Federal Legislation In Helathcare

Federal Legislation in Health Care

The legislative process is a very detailed, daunting task. There are many steps involved in a bill becoming a law. Thousands of bills are introduced into each session of Congress every year, but only small percentages actually become laws (U.S. Gov Info, 2005, 1). There are many opportunities for the bill to die at any point during the process. One main reason for the death of a bill is lack of support (Phillips, 2003, 16). Therefore, when there is important health care legislation introduced, it is imperative for nurses to use their power and influence to assist with the bill's outcome. Having knowledge of the process a bill goes through to become a law will enable the nurse to know when to act (Phillips, 2003, 18). This paper will use the current pending legislation H.R. 1372, the Quality Nursing Care Act of 2005, to illustrate the legislative and administrative process. The history of similar types of legislation, and the stand taken by various health organizations on H.R. 1372 will also be discussed.

Legislative process

A bill usually originates from an idea or concern someone has about an issue. Anyone can draft a bill, but only a member of Congress can introduce a bill, thus becoming its primary sponsor. Prior to introducing the bill, the Congressman will usually research and collect data about the issue. At this point of the process, the nurse and nursing organizations can provide information to the Congressman concerning the bill and have considerable influence (Phillips, 2003, 4 & 5). A bill can be introduced any time during the time that the House is in session. The primary sponsors signature must be on the bill and the bill is placed in a wooden box, called the hopper, which is located in the House Chamber (Johnson, 2003, p.8). The bill is then assigned a legislative number by the clerk. The letters H.R. followed by the legislative number designates bills originating in the House (Johnson, 2003, p.6). Representative Lois Capps and Representative Robert Simmons introduced H.R. 1372 on March 17, 2005 (H.R. 1372, 2005).

Once the bill is introduced and assigned a number, it is referred to a committee by the Speaker of the House, as required by the rules of the House (Johnson, 2003, p. 9). The Committee on Commerce has jurisdiction over most of the health care topics in the House of Representatives (University of North Carolina [UNC], 2004, 2). The Quality Nursing Care Act of 2005, H.R. 1372, was referred to the Committee on Energy and Commerce and was also referred to the Committee on Ways and Means (H.R. 1372, 2005). Once assigned to a committee, the bill is printed in its introduced form and copies are made available to both Houses and the public (Johnson, 2003, p 9). The action taken in a committee is an important part of the legislative process. This is the time where the most intense consideration is given to the proposed legislation and also the time when people are given an opportunity to be heard (United States House of Representatives, n.d., 2). The Committee can review it as a whole or refer it to a subcommittee. If the committee does not act on the bill, then it is essentially dead (N-Stat, n.d., 3). On March 24, 2005, H.R. 1372 was referred to the House Subcommittee on Health (Library of Congress, n.d.). This is the last action recorded to date on H.R. 1372. Bills in the subcommittees are studied and hearings are conducted. The hearings provide an opportunity for the members of the committee to obtain written and oral testimonies concerning the bill from supporters and proponents of the bill, the executive branch, and experts in the area related to the bill (Cherry & Jacob, 2005, p. 218). After all of the hearings have been conducted, the subcommittee may make changes or amendments to the bill, also known as "marking up" the bill, before recommending it to the full committee. If the subcommittee votes not to refer the bill to the full committee, then the bill dies (Cherry & Jacob, p. 218). If the bill makes it out of the subcommittee to the full committee, then the committee can either conduct further hearings, or vote on the recommendations of the subcommittee. The full committee can then vote on its recommendations to the House, a procedure known as "ordering a bill reported" (N-Stat, 6). Once the committee votes to report a bill, then the chair of the committee instructs the staff to prepare a written report describing the intent and scope of the legislation, the impact on existing laws and programs, the position of the executive branch, and the views of the dissenting members of the committee (N-Stat, 7). After the bill is returned back to the House, the bill is placed in chronological order on a legislative calendar. In the House, there are five different legislative calendars. Most public bills are placed on the Union Calendar or the House Calendar (Johnson, p.20) and it is up to the Speaker and the majority leader to determine, if, when, and in what order a bill will come up (N-Stat, 8). Once the bill reaches the floor, it is open for debate. There are specific rules governing the conditions and the amount of time for the debate (N-Stat, 9). After the debate is complete, then the members of the House are provided the opportunity to vote to pass or defeat the bill. If the bill is passed, then it is referred on to the Senate where it will go through a similar process. The Senate can approve the bill as it is, ignore the bill, reject the bill, or change it. If the bill makes it through the Senate with only minor changes, then it goes back to the House for approval. If there were major changes made in the bill by the Senate, then a Conference Committee must be formed to reconcile the differences in the bill versions. If an agreement cannot be reached, then the bill dies. If an agreement is reached, then a conference report is written with the recommendations. The House and Senate have to agree to the recommended changes (N-Stat, 10 &11). Once the House and the Senate have approved the bill, then it is sent to the President. For the bill to become a law, the President can approve it and sign it, or take no action for ten days while Congress is still in session and allow it to become a law automatically. The president can veto a bill if he does not approve of it. If the President vetoes a bill, then Congress can override the veto with a two-thirds majority vote (N-Stat, 13 & 14). The bill can also die if the President does not take any action after Congress has adjourned its second session. This is known as a "pocket veto" (N-Stat, 13).

Implementation of a bill that has become a law falls under the jurisdiction of one of the departments under the executive branch of government. Most health care policies fall under the jurisdiction of the Department