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CHART 1 Health Care Reform: A Retrospective Health Care Reform: A Retrospective Alan Schlobohm Senior Program Administrator Kaiser Family Foundation CHART 2 The Process of Health Reform Legislation Health reform on the agenda Health reform: some key players in the Administration

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Health Care Reform: A Retrospective

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CHART 1

Health Care Reform: A Retrospective

Health Care Reform: A Retrospective

Alan Schlobohm

Senior Program Administrator

Kaiser Family Foundation


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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

Resolving differences between House and Senate legislation

Signed into Law by the President

Return to Tutorials


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CHART 3

Health Reform and the national agenda

President Obama at the White House Forum on Health Care Reform, March 5, 2009

Health reform was at or near the top of the national agenda from the early days of the Obama presidency

Return to Tutorials


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CHART 4

Health Reform: Some key players in the Administration

Nancy-Ann Min DeParle, Director

White House Office for Health Reform

Melody Barnes, Director

Domestic Policy Council

Kathleen Sebelius, HHS Secretary

Peter Orszag, Director

White House Office of Management and Budget (to July 2010)

Rahm Emanuel,

White House Chief of Staff

Lawrence Summers, Director

National Economic Council

Return to Tutorials


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CHART 5

The Congressional Budget and Health Reform

  • The Congressional Budget

    • Adopted by Congress in April 2009

    • Provided a ‘reserve fund’ for health reform legislation

    • Required health reform legislation to be budget neutral

    • Allowed health reform legislation to be protected from Senate filibuster through the use of ‘budget reconciliation’ procedure

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Energy & Commerce

Rep. Henry Waxman (D-CA)

chairman

Ways & Means

Rep. Charles Rangel (D-NY)

chairman

Education & Labor

Rep. George Miller (D-CA)

chairman

CHART 6

House Committees with Jurisdiction over Health Reform

House Committees

Jurisdiction:

Medicaid, CHIP, Medicare, federal health programs

Jurisdiction:

Tax subsidies for health care, Medicare

Jurisdiction:

Pension/Employee Health benefits, ERISA

Return to Tutorials


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CHART 7

Senate Committees with Jurisdiction over Health Reform

Senate Committees

Finance

Jurisdiction:

Tax Policy, Medicaid, CHIP

Sen. Max Baucus (D-MT)

chairman

Health, Education, Labor & Pensions

Jurisdiction:

Pensions, health/employee benefits, ERISA

Sen. Chris Dodd (D-CT) *

* In the absence of Sen. Edward Kennedy (who passed away August 9, 2009), Sen. Dodd led the HELP Committee deliberations

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CHART 8

Hearings

  • Public hearings

    • Forum for raising important issues

    • Comments from policy experts and stakeholders

    • Allowed committee members to voice their opinions

  • Range of public and private interest groups

    • Patients rights advocates

    • Medical community

    • Insurance companies

    • Pharmaceutical companies

    • Employers

    • Labor unions

  • “Walk-throughs” -- explain and debate specific proposals

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CHART 9

Drafting Legislation

  • Each committee worked on specific legislative language

  • House - committees presented a combined “tri-committee” bill

  • Senate - two committees worked on separate areas of the bill

    • HELP Committee - public health and insurance market reform sections

    • Finance Committee - revenue provisions, Medicare, Medicaid

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CHART 10

Congressional Budget Office Analysis

  • Review by Congressional Budget Office (CBO), a nonpartisan agency that works for Congress

    • Estimates the costs and effect on federal budget

    • Considers legislation as a whole and each component separately

    • Committee’s staff consults CBO regarding budgetary effect of specific provisions

  • President Obama set maximum total cost for reform bill of $1 trillion

    • Bill was to be fully paid for (i.e. not increase the deficit)

    • Committee leaders and staff worked to keep everything at or under this target

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CHART 11

Mark-Ups

  • Mark-Ups – public meetings to vote on bill

    • Bill debated by committee members and amendments are offered and voted upon

  • Each of the five committees approved health reform legislation

    • Votes in each committee along party lines, except the Senate Finance Committee

  • After committee approval, bill forwarded for consideration by full House or Senate

