Healthcare Special Interest Groups in the Legislative Process

By Lori Grant | Mar 24, 2009

Now that we understand the role of Congress and its committee system, what role will interest groups play in healthcare reform? How can special interest groups influence healthcare reform in the legislative process? Before we answer this question, we must first understand the function of special interest groups.

Special Interest Groups Defined
Special interests groups are an association of individuals or organizations that attempts to influence public policy. They are usually concerned with one or a small range of issues. Their role is to link the governed with the government, allowing the group to politically participate in the public policy process. They often act as sources of technical and political information for policymakers. A lobbyist is a person who represents an interest group to government in order to influence governmental actions in that group’s favor.

The problem with interest groups lies in the fact that not all people are represented by interest groups. Interest groups are able to use their group resources (money, membership, and information, etc.) into political power. The following are four types of special interest groups:

  • Economic interest or producer groups - business, labor, or health care
  • Promotional or cause groups - the Sierra Club or American Civil Liberties Union
  • Government and quasi-government interests - government agencies and foreign governments
  • State and local interest groups

Healthcare’s Special Interest Groups

Which special interest groups will be involved in healthcare reform? Above is diagram of how various healthcare interests participating in The White House Forum on healthcare reform earlier this month. But who are the “special interests” in healthcare? Below is a sample of special interest groups categorized by healthcare delivery system components that will lobby the executive branch and Congress:

Healthcare Special Interest Groups Path to Influence
How can special interest groups influence healthcare reform in the legislative process? Interest groups use several paths and tactics to influence Congress by direct lobbying, grass-roots lobbying, political campaigns to intermediaries, the public, and Congress. Through these efforts, interest groups influence the public and intermediaries on Congress through direct lobbying, constituent pressures, and citizen participation. See Keefe and Ogul’s The Paths of Interest-Groups Influence diagram below for details.

CLICK TO SEE THE DIAGRAM IN FULL SIZE

What’s the special interest groups role in healthcare reform?  When you read news headlines like “Study: 86.7 million Americans uninsured over last two years” or “New Study Shows Health Care Costs Put U.S. Workers at Significant Disadvantage Compared with Global Competitors,” the chances are a special interest group commissioned the study to educate  the public, Congress, and the executive branch in their effort to lobby their position on healthcare reform.

Sources:

  • The American Legislative Process: Congress and the States by Willam J. Keefe and Morris S.Ogul
  • First World Interest Groups: A Comparative Perspective by Clive S. Thomas

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The Congressional Committee System and Healthcare Reform

By Lori Grant | Mar 18, 2009

Capitol Building and surrounding groundsOn a daily basis, we see health reform news headlines, like “Congressional Committee Chairs to Lead Health Care Reform Effort,” “Obama Open to Baucus’ Idea of Taxing Health Benefits,” or “Sen. Kennedy helps launch Obama administration’s health-care effort.”

What role will congressional committees play in healthcare reform? To understand how the committee system affects healthcare reform legislation, we must have an understanding of the role of committees, what function the committee system plays in the legislative process, and how committee chairmanships may influence healthcare reform.

Committees in the Congressional Committee System
As it works on healthcare reform, Congress will use its committee system to control the congressional agenda and guide legislation from its introduction into Congress to its sendoff for the president’s signature. But what are committees and the committee system? The Congressional committee is defined as:

  • Committees are permanent units established in the rules of the House and Senate, allowing Congress to effectively manage the number of proposals introduced
  • In its legislative role, committees studying, sort, draft, and report legislation that has been referred into it
  • In its executive role, committees are concerned with presidential nominations, treaties, and executive agreements
  • As investigative bodies, they hold hearings, invite and subpoena witnesses to testify and to be interrogated, call for records, inquired into the operations of executive agencies and policies, and issue reports

The committees as a whole are a highly complex system, partially hidden from the public audience, with the following functions:

  • The committee system brings policy specialization on issues
  • Committees understand existing statutes, details that need to be written, and estimates and decisions regarding the requirements of passage have to be made
  • The committee process facilitates negotiation, where compromises can be arranged to the interest of all major affected
  • Bills become law through skillful management in committees through the committees systems and on the floor

