1. AAP Pediatric Residency Advocacy Training
Overview of the Legislative Process

2. Introduction
You don’t need to be an expert on the legislative process, but a general familiarity can help you feel more confident and comfortable as you get started.
Know where to go to get more information if you need it:
AAP Advocacy Guide
AAP chapter
AAP Division of State Government Affairs
AAP Department of Federal Affairs
AAP Community Pediatrics Training Initiative
Trainer Notes:
Refer back to the case study to illustrate that the pediatric resident we heard
about was not an expert on the legislative process, but rather, had a basic
understanding of the decision-making process and where he/she could weigh-in
to affect these decisions by telling their story.
A basic familiarity can help you – as a pediatric resident – know how decisions
are made and when.
This information can help inform you of how to best weigh-in on and contribute
to changing public policies that affect children’s health and well-being.

3. The Legislative Process and Children’s Health Policy
Local, state, and federal governments have processes for enacting and changing the public policies and laws that affect children’s health.
Public policy refers to a rule, guideline, or framework and can be defined broadly. Essentially, public policy is what government, together with advocates, chooses to do or not to do. This can happen at the local, state, or federal level.
These policies, bills, and regulations are enacted at the local, city, county, state or federal level.
Trainer Notes:
Consider providing an example of a recent and relevant public policy that
affects children’s health and/or the profession of pediatrics.
Ask pediatric residents for additional examples of public policies, legislation, or
regulations that they have experienced in their work.

4. Basics of Government
Each decision-making body, whether it is local, state, or federal, has three independent components:
The legislative branch makes the laws. An example of the legislative branch at the local level could be a city council. An example of the legislative branch at the state and federal level includes the Senate and the House of Representatives.
The executive branch carries out the laws and also has the power to set budgets. The executive branch includes Mayors, Governors, and the President, as well as their cabinet members.
The judicial branch interprets the law. The judicial branch includes courts at all levels of government.
State that it is important for pediatric residents to remember that
elected officials – whether they serve at the local, state, or federal level –
come from a diverse background. They may be teachers, farmers, bankers,
homemakers, or lawyers. Most will not have a medical degree or background.
This is why it is important that elected officials hear from pediatric residents –
because pediatric residents are experts in children’s health and have the personal
stories and experiences to educate and influence decision-makers.

5. Overview of Local Lawmaking
Local municipalities—including cities and counties—make laws and set budgets that affect children’s health and well-being.
Local counties set budgets for county hospitals and public health programs.
School boards can determine policies on vending machines.
Cities and towns can also set budgets and pass local ordinances related to child health issues, such as bike helmet safety and smoke-free areas.
The law-making process will vary from one municipality to the next, but one thing is usually consistent—many locally elected officials have more time to respond to their constituents.

6. Overview of State Lawmaking
State legislatures have become increasingly active players in the day-to-day governing of the country. In fact, state legislatures on average pass eighty state bills for every one federal bill that Congress enacts.
State legislatures are responsible for raising enormous amounts of money through state tax revenue and coming up with new solutions to managing complex public problems.
State legislatures create laws affecting children on issues such as the state’s Medicaid program, child abuse prevention, and safety laws.
Trainer Notes:
Often states serve as models for laws and programs that eventually become national programs.

7. State Lawmaking
Each state operates under a different law-making process, however many commonalities exist among states.
Forty-nine states have bicameral, or two-chamber legislatures. The “upper” chamber is commonly known as the senate and the “lower” chamber is known as the House of Representatives or the assembly. The exception is Nebraska, which is unicameral, or one house.
Legislative sessions vary from state to state and year to year.
The governor is the chief executive of a state and is responsible for the administration of the government.
Trainer Notes:
Add a few quick facts about your state’s government, such as how many state
legislators there are and when the state legislature meets.
Let pediatric residents know that you will provide them with a link to more information
at the end of the module where they can find out more information about their state
government.

8. Overview of Federal Lawmaking
The federal government is responsible for passing federal legislation and appropriating funds for federal and many state programs.
The United States Congress has two chambers—the Senate and the House of Representatives.
Each chamber has its own leadership, its own committee structure, and its own set of rules. Senators serve six-year terms and Representatives serve two-year terms.
Each state has two senators representing the entire state. The number of representatives for each state depends upon the state’s population. This number may change every ten years when a census is taken.
Trainer Notes:
Mention that Since the House of Representatives is limited to 435 members
and that population shifts in the country alter the representation in several states.
Consider mentioning the names of the US senators and US representatives
that represent the state or area of the pediatric residency program.

