Transcript US Government: A Case Presentation

US Government: A Case Presentation
Dana M. Block, OMS-IV
SOMA National Director of Political Affairs
Introduction
• Purpose: to provide osteopathic medical students
with a basic understanding of the structure and
function of the US Government and the processes
involved in a bill becoming a law
• This presentation is Part I of III in the Student
Osteopathic Medical Association (SOMA) Political
Action Training Course (PATC), completion of which
is recommended for all D.O. Day on the Hill
participants
• Completion of the SOMA PATC is one requirement
for induction into Omega Beta Iota (ΩΒΙ), the
national osteopathic political action honor society
(exceptions will be made for 2007 ΩΒΙ inductees, as
this is the first SOMA PATC to be given)
Presentation Overview
• “Case” presentation
of sample issue
• Topic Review
• Structure and functions
of US government
branches
• How a bill becomes a
law
• Save the Date: D.O.
Day on the Hill
(4/26/07)
“Case” Presentation
•
Disclaimer: the “case” used in this presentation represents a current issue and is a
creative adaptation of such; it therefore should not be taken too literally nor is this an
official production of the American Osteopathic Association (AOA).
• CC: “We need improved funding for osteopathic graduate
medical education (OGME).”
• HPI: The AOA is a 110-year-old membership organization that
supports, unifies, and represents osteopathic physicians within
the USA, and is currently in need of improved funding for
OGME. Although this need has been apparent for several
years, it only recently became so severe that it required
immediate attention. The need for funding is a deep,
constant, 10/10 and worsens as graduating osteopathic
medical student numbers increase. It improves slightly if
Medicare provides additional funding and if approval for new
OGME programs is attained. ROS is (+) for collaboration with
other osteopathic organizations, employment of a team of
political advocacy experts, and the promotion of osteopathic
postdoctoral training institutes (OPTIs). All other ROS are (-).
Pertinent History
• PMHx: the Balanced Budget Act of 1997
established a full-time equivalent resident
“cap” on funded residency positions.
Additionally, OGME programs are limited by
Medicare laws and the restricted utilization
of ambulatory sites in teaching hospitalaffiliated OGME programs
• PSHx: OGME programs have been
restructured in the past to assure
compliance with current legislation
• Soc Hx:
• Medications: none
• NKDA
Pertinent “Physical Exam” Findings
(a.k.a. Pertinent Statistics)
• Vital signs, as of June 2006:
• Total # of osteopathic medical
students: 13,406
• Estimated # of graduating
osteopathic medical students
(13,406/4): 3352
• Total # of AOA-approved OGME
internship programs: 229
• Total # of AOA-approved OGME
internship positions: 2777
• Osteopathic physicians in
self-identified specialties, as
of June 2006:
•
•
•
•
•
•
Family Medicine: 46.4%
Internal Medicine: 8.3%
Pediatrics: 4.2%
OB/GYN: 3.9%
OMT: 1.2%
Non-primary care: 36.0%
• Visits to osteopathic
physicians account for
roughly 20% of annual
patient visits to
general/family practitioners,
according to the National
Ambulatory Medical Care
Survey 2003-2004
Pertinent Laboratory Data/Imaging
• D.O. internships are offered in only 36 of the 50 states:
Alaska, Arkansas, California, Colorado, Connecticut, Delaware,
Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana,
Massachusetts, Maine, Michigan, Missouri, North Carolina, North
Dakota, New Hampshire, New Jersey, New Mexico, New York, Nevada,
Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas,
Virginia, Washington, West Virginia, Wisconsin, and Wyoming
Assessment and Plan
• Assessment: we are in need of
additional funding to improve upon
existing, and to create additional,
OGME programs
• Plan: author a bill to promote funding
for the addition and improvement of
OGME programs, and lobby to help the
bill become a law!!!
Topic Review: US Government
• The United States government
is composed of three branches,
as delineated in the
Constitution:
• Executive (President)
• Legislative (Congress)
• Judicial (Supreme Court)
• These branches were created to
provide “checks and balances”
• Each branch of government has
the right to amend or void those
acts of another branch of
government that fall within its
purview
Topic Review: US Government
• Executive Branch in detail:
• Purpose: responsible for enforcing the laws of the US
• Membership:
• President (US leader, Commander-in-Chief of the US military,
and appoints Department leaders)
• Vice-President (President of the Senate)
• Executive Office of the President
• Departments:
• Department heads advise the President on policy issues and help
put policies into practice
• Agriculture, Commerce, Defense, Education, Energy, Health and
Human Services, Homeland Security, Housing and Urban
Development, Interior, Justice, Labor, State, Transportation,
Treasury, Veterans’ Affairs
• Independent Establishments and Government Corporations
• Provide special services and help execute policies
• CIA, NASA, USPS, etc.
Topic Review: US Government
• Judicial Branch in detail:
• Purpose: to decide arguments about the meaning of
laws, how they are applied, and whether or not they
violate the US Constitution
• Membership:
• The Supreme Court is the highest court in the US and is
the only court created by the Constitution
• Several other federal courts have since been created by
Congress as allowed by the Constitution
