US Government: A Case Presentation

1. US Government: A Case Presentation Dana M. Block, OMS-IV SOMA National Director of Political Affairs

2. Introduction • Purpose: to provide osteopathic medical students with a basic understanding of the structure and function of the US Government and the processes involved in a bill becoming a law • This presentation is Part I of III in the Student Osteopathic Medical Association (SOMA) Political Action Training Course (PATC), completion of which is recommended for all D.O. Day on the Hill participants • Completion of the SOMA PATC is one requirement for induction into Omega Beta Iota (ΩΒΙ), the national osteopathic political action honor society (exceptions will be made for 2007 ΩΒΙ inductees, as this is the first SOMA PATC to be given)

3. Presentation Overview • “Case” presentation of sample issue • Topic Review • Structure and functions of US government branches • How a bill becomes a law • Save the Date: D.O. Day on the Hill (4/26/07)

4. “Case” Presentation • Disclaimer: the “case” used in this presentation represents a current issue and is a creative adaptation of such; it therefore should not be taken too literally nor is this an official production of the American Osteopathic Association (AOA). • CC: “We need improved funding for osteopathic graduate medical education (OGME).” • HPI: The AOA is a 110-year-old membership organization that supports, unifies, and represents osteopathic physicians within the USA, and is currently in need of improved funding for OGME. Although this need has been apparent for several years, it only recently became so severe that it required immediate attention. The need for funding is a deep, constant, 10/10 and worsens as graduating osteopathic medical student numbers increase. It improves slightly if Medicare provides additional funding and if approval for new OGME programs is attained. ROS is (+) for collaboration with other osteopathic organizations, employment of a team of political advocacy experts, and the promotion of osteopathic postdoctoral training institutes (OPTIs). All other ROS are (-).

5. Pertinent History • PMHx: the Balanced Budget Act of 1997 established a full-time equivalent resident “cap” on funded residency positions. Additionally, OGME programs are limited by Medicare laws and the restricted utilization of ambulatory sites in teaching hospital-affiliated OGME programs • PSHx: OGME programs have been restructured in the past to assure compliance with current legislation • Soc Hx: • Medications: none • NKDA

6. Vital signs, as of June 2006: Total # of osteopathic medical students: 13,406 Estimated # of graduating osteopathic medical students (13,406/4): 3352 Total # of AOA-approved OGME internship programs: 229 Total # of AOA-approved OGME internship positions: 2777 Osteopathic physicians in self-identified specialties, as of June 2006: Family Medicine: 46.4% Internal Medicine: 8.3% Pediatrics: 4.2% OB/GYN: 3.9% OMT: 1.2% Non-primary care: 36.0% Visits to osteopathic physicians account for roughly 20% of annual patient visits to general/family practitioners, according to the National Ambulatory Medical Care Survey 2003-2004 Pertinent “Physical Exam” Findings(a.k.a. Pertinent Statistics)

7. Pertinent Laboratory Data/Imaging • D.O. internships are offered in only 36 of the 50 states: Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Missouri, North Carolina, North Dakota, New Hampshire, New Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin, and Wyoming

8. Assessment and Plan • Assessment: we are in need of additional funding to improve upon existing, and to create additional, OGME programs • Plan: author a bill to promote funding for the addition and improvement of OGME programs, and lobby to help the bill become a law!!!

9. Topic Review: US Government • The United States government is composed of three branches, as delineated in the Constitution: • Executive (President) • Legislative (Congress) • Judicial (Supreme Court) • These branches were created to provide “checks and balances” • Each branch of government has the right to amend or void those acts of another branch of government that fall within its purview

10. Topic Review: US Government • Executive Branch in detail: • Purpose: responsible for enforcing the laws of the US • Membership: • President (US leader, Commander-in-Chief of the US military, and appoints Department leaders) • Vice-President (President of the Senate) • Executive Office of the President • Departments: • Department heads advise the President on policy issues and help put policies into practice • Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Homeland Security, Housing and Urban Development, Interior, Justice, Labor, State, Transportation, Treasury, Veterans’ Affairs • Independent Establishments and Government Corporations • Provide special services and help execute policies • CIA, NASA, USPS, etc.

11. Topic Review: US Government • Judicial Branch in detail: • Purpose: to decide arguments about the meaning of laws, how they are applied, and whether or not they violate the US Constitution • Membership: • The Supreme Court is the highest court in the US and is the only court created by the Constitution • Several other federal courts have since been created by Congress as allowed by the Constitution • Additional courts included within the judicial branch of government are: the US Court of Appeals, US district courts, the US sentencing commission, etc

12. Topic Review: US Government • Legislative Branch in detail: • Purpose: create and establish US laws • Membership: • Congress = Senate + House of Representatives • Senate: equal representation provided for each state, regardless of state’s population (2 Senators per state, period) • House of Representatives: representation provided for each state based upon state’s population (each state may have several representatives, elected from given districts) • Agencies: provide support services for Congress • Architect of the Capitol, Congressional Budget Office, General Accounting Office, Government Printing Office, Library of Congress • This is the branch of government we will work most closely with when we participate in advocacy campaigns, including writinglegislation and lobbying!