9. Federal Lawmaking
Each Congress has two sessions, each lasting one year. A new Congress always begins in January of odd-numbered years. National elections occur in November of the second session of a Congress.
The executive branch consists of the president and the various departments of the federal government.
Each department is headed by a secretary who is a member of the president’s cabinet. A cabinet secretary not only serves as the chief administrative officer for that department, but also as an advisor to the president on policies relating to his or her department.
Trainer Notes:
Mention that most children’s health issues fall under the department of health
and human services.
Give pediatric residents the name of the current Federal Health and Human Services
secretary.
Mention that pediatric residents can contact administrative officials at the state and
federal levels to advocate for children’s health policy as well as elected officials.

10. How A Bill Becomes a Law
Whether you are working at the local, state, or federal level, each decision-making body has a process they go through to take an idea and turn it into a law or public policy.
The process will differ somewhat from state to state and by municipality to municipality.
Regardless of the exact process used in your city, county, or state, the important thing to watch for is where you can influence the process by sharing your perspective, story, and experience.
The following slide illustrates how a bill becomes a law at the federal level.

11. Step 3: Committee consideration: Public participation encouraged!
Step 1: Someone says, “This ought to be a law…”
Step 4: Committee mark-up and vote
Step 2: Bill introduction
Step 5: Floor consideration: Another good time to contact your decision-makers.
Trainer Notes:
Each time you click the enter key, a new arrow will appear that will guide you to the next step.
Some of the steps are self-explanatory; however, some will require more explanation. Feel free to use the
following talking points for each step.
Step 1: After an idea is formed, it is drafted into a document. This could be done by an elected official or their
staff or by a citizen’s group.
Step 2: After a legislator writes a proposal, the bill must be introduced on the floor of the Senate or House. One or more
sponsors may present the bill before it is assigned a number and referred to an authorizing committee for study.
Step 3: While in committee, members will analyze, scrutinize and revise the bill. Hearings, which allow other congressional
staff, constituents, advocacy groups and lobbyists to submit testimony on the bill, are also critical to the outcome of a bill. Public
participation is encouraged! As the committee gathers information, they will also negotiate and compromise the fine details of the bill.
Step 4: This is the formal procedure by which all prior negotiations are approved. Often, this is a two step process as a bill is considered
and cleared by a subcommittee and then sent to a full committee for a final vote.
Step 5: Once a committee passes a bill, it is scheduled for floor debate and a vote.
Step 6: The bill passed by the first chamber must be introduced by a member of the second chamber. For example, if it passes the Senate,
it must be introduced by someone in the House of Representatives. The preceding four steps are then repeated in the second chamber.
Step 7: A conference must be held to reconcile the differences between the Senate and House versions of the same or similar bills.
Step 8: Votes by both chambers are needed to approve the compromise agreed to by the conference committee.
Step 9: The bill reaches the president’s desk! He or she has 10 days to either sign or veto it.
Step 6: Second Chamber
(Repeat steps 1-5)
If vetoed, the bill goes back to Congress for reconsideration. A two-thirds vote of both the Senate and the House is required to overturn a veto.
Step 7: Conference committee: Conference committee members are good decision-makers to contact – whether they represent you or not.
Step 9: Presidential action: Don’t forget to contact the executive branch in support of the bill.
Step 8: Final vote: This is another opportune time to contact your decision-maker.
Step 10: If signed…
BILL BECOMES LAW!

12. Making a Difference
You don’t have to be a legislative expert to effect change.
Decision-makers do not necessarily have health or medical backgrounds and need to hear from people who do.
Opportune times to weigh-in:
During committee hearings.
Before key votes.
During the budget process—when budget is being created by executive branch and when being adopted by legislative branch.
Decision-makers that need to hear from you include:
Your own decision-maker(s).
Committee members and conference committee members.
Members of the Executive branch.

13. Additional Resources and Information
AAP Advocacy Guide (
AAP Chapters (
AAP Division of State Government Affairs (
AAP Department of Federal Affairs (
AAP Community Pediatrics Training Initiative (