Committees and Healthcare Reform
What are the different types of committees and how do they affect healthcare reform? There are four types of committees: standing committees, joint committees, conference committees, and select committees. The committee definitions are as follows:

  • Standing committees: standing committees were formed to handle bills in difference policy areas. The House and Senate have its own standing committees.
  • Joint committees: joint committees exist a few policy areas with their membership drawn from the House and the Senate. They are used as means to achieve coordination in the House and the Senate.
  • Conference committees: conference committees are formed when the Senate and the House pass a particular bill in different form. Its members are appointed through party leadership. This conference committee irons out the differences between Senate and House differences and report back with a compromise bill.
  • Select committees: select committees are appointed for a specific purpose; it looks into specific issues like Watergate.
  • Subcommittees: “subcommittees are responsible to, and work within the guidelines established by, their parent committees. In particular, standing committees usually create subcommittees with legislative jurisdiction to consider and report bills. They may assign their subcommittees such specific tasks as the initial consideration of measures and oversight of laws and programs in the subcommittees’ areas.”

Six key standing committees play a significant role in healthcare reform. These committees and their chairs are as follows:

How can these six democratic chairs influence healthcare policy? According the CQ Today, the key standing committees in healthcare could affect healthcare reform through budget process by:

  • Gearing up to play a leading role’ in health care reform, which will require them to ‘overcome years of policy deadlock
  • Keeping their own committees in line
  • Massage their leaders
  • Deal with a GOP minority that wants its say and will probably oppose many ideas the Democrats try to push through
  • Satisfy the Obama White House.

A Context for Understanding Committee Headlines
During healthcare reform, the media focuses on Senator Max Baucus (D-Mont.) or Senator Edward Kennedy (D-Mass.) because of their influence on their respective committees chair positions. Special interest groups will “lobby” committees during the legislative process, while opposing congressional members also attempt to influence healthcare reform in their own way. Now, when you read headlines about the Senate Finance or H.E.L.P. committees, you’ll have an understanding of the legislative context for the healthcare reform be discussed.

If this explanation of committees was too confusing, then check out this classic video of how an idea becomes a bill.

Update March 22, 2009:

Watch Rachel Maddow explain how the filibuster has changed the Senate process, altering Schoolhouse Rock’s light-hearted explanation of  “I’m Just a Bill.” More importantly, Maddow asks if it’s time to end the filibuster, since the Republicans political strategy is to obstruct everything by using this tactic.


Related Post:

Sources:

  • The American Legislative Process: Congress and the States by Willam J. Keefe and Morris S.Ogul
  • Government in America: People, Politics, and Policy by Lineberry, Edwards, and Wattenberg
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The Role of Congress and its Legislative Process in Healthcare Reform

By Lori Grant | Mar 18, 2009

Capitol Building and surrounding groundsEvery day we read headlines like “Health-care Reform Consensus Builds Around Three Major Goals,” “White House Healthcare Summit Offers Opportunity for Input Into Reform,” or “WellPoint CEO optimistic about healthcare reform.” To understand the news on healthcare reform, we must understand the role of Congress and its legislative process. What’s the job a Senator or House Representative? What role does Congress play in healthcare reform? What’s the legislative process of reforming healthcare? What are the challenges facing Congress in the legislative process?

The Job of a Congressman
Before answering these questions, we must first understand the job of a Congressman and the function of Congress.  Below are the basics job functions of a Congressman:

  • Studying and doing basic research on proposed legislation
  • Keeping track of the way government agencies are administering laws passed by the Congress
  • Working in committee or subcommittee on oversight activities
  • Debating and voting on legislation on the floor of the House
  • Working informally with other members to build support for legislation of concern
  • Taking the time to gain a firsthand knowledge of foreign affairs
  • Working to develop legislation
  • Sending updates about the activities of Congress to people in their district
  • Helping people in their district who have personal problems with the government
  • Working in subcommittees to develop legislation
  • Meeting personally with constituents when they come to Washington
  • Talking the time explain to citizens what their government is doing to solve important problems and why
  • Making sure their district gets its fair share of government money and projects
  • Staying in touch with local government officials in its district
  • Giving speeches and personal appearances to talk to interested groups about legislative matters before Congress
  • Getting back to their district to stay in touch with their constituents

The function of Congress in healthcare reform or any issue is to:

  • Make law
  • Check the administration
  • Educate the public
  • Represent constituents, localities, and “interests”
  • Judicial function such as its power to impeach and remove officials

The Legislative Process
Now that we understand the basics of a Congressman’s job and Congress’ role in government, how does the Congressional legislative process work? The legislative process is the center of political, economic, and social advantages struggles. Legislative politics and public policy are dominated by organized special interests, such as the agriculture, business, or healthcare lobby. Institutional arrangements in the legislature that are hidden for the public’s view make it difficult to assign responsibility for actions taken by government. At times, it seems like the legislative process is a black box that obscures the public for understanding how bills are formed.

