1. Maryland State Delegate Joseline A. Peña-Melnyk Health and Government Operations Committee Legislative District 21 October 21, 2010 7th National Conference on Quality Health Care for Culturally Diverse Populations

2.  Introduction  Legislative Process ◦ Conception of the Bill ◦ Identification of a Sponsor ◦ Confirmation of the Need ◦ Recognition of the Issues ◦ Identification of the Stakeholders ◦ Achievement of Consensus ◦ Drafting of the Bill ◦ Working the Bill  Conclusion 2 Achieving Consensus in Legislation Addressing Health Disparity Issues

3. 2008 – HB1176: Committee on Childhood Obesity (passed) 2008 – HB802: HIV Testing and Information Mortality Reduction (failed) 2009 – HB119: Children’s Products Containing Lead (passed) 2009 – HB 756: Cultural and Linguistic Health Care Provider Competency Program (passed) 2010 – HB561: Prince George’s County – Prohibition on Issuing Licenses to Fast Food Style Restaurants in Locations with a High Index of Health Disparities (failed) Achieving Consensus in Legislation Addressing Health Disparity Issues3

4.  Can originate with constituent, lobbyist, legislator, state government agency, or other interested party  Constituent often suggest bill based on personal situation  Lobbyist suggests bill based on interest of client  Government agency suggests bill based upon problems it encounters in its daily operation  Legislator conceives bill based on perceived need 4 Achieving Consensus in Legislation Addressing Health Disparity Issues

5.  If bill is proposed by other than a legislator, the person or entity requesting the legislation must find a willing sponsor in the Legislature  Factors such as Legislator’s committee assignment, party affiliation, legislative record, etc. should be considered 5 Achieving Consensus in Legislation Addressing Health Disparity Issues

6.  Purpose of the bill must be clear  Survey done by Legislative Services to confirm there is currently no law achieving the purpose of the proposed bill  If necessary, opinion of Attorney General is sought regarding the constitutionality of the proposed bill 6 Achieving Consensus in Legislation Addressing Health Disparity Issues

7.  Legislator meets with proposer of bill to determine who will back a bill and who will fight it  Issues to overcome are identified and potential solutions are discussed  Similar legislation in other states is reviewed, including how issues are addressed 7 Achieving Consensus in Legislation Addressing Health Disparity Issues

8.  Those potentially benefitting from bill are identified  Those with issues noted in previous step are identified  All stakeholders are notified and invited to the table 8 Achieving Consensus in Legislation Addressing Health Disparity Issues

9.  Stakeholders meet and discuss their issues  Attempt is made to achieve a compromise acceptable to all  Legislator brokers the discussion  100% consensus rarely achieved 9 Achieving Consensus in Legislation Addressing Health Disparity Issues

10.  Bill drafting is an iterative process  Legislator provides Bill Drafting with specifics of the bill  Bill Drafting drafts language, often based on language used in other Maryland legislation, or on language uses in similar bills in other states  Legislator circulates proposed language among stakeholders (continued next slide) 10 Achieving Consensus in Legislation Addressing Health Disparity Issues

11.  Changes are proposed and discussed  Acceptable changes are sent to Bill Drafting for rewrite  Rewritten bill is returned to Legislator and review cycle begins anew  Eventually, final language of bill is set, contingent upon further amendment in committee or on the floor 11 Achieving Consensus in Legislation Addressing Health Disparity Issues

12.  Sponsoring Legislator and staff seek out co- sponsors  Objections of non-supporters are anticipated  Supporting facts are drawn together for testimony  Witnesses from among stakeholders are identified  Testimony is written (continued next slide) 12 Achieving Consensus in Legislation Addressing Health Disparity Issues

13.  Bill is heard in assigned committee  Committee members are lobbied for support  If passed in committee, bill goes to floor where full membership is lobbied for support  If passed on floor, bill crosses to other chamber where hearing, committee vote, and floor vote proceed as before 13 Achieving Consensus in Legislation Addressing Health Disparity Issues

14.  Key factor is success of bill is to identify ALL stakeholders and anticipate their concerns  Important to bring legislation to the floor with no surprises for stakeholders  Work the bill HARD! 14 Achieving Consensus in Legislation Addressing Health Disparity Issues

15. Delegate Joseline A. Peña-Melnyk Maryland General Assembly 6 Bladen Street, Room 209 Annapolis, MD 21401 410-841-3502 301-858-3502 Joseline.pena.melnyk@house.state.md.us Achieving Consensus in Legislation Addressing Health Disparity Issues15