13. Topic Review: How a Bill Becomes a Law • A bill always begins with an idea– ours is to promote funding for the addition and improvement of osteopathic graduate medical education (OGME) programs • Let’s pretend we already authored our bill and we now are wanting to make it into a law…

14. Topic Review: How a Bill Becomes a Law • Anyone may write a bill, but a bill may only be introduced to Congress by a Member of Congress when the House is in session • There are 4 types of legislation: • Bills • Joint Resolutions • Concurrent Resolutions • Simple Resolutions • There are also different types of bills: • Private: affects a specific person or organization • Public: affects the population at large

15. Topic Review: How a Bill Becomes a Law • The process of introducing a bill depends on if it is being introduced in the House or in the Senate: • In the House of Representatives, a bill is introduced by placing it in the “hopper,” a receptacle near the Speaker’s podium; it is then assigned a number by a bill clerk • House bills are abbreviated “H.R.” • The first reading of a bill in the House means its title is read on the House Floor; it is then referred to committee for markup • In the Senate, a bill is introduced by placing it on the presiding officer’s desk or by formally introducing it on the Senate Floor • Senate bills are abbreviated “S.” • Once introduced in the Senate, a bill is also referred to committee for markup • Once a bill is formally introduced in either the House or the Senate, the Library of Congress receives an electronic copy • The Library of Congress then posts the bill and its status on a public website named THOMAS, http://thomas.loc.gov/; updates on bills at each step of the process are also included on the THOMAS website

16. Topic Review: How a Bill Becomes a Law • There are 19 House Standing Committees and 16 Senate Committees, each with jurisdiction over a specific area of public policy • Committee Actions: • Bill is placed on Committee Calendar • Bill is debated and altered (if deemed necessary) utilizing parliamentary procedures • Bill may be “tabled” if it is determined to be unwise or unnecessary • Bill may be referred to subcommittee for further evaluation • Subcommittee evaluation of a bill mirrors that of Committee evaluation, but subcommittees may include hearings to obtain views of experts, supporters, and opponents • Once a subcommittee approves a bill, it is sent back to the full committee for a vote • Bill is voted upon after it is debated and/or amended • Approved bill is reported back to the House or Senate Floor

17. Topic Review: How a Bill Becomes a Law • The bill is termed “reported” once it has passed through Committee; the bill is accompanied by a report outlining all of its provisions, hence the term “reported”

18. Topic Review: How a Bill Becomes a Law • A reported bill is then placed on a House calendar for “consideration” on the House floor • Debate ensues according to established parliamentary procedure (which may be special rules for the specific bill) • After the debate, the second reading of the bill occurs, allowing the opportunity for scrutiny and further amendment • Following further amendment (if performed), the bill is read a third time in preparation for a vote by the House

19. Topic Review: How a Bill Becomes a Law • House voting: • The bill is read by title only and put to a vote • Members of the House who are present vote to pass or not to pass the bill • The House has an electronic voting system • Members may vote to pass the bill (“yea”), not to pass the bill (“nay”), or abstain (“present”) • The bill passes with a majority vote of the House • A bill is termed “engrossed” once it (and its amendments) has passed the House and has been certified by the Clerk • A bill that passes the House is then referred to the Senate to undergo a similar process again

20. Topic Review: How a Bill Becomes a Law • Senate voting: • The Senate may decide to vote on a House bill or to continue its own legislation • The bill may be sent to committee • The bill may be voted upon by Senators • If the bill undergoes revision within and passes the Senate with language other than what was introduced, the bill must be sent to a conference committee for review • The conference committee is comprised of members from both the House and the Senate • Differences must be reconciled before the bill may be sent to the President for signature • A bill must pass both the House and the Senate in order to become a law

21. Topic Review: How a Bill Becomes a Law • A bill is termed “enrolled” when it is submitted to the President for signature • The President may: • Take no action (if Congress is in session, the bill automatically becomes law in 10 days) • Pocket veto (if Congress is not in session and the bill is not signed in 10 days, it does NOT become a law) • Veto the bill • Sign the bill to make it a law • A bill becomes a law once it has passed both the House and the Senate and has been signed by the President, or if Congress overrides a President’s veto

22. Topic Review: How a Bill Becomes a Law • If a Presidential veto occurs: • The bill returns to either the House or the Senate, wherever it originated • Objections to the veto are read and debated • If enough objections to the veto exist, a vote to override the veto may be obtained • If the vote on the veto override passes, the bill becomes a law • In order to pass, a 2/3 majority of BOTH the House and the Senate is required • If the House or Senate does not vote on a veto override, or if the vote on the veto override fails, the bill does not become a law

23. Topic Review: How a Bill Becomes a Law • So, WHY did we time-travel back to fifth-grade social sciences to review all of this stuff? • Our brains are currently inundated with medical jargon • We got free food for coming to the meeting • It’s required for induction into the national osteopathic political action honor society, Omega Beta Iota (ΩΒΙ) • It’s important to understand the basics and the processes behind the legislation we will be lobbying to support in DC during D.O. Day on the Hill!

24. Save the Date D.O. Day on the Hill April 26, 2007 Register online now! www.do-online.org

25. THANK YOU FOR YOUR ATTENTION! QUESTIONS???

26. Notes • Part II of the SOMA Political Action Training Course will be coming to you in the beginning of March! • Topic: The osteopathic medical student lobbyist how-to guide • Part III of the SOMA Political Action Training Course will be coming to you in late March or early April! • Topic: Preliminary introduction and review of 2007 AOA priority issues to be lobbied during D.O. Day on the Hill

27. References • Licciardone JC. A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the national ambulatory medical care survey. Osteopathic Medicine and Primary Care, 1:2, January 12, 2007. • AOA 2006 Report, including data from AACOM, accessed online at https://www.do-online.org/pdf/ost_factsheet.pdf • www.do-online.org • AOA’s 110th Congress Legislative, Regulatory, and Advocacy Agenda, accessed online at https://www.do-online.org/pdf/110thCongressReport.pdf • http://bensguide.gpo.gov/9-12/government/branches.html • http://clerkkids.house.gov/laws/bill_begin.html • Google images search