1. Congress: the institution

2. How a bill becomes a law Introduced by a member in either chamberIntroduced House.gov Referral to the committee(s) with jurisdictionReferralcommittee –Committee assignments and makeup –Committee (and subcommittee) chairs After referral to subcommitteereferral to subcommittee –Into the Garbage can –HearingsHearings –Markup –Vote Same process at full committee level Before it goes to the floor: Rules committeeRules committee –Powers of the Speaker of the HouseSpeaker of the House

3. How a bill becomes a law Same process in the other chamber Senate.gov Referral to the committee(s) with jurisdictionthe committee(s –Committee (and subcommittee) assignment –Committee (and subcommittee) chair After referral to subcommittee –Into the Garbage can, hearings, Markup, Vote Same process at full committee level Floor procedure –Unlimited debate, filibuster, cloturecloture –Powers of the Majority leader

4. How a bill becomes a law Bill that passes both houses goes to Conference Committee Re-passage of identical bill in both houses President’s Desk for veto or signature 2/3 vote in both houses to override

5. Questions Which is easier: passing a bill or stopping a bill from passing? What are the majority party’s advantages in the House? The Senate? What are the minority party’s advantages in the House? The Senate? Who controls the agenda? Who controls the content of legislation? What is the president’s role in the legislative process? What is his bargaining position?

6. Health Care

7. Terminology Terminology: –Medicare –Medicaid/Medical –HMO/PPO –Fee for service –Premium –Employer Mandate –Individual Mandate –Deductible –Catastrophic coverage –Others??

8. Topics for discussion What are your personal experiences with the health care system? What do you think are the “problems” with the health care system? What are the cost issues associated with health care reform?

9. Health care costs rise quickly Expenditures on health care in the economy: 1980:$253 billion 1990: $714 billion 2007: $2.2 trillion, 16% of GDP 46% of health care spending is public spending

10. Health care expenditures (From the Kaiser Family Foundation background brief on health care costs, 9/13/09)

11. Reform proposals