1. Development and Implementation HAS 4320

2. How does a bill become a law? Draw it…

3. Developing legislation Ideas Drafting legislation Introducing legislation House and Senate Conference Committee Executive Action

4. Ideas Members of Congress Individual Citizens Health-related organizations Interest groups Executive branch

5. Drafting Legislation Only members can sponsor Requires skill, knowledge, experience Usually staff is involved May be co-sponsored

6. Introducing Legislation Goes to committee(s) Public hearings

7. House/Senate Floor Receives bills from committees Debates Sent to other chamber If passed, differences are resolved

8. Conference Committee Usually ranking members Differences ironed out Conference report written/voted Bill dies if no resolution

9. Executive Action Signs or vetoes Doesn’t sign…then If Congress adjourns

10. Key Health Committees Committee on Finance (Senate) Committee on Labor and Human Resources (Senate) Committee on Appropriations (Senate) Committee on Ways and Means (House) Committee on Commerce (House) Committee on Appropriations (House)

11. Implementation Not as much time Responsibility Effective implementation is key Legislative oversight

12. Regulation Bureaucracy Interested parties Hearings Federal Register

13. Rulemaking Implementation begins Executive branch Rules have legal effect Ongoing Changes Interest groups

14. Operation Goals Not vague Not too restrictive Implementing organizations – Designer – Strategist – Leader

15. Operation (cont) Inter-organizational relationships

16. Challenges to Implementation No enthusiasm Vague instructions Multiple goals Rivalries No cooperation Too many people Time State and local agencies

17. Health Bureaucracy Department of Health and Human Services – Public Health Service – National Institutes of Health – CDC – FDA Health Care Financing Administration (HCFA)

18. Three key groups… FDA FTC OSHA

19. Authority of agencies Impossible to write a detailed law Members don’t want to deal with it Complex Experimental Agencies and Congress..some stories Federal and State

20. Policy Outcomes Consequences – Policies and individuals – Policies and health-related organizations – Policies and interest groups Input

21. Analyzing Policy Scanning Monitoring Forecasting Assessing Diffusing

22. Summary Development of legislation Policy implementation Regulations Rulemaking Operation Outcomes