Legislative Process Explained

Federal Legislative Process*

Bill Introduced: 
Any member of the House or Senate may introduce a bill.

Committee Action:
Bills are referred to the appropriate committee based on the subject.

  • Subcommittees review the proposed legislation and hold hearings where experts and stakeholders testify about the potential impact. The bill is edited or “marked up”, and the committee votes on approval of the legislation.
  • Major committees with jurisdiction over health issues:
    • Senate Finance: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP)
    • Senate Health, Education, Labor, & Pensions: Most agencies in HHS; public health and health insurance statutes
    • House Ways and Means: Medicare
    • House Energy and Commerce: Medicare (Parts B, C, D), Medicaid, CHIP, public health

Chamber Votes: 
Once a committee approves a bill, it is sent to the floor of each chamber for a vote. A bill must pass in both houses of Congress before it can become law.

House Floor Vote:

  • It is extremely difficult to bring a bill up for a vote unless the majority party has scheduled it.
  • Most bills require a simple majority (218 of 435) to pass and/or be amended.

Senate Floor Vote:

  • Senate votes are also scheduled by the majority party, but there is more procedural room for the minority party.
  • Most bills require a simple majority (51 of 100) to pass and/or be amended.
  • One Senator can stop or slow down a vote through filibuster or other procedural hurdles that require 60 votes to overcome.

Conference Committee: 
If there are differences in the bills passed by the House and Senate, the bills move to a Conference Committee so that the differences between the two bills can be reconciled.

  • The reconciled bill must be voted on again in the House and Senate with a majority vote in both chambers (cannot be amended).
  • Conference committees work largely behind closed-doors, without rules or public participation.

President Signs into Law: 
If a bill passes, the President has 10 days to sign a bill into law or veto it (if the President does nothing, the bill becomes law).

  • If the President vetoes the bill, both the House and Senate must secure a 2/3 majority vote to override the veto.

Federal Regulatory Process

Regulations, also known as rules, are issued by agencies to implement new, or modify existing, programs authorized by Congress.

  • Regulations have the force of law.
  • Under the Administrative Procedures Act, agencies must establish a comment period that permits stakeholders to remark on proposed rules.

Agencies may issue regulations in response to:

  • New legislation approved by Congress and signed by the President
  • Clarifying or interpreting existing legislation
  • Implementing new agency priorities within the statutory authority of the agency
  • Responding to new scientific data

Proposed Rule:
Agencies issue a Notice of Proposed Rulemaking (NPRM) to add, change, or delete regulatory text.

1. Agency Review Process: Multiple offices review based on subject matter; may be reviewed by the General Counsel and Office of the Actuary; agency may seek clarification from Congress and get stakeholder input.

2. Department Review Process: Typically reviewed by multiple agencies within a department.

3. Office of Management & Budget (OMB) Review Process: OMB only reviews “significant” rules (i.e., budget impact >$100 million or novel policy issue); may halt rules that counter Presidential policy priorities, legislative intent, or severely impact affected industries.

4. Public Comment Period: NPRM must be published in Federal Register; required 60-day public comment period (unless under expedited review); in some cases, the agency may hold a public hearing if needed, generally at the agency’s discretion.

Final Rule:
Final rule may be revised from NPRM based on public comments; must allow 60 days before rule takes effect.

*Note: State legislative processes function similarly to the federal process.  However details and timelines may vary among states.  For example, many states are on a two-year legislative and budget cycle.