Chapter 4: Key Players at National and State Levels
Ya Gotta Have Friends!
It is a truism that no one can succeed alone. MCH leaders have learned this lesson well over the years. Chapter 4 provides more specific information about the legislative process (federal and state), as well as some of the Title V partners that share similar concerns and viewpoints with MCH and CSHCN programs. Some are federal agency partners and others are advocacy organizations that offer services that you may find useful.
Public Policy at National and State Levels
The federal government is a key national partner for the Title V program, particularly because the program exists as a result of federal legislation and annual appropriations. For those of you who need a quick reminder, a review of the three branches of government and the federal and state legislative processes may be helpful. If you are already familiar with this information, feel free to skip ahead to the sections on national and state agencies.
The Legislative Process
The business of Congress is to make laws; their work begins with the introduction of a proposal that can take the form of a bill, a joint resolution, a concurrent resolution or a simple resolution. A bill is the form used for most legislation and can originate either in the House of Representatives or the Senate. The letters "H.R." designate a bill originating in the House of Representatives ("S." is used for bills originating in the Senate), followed by a number that the bill retains throughout its parliamentary stages. Bills are given to the president for action when approved in identical form by both the House and the Senate.
Joint resolutions may originate either in the House or the Senate; there is little practical difference between a bill and a joint resolution as both become law in the same manner (except for a joint resolution proposing an amendment to the Constitution).
Concurrent resolutions are used for matters affecting the operations of both the House and the Senate. On approval by both bodies, they are signed by the clerk of the House and the secretary of the Senate and are not presented to the president for action. A matter concerning the operation of either the House or Senate alone is initiated by a simple resolution that is not presented to the President for action.
Any member of the House or Senate may introduce a bill. An important phase of the legislative process is the action taken by committees that function similarly in both bodies. It is during committee action that the most intense consideration is given to the proposed measures. Each bill is referred to the committee that has jurisdiction over the area affected by the measure. Usually the first step in the process is a public hearing where committee members hear witnesses representing various viewpoints. After hearings are completed, the bill is considered in a session that is commonly known as the "markup" session where amendments may be offered to the bill, and the committee members vote to accept or reject these changes. Markup can happen in either the subcommittee, full committee or both. At the conclusion, a vote of the committee or subcommittee members decides what action to take. It can be reported, with or without amendment, or tabled. If the committee approved extensive amendments, they may decide to report a new bill incorporating all the amendments, known as a "clean bill" which is also given a new number. If the committee votes to report a bill, the Committee Report is written to describe the purpose and scope for the measure and the reasons for recommended approval. After the committee has reported a bill, it is generally ready for action by the full House or Senate where debate time is provided to proponents and opponents, and a final vote is held. Once a measure passes the House or Senate, it is sent to the other body for consideration. A bill must pass both bodies in the same form before it can be presented to the president for signature into law. If there are any changes, differences must be resolved, usually by a conference committee appointed with both House and Senate members. This group will resolve differences and report an identical measure back to both bodies for a vote. Final votes may be taken by the electronic voting system that registers each individual member's response (although votes in the House may be by voice vote without a record of individual responses). After a bill has passed both the House and the Senate, it is considered "enrolled" and is sent to the president, who may sign it into law, veto it and return it to Congress, let it become law without signature, or, at the end of a session, pocket-veto it.
The state legislative process. The legislative process used in most states mirrors that of Congress although there can be some unique differences. Besides understanding the federal legislative process, it is important that the Title V leader be completely familiar with the legislative process for his own state or jurisdiction and to know the relevant committees and their members. Usually the state legislature will print a limited number of legislative directories. If you are unable to obtain a copy of that directory, some advocacy or professional organizations print and distribute free copies of state legislative rosters, committee assignments, maps of districts, etc. If the state agency has a legislative liaison, meet with that person to establish your interest in all bills and public hearings concerning MCH, CSHCN and family health issues. There may also be a daily publication or website that provides information about bills introduced, committee assignment for bills, hearing schedules, reports of testimony, and other information. You should scan these publications frequently while your legislature is in session to ensure that you are aware of any proposed bills that impact the Title V program and alert your agency's legislative liaison or chain of command about the need for possible agency positions, testimony or behind-the-scenes conversations with the sponsors or friendly legislators.
Tips for success
- Stay well informed about current legislative activity at both the federal and state level.
- Keep one-page, "thumbnail" descriptions of your programs handy as background information to use during bill drafting, hearings, etc.
The Judicial Branch
The U.S. Supreme Court is the highest court in the country and is vested with the judicial powers of the government. There are lower federal courts that have been established by Congress using the power granted from the Constitution. Courts decide arguments about the meani