preview reportPresident transmits the budget, including a sequester preview report

and first Monday in Februaryand first Monday in February

Six weeks laterSix weeks later Congressional committees report budget estimates to Congressional committees report budget estimates to budget committees budget committees

April 15April 15 Action to be completed on congressional budget resolutionAction to be completed on congressional budget resolution

May 15May 15 House consideration of annual appropriations bills may beginHouse consideration of annual appropriations bills may begin

June 15June 15 Action to be completed on reconciliationAction to be completed on reconciliation

June 30June 30 Action on appropriations to be completed by HouseAction on appropriations to be completed by House

July 15July 15 President transmits midsession review of budgetPresident transmits midsession review of budget

August 20August 20 OMB updates the sequester previewOMB updates the sequester preview

October 1October 1 Fiscal year beginsFiscal year begins

15 days after the end of a session15 days after the end of a session OMB issues final sequester report, and the president issues a OMB issues final sequester report, and the president issues a sequester of Congresssequester of Congress order, if necessaryorder, if necessary

Budget ProcessBudget Process

President must submit budget by President must submit budget by first Monday in Februaryfirst Monday in February

Budget establishes priorities for Budget establishes priorities for program funding and funding levelprogram funding and funding level In election years, the budget is a broad In election years, the budget is a broad

overviewoverview

Budget ProcessBudget Process

Congress develops a budget Congress develops a budget resolution resolution Defines parameters all budget related Defines parameters all budget related

activitiesactivities Defines size of budget, levels of funding, Defines size of budget, levels of funding,

and revenuesand revenues Must consider revenues for the Must consider revenues for the

forthcoming year and next 10 fiscal yearsforthcoming year and next 10 fiscal years

Budget ProcessBudget Process

Budget Resolution is not lawBudget Resolution is not law Concurrent resolution of both HousesConcurrent resolution of both Houses

Budget ProcessBudget Process

Levels established in the budget Levels established in the budget resolution are supported by procedural resolution are supported by procedural mechanisms followed in both Housesmechanisms followed in both Houses

Budget ProcessBudget Process

Budget resolution is an outline for Budget resolution is an outline for the budgetthe budget Legislation must be passed to Legislation must be passed to

implementimplement Appropriation ActAppropriation Act Changes in tax lawChanges in tax law Entitlement programsEntitlement programs

Budget ProcessBudget Process

Discretionary spending allocated to Discretionary spending allocated to Appropriation CommitteesAppropriation Committees

House and Senate Appropriation House and Senate Appropriation committees sub-allocate spending to 13 committees sub-allocate spending to 13 subcommitteesubcommittee

Develop 13 appropriation billsDevelop 13 appropriation bills Each bill must move through the Each bill must move through the

legislative process and be signed by the legislative process and be signed by the presidentpresident

Budget ProcessBudget Process

In years the Budget Resolution calls In years the Budget Resolution calls for changes in taxes or entitlementsfor changes in taxes or entitlements Budget Committee direct relevant Budget Committee direct relevant

committees to enact legislation to committees to enact legislation to reconcile changesreconcile changes

ReconciliationReconciliation

Budget process has weakened the Budget process has weakened the authorizing committeesauthorizing committees

Increase leadership ruleIncrease leadership rule Authorizing Committees rarely Authorizing Committees rarely

launch new programs - protect older launch new programs - protect older programs from cutsprograms from cuts

Appropriation CommitteesAppropriation Committees

Increased powerIncreased power Spending caps require tough Spending caps require tough

decisionsdecisions Important to special interestsImportant to special interests

Reconciliation BillReconciliation Bill

Important to health policyImportant to health policy Implements the concurrent budget Implements the concurrent budget

resolutionresolution Little attention to specifics - no hearingsLittle attention to specifics - no hearings In 1980s every major health legislation In 1980s every major health legislation

in reconciliation billin reconciliation bill Health block grantsHealth block grants Physician payment reformPhysician payment reform

ReconciliationReconciliation

Henry Waxman used to expand Henry Waxman used to expand MedicaidMedicaid

Many argued reconciliation made Many argued reconciliation made legislation more secret, increased legislation more secret, increased budget and staffing needsbudget and staffing needs delayed impact of changesdelayed impact of changes increased power of smart chairs and increased power of smart chairs and

membersmembers