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CHART 12

House Floor Procedures

  • Three House committee bills combined into single piece of legislation (HR 3962)

  • ‘Whip Count’

    • Final vote tally for bill

  • House Rules Committee

    • Defines rules for terms of debate on House floor

  • Debate bill

    • Bill passed on November 7, 2009: 220-215

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CHART 13

Senate Floor Procedures – Regular Order

  • Debate

    • Senators who have the floor may speak as long as they want

  • Amendments

    • May offer as many amendments as they desire

  • Filibuster

    • Tactic used to delay legislation

  • Cloture

    • Motion for ending filibuster

    • Requires three-fifths vote

  • Passage

    • After cloture, passage requires simple majority

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CHART 14

Senate Floor Procedures – Budget Reconciliation Option

  • Two types of bills not subject to filibuster in the Senate

    • Budget Resolutions

    • Budget Reconciliation

  • Budget Resolution

    • Provides broad outline of spending and revenue

  • Budget Reconciliation

    • Optional

    • Requires simple majority

    • Limited debate time

    • No limit on the amount of amendments that can be offered

    • Byrd Rule - Legislation and any amendments must be budget related

  • H.R. 3590 was passed on December 24, 2009 – by a vote of 60-39

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CHART 15

Resolving Differences Between House and Senate Legislation

  • Option 1 – House Senate Conference Committee

    • Negotiations

    • Conference Report

    • Full House, Senate approve revised legislation and send to President

  • Option 2

    • One chamber accepts the other chamber’s bill without making any changes, sending the legislation on to the President

  • Option 3

    • After the bill is enacted (option 2), Congress passes a second bill which makes changes to the new law

    • The second bill is then sent to the President

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CHART 16

Legislation Signed Into Law

  • Health Reform in 2010 – President Obama Signed two bills into law

  • H.R. 3590 – Public Law 111-148

    • Health reform bill passed by the Senate in December 2009, passed by the House March 2010, and signed into law on March 23, 2010

  • H.R. 4872 – Public Law 111-152

    • Passed under budget reconciliation procedures by House and Senate; made some changes to P.L. 111-148

    • President Obama signed budget reconciliation bill on March 30, 2010

Return to Tutorials


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December 24

November 7

Floor debate - 21 days

Nov. 30-Dec. 24

CHART 17

Overview - Committees and Floor Debate (2009)

HOUSE

SENATE

Energy & Commerce

Ways & Means

Education

& Labor

Finance

HELP

COMMITTEES

Passed

July 31

Passed

July 16

Passed

July 17

Passed October 13

Passed

July 16

Three bills combined into one

Two bills combined into one

October 29

November 18

FLOOR

CONSIDERATION

Motion to proceed to debate adopted

November 21

Limited floor debate – One day

Two Amendments Considered;

One Adopted

Defeated 3 times

-- on 2 amendments

and on the bill

Filibuster

Dec. 21-23

By Invoking Cloture

-- 60 votes required

HOUSE VOTE

NEGOTIATIONS BETWEEN

SENATE VOTE

Passed 220-215

Passed 60-39

HOUSE, SENATE & PRESIDENT

November 7


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March 23

HOUSE VOTE

Passed 220-211

March 21

CHART 18

Overview – Resolving Differences and Final Enactment (2010)

House-passed bill

Senate-passed bill

H.R. 3962

H.R. 3590

HOUSE VOTE

Signed into law

Signed into law

by the President

by the President

Passed 219-212

Public Law

111-152

Public Law

111-148

March 21

The House made changes to H.R. 3590 which were incorporated in…

Reconciliation bill

H.R. 4872

Kaiser’s Health Reform Resource:

http://healthreform.kff.org/

The Senate agreed to the House bill, but made small changes…

SENATE VOTE

Passed 56-43

March 25

March 30

The House passed the bill as amended by the Senate

HOUSE VOTE

Passed 220-207

March 25


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