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 meaning of laws, how they are applied and whether they violate the Constitution. The judiciary uses its power of judicial review to provide checks and balances on the legislative and executive branches of government.
The Executive Branch
The executive branch of government is responsible for enforcing laws. It is recognized that one person, the president, cannot carry out the duties of the office without advice and assistance. The vice president, department heads (Cabinet members) and heads of independent agencies assist in this capacity; however, their powers are not defined in the Constitution although each has specific powers and functions that have been spelled out in law. Department heads advise the president on policy issues and help to carry out those policies. You will relate most to the agencies and programs within the U.S. Department of Health and Human Services (DHHS).
The Federal Budget.The president submits a budget to Congress by February 1 each year. The budget contains estimates of federal government income and spending for the upcoming fiscal year (obtained from the Office of Management and Budget - OMB) and also recommends funding levels for the federal government. The president's budget is jointly developed and negotiated through the programs and departments, OMB and White House advisors before the president reviews and approves it for submission to Congress. Congress then must pass all appropriations bills based on the president's recommendations and congressional priorities.
There is a congressional budget plan, separate from the president's budget. The Senate Committee on the Budget, along with the House Budget Committee, is responsible for drafting Congress's annual budget plan and monitoring action on the budget for the federal government. The annual budget resolution is an agreement between the House and Senate on a budget plan for the upcoming fiscal year and at least the following four fiscal years. The budget resolution is in the form of a concurrent resolution, so it is not sent to the president for his signature and thus does not become law, but it does provide a framework for subsequent legislative action on the appropriations bills. Additionally, the budget committees have jurisdiction over the Congressional Budget Office (CBO). The CBO provides Congress with objective, timely, nonpartisan analyses needed for economic and budget decisions.
There is a timetable for the consideration of budgetary legislation:
- May 15, annual appropriation bills may be considered in the House
- June 10, House Appropriations Committee reports the last appropriation bill
- June 30, House completes action on annual appropriation bills
- October 1, federal fiscal year begins and all appropriations actions should be completed
June 10 and June 30 serve as target dates. If Congress does not pass all appropriations measures by the start of the fiscal year, it has to enact a continuing resolution to keep the government running. In recent years, Congress has not been able to complete its work on all of the appropriations bills by the deadline. As a result, there have been multiple continuing resolutions adopted to keep federal agencies open and functioning at the same (i.e., continuing) level of funding.
You should be prepared for the management issues that arise in your agency when your federal funding is dependent upon a continuing resolution.
In one recent fiscal year, three continuing resolutions over nearly two quarters were necessary before the appropriations bill was finally adopted. If the final appropriations bill results in a cut to the previous funding level, it is more difficult for the state to adjust its spending in a fiscal year already underway with a higher level of spending. It's important to keep an eye on the federal budget process and to alert your agency's leadership about any anticipated problems you may have in meeting fiscal obligations.
Remember that the congressional budget process involves two separate and distinct parts. First is legislation that sets a ceiling for future spending for a specific program, known as the authorization level. Besides setting a funding ceiling, authorization legislation also lays out the overall policy framework for programs. Currently, the authorization level for the Title V-MCH Block Grant is $850 million. Once a program is authorized, Congress can choose to fund the program (or not) in the separate appropriations act process already described above.
Federal Spending. Spending by the federal government is a multi-step process in which budget authority is enacted and obligated, and outlays are generated. Budget authority is enacted into law and gives federal agencies the legal basis to incur obligations. Obligations establish the financial liabilities of the federal government and reflect such activities as employing staff and contracting. Outlays are the payments (expenditures) made to honor the obligations.
Budget authority is the specific dollar amount made available for obligation and is provided in appropriations and direct spending legislation. For some programs, however, budget authority is indefinite, providing "such sums as may be necessary" to achieve certain purposes. Budget authority may be enacted for one year, several years or no-year periods. Annual budget authority is available for obligation only during a specific fiscal year, and any unobligated authority expires at the end of that fiscal year. Multi-year authority is available for a period of time longer than one year (the Title V block grant has two-year budget authority, which allows funds appropriated in one year's budget to be spent over a two-year period), and no-year budget authority is available indefinitely. Federal agencies are prohibited by law from obligating more budget authority than was provided by the appropriations act. Adjustments such as a rescission (cut) may be made to cancel or reduce budget authority after it was enacted into law.
The State Budget. The state budget process generally involves only the legislative process for a budget appropriations bill. Usually this is done annually, although some states have a biannual budget process. Before the governor's budget is introduced in the state legislature, however, there is a great deal of work that goes into the preparation of that budget. As a Title V leader, you will be involved in the budget preparation process to a greater or lesser degree for the programs under your supervision. Generally, the state's office of budget and management (OBM or comparable title) provides budget preparation guidance and a proposed funding ceiling by line item to the agency director and fiscal/budget officer. The programs must then develop justifications for maintaining current funding levels, justifications for increased funding, or adverse impact statements for reduced or eliminated funding. Once the agency responds to the initial proposal from the state's budget office, an opportunity might be provided to negotiate and resolve differences between what OBM suggested and the state agency requests.
You should try to participate in meetings with OBM if possible to present strong justification for your program needs. If that is not permitted, be certain that you thoroughly brief the staff who do attend the OBM meeting.
It is common that all of the steps of the budget preparation process are kept confidential until the governor has approved the budget and it has been introduced into the state legislature as a bill. Once the budget bill has been introduced, your agency will likely be expected to support the governor's budget request. If the budget request is inadequate to meet the program needs, you are in a difficult situation because you cannot publicly criticize your governor's budget. You will find that program advocates and families are in the best position to press the legislators for additional funds during budget hearings. They may request information from your programs in order to be effective in their advocacy.
Be sure that you completely understand the budget development and adoption process for your specific jurisdiction. In some states, the legislature plays a more prominent role than the governor in making funding decisions. While the nuances may vary depending on your locale, the role you play as the MCH senior manager will remain largely unchanged. Be prepared to respond quickly, efficiently and effectively to information requests when the legislature is giving consideration to the budget. Anything can happen!
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