Below is flowchart of the legislative process from the Congressional Deskbook - The Practical and Comprehensive Guide to Congress.

legislativeprocesspt1

legislativeprocesspt2

As it tackles healthcare reform, how will Congress allow the public to view its legislative process, providing a similar transparent approach like President Obama’s? President Obama uses a public forum that brings together the people who have a stake in our health care system and the people who have the ability to change it. The official White House website live blogs the event, while providing video of healthcare summit highlight. President Obama also launched an official website on healthcare reform to educate citizens on the issues.

The Challenges facing Congress
The typical challenges facing Congress in addressing healthcare reform or any issues are typically with special interest groups, its committee system, and the divided control of the government.

  • Special interest groups (lobbyists) sometimes take a toll on the legislature’s ability to serve broad public purposes.
  • The committee system is often a point of controversy. Committees composition and policy perspective are sometimes out of step with the main elements of their party or nation.
  • Divided control of government with one party in control of the executive branch and one or two parties in control of the legislature; however, with a democrat in the White House and democratic majority in the House and Senate, divide control should not be a barrier at this time.

Congress and its legislative process face many challenges in reforming healthcare. Congress must work with special interests groups on how proposed healthcare reform will affect the delivery system, financial resources, non-financial resources, existing government programs, and consumers (see “An Overview of the Healthcare Delivery System“); work with the White House and its supporters on healthcare reform; and balance the needs to their constituents and the nation.

Souces:

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Bill Clinton Says Road to Healthcare Reform Easier Now

By Lori Grant | Mar 13, 2009

Former President Bill Clinton says President Obama’s plan less controversial than the one he pushed in 1993. In an interview with Dr. Sanjay Gupta taped for CNN’s “Larry King Live,” Clinton said “We have a simpler, clearer path to the future.”

President Obama’s plan avoids some of the more controversial aspects of that effort by offering people the chance to buy into the federal government insurance plan. After undergoing fine-tuning during the primary, Obama’s plan offers the chance to buy into same coverage as federal employees.

According to Clinton, “The politics and the economics are much better now and the policies are better.” “They’ve made advances over where we were.” The political climate is different now. The House and Senate Democrats hold majorities, meaning fewer Republican votes are required to reach the 60 votes needed to avoid a Senate filibuster.

The key take away from the Clinton interview? There is consensus across key stakeholders in business, health insurances companies, providers, and some Republicans to provide coverage for the uninsured. How will this coverage be provided? How will it be funded? It’s too early to tell with competing perspectives on how to structure this coverage for the 47 million uninsured Americans.

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Health Insurers & Drug Companies Contributed $5.5 Million to Top Senate and House Recipients

By Lori Grant | Mar 10, 2009

According to the nonprofit, nonpartisan Consumer Watchdog, “health insurers and pharmaceutical manufacturers contributed $5.5 million to the top 10 recipients in the U.S. Senate and House of Representatives during the last two election cycles.”

The Consumer Watchdog’s study found that:

  • Health insurers contributed $2.2 million to the top 10 members of the U.S. Senate and House.
  • Drug manufacturers contributed $3.3 million to the top 10 recipients in each legislative body.
  • Health insurers and drug manufacturers contributed $24,220,976 to the current members of Congress in the last two election cycles.

Biggest Beneficiaries - Democrats

  • Senator Max Baucus, a democrat from Montana and chairman of the Senate Finance Committee received $413,000 in campaign contributions from the pharmaceutical and health insurance industries than any other current Democratic member of the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies. Baucus has become the leading architect of health care reform in Congress, playing a leading role in the debate over healthcare reform.
  • House Rep. Earl Pomeroy (N.D.) received contributions from the insurance sector ($104,000)
  • House Rep. John D. Dingell (Mich.) took in $180,000 from drug companies.

Biggest Beneficiaries - Republicans

Powerful Lobbies Influence on Healthcare Reform
According to the Washington Post’s Dan Eggen, “the health-care sector has long ranked with financial services and energy interests as one of the most powerful political forces in Washington, and it spent nearly $1 billion on lobbying in the past two years alone. As momentum moves toward overhauling health care, major medical groups have stepped up their lobbying and campaign activities while shifting money and attention to newly empowered Democrats, according to federal records and industry experts.”

Carmen Balber, Director of Consumer Watchdog’s Washington D.C. office, states that “when the engineer of the health care reform train is getting more fuel from the HMOs and drug companies that any other Democrat on Capitol Hill, you have to wonder who is really driving the train and whether average Americans will be tied to the tracks. HMO and drug company money will sour the President’s plan for affordable, accessible health care if these industries’ backers on Capitol Hill allow their financial interests to drive the debate.”

Why should you care? The Consumer Watchdog’s study will help you understand how the health insurance and pharmaceutical industries influence healthcare reform and policy through their campaign contributions. These lobbies back key Senate and House democrats and republicans that are expected to play a key part legislative process as healthcare reform is formed the Senate and House.

Sources

Health Insurance & Pharmaceutical Manufacturers in Healthcare Delivery System

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An Overview of the Healthcare Delivery System

By Lori Grant | Mar 9, 2009

Healthcare reform. The idea of healthcare reform feels daunting to me. President Obama’s health insurance reform includes the following goals as listed at The White House:

  • Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
  • Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
  • Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
  • Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
  • Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees’ health care
  • Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
  • Ensure everyone who needs it will receive a tax credit for their premiums.

Not only does President Obama want to change health insurance, but he also hopes to reduce costs for consumers and business by:

  • Lowering drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
  • Requiring hospitals to collect and report health care cost and quality data.
  • Reducing the costs of catastrophic illnesses for employers and their employees.
  • Reforming the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

I can’t imagine the average person understanding all the stakeholders that will battle it out as the President and Congress goes through its federal budget process to reform healthcare because the healthcare industry is complex. The delivery system has five major components—financial resources; nonfinancial resources; state and local governments; and consumers/patients. The image below is a general overview of the healthcare delivery system. As you listen to the news, refer to this diagram so you can have a broader context of which part of the delivery system the media and government officials are discussing.

The Healthcare Delivery System’s Components

Healthcare Delivery System Components

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The American Recovery and Reinvestment Act and Healthcare Spending

By Lori Grant | Mar 5, 2009

The American Recovery and Reinvestment Act, signed into law by President Obama on February 17, 2009, jump starts President Obama’s healthcare reform. According to Families USA, the bill includes healthcare spending for Medicaid, healthcare efficiencies, assistance for seniors by providing  healthcare provisions. The following are highlights from the stimulus bill:

  • COBRA: $24.7 billion to subsidized to hlep unemployed workers purchase their employer’s COBRA coverage.
  • Medicaid: Increase federal dollars for state Medicaid programs by $87 billion until the end of 2010 to support this crucial safety net program amidst rising demands.
  • Healthcare improvements: $19.2 billion to encourage the use of electronic medical records, including the collection of data on race, ethnicity, primary language, and gender, health information technology (HIT), and comparative effectiveness guidelines in order to promote system-wide efficiency and more effective clinical treatment.
  • Transitional Medical Assistance: Extend Transitional Medical Assistance (TMA), a program that allows families to maintain Medicaid coverage temporarily when they start a new job and earn income that would otherwise render them ineligible. TMA prevents families from being penalized for working.
  • Qualified Individual Program: Continue the Qualified Individual (QI) program, which helps low-income seniors and disabled Americans pay their monthly Medicare premium.
  • National Institutes of Health: $10 billion for the National Institutes of Health (NIH)
  • Wellness Programs: $650 million to support prevention and wellness activities targeting obesity, smoking, and other risk factors for chronic diseases
  • Training Programs: $500 million for health professions training programs, including $300 million to revitalize the National Health Service Corps (NHSC).

Additional resources on the healthcare spending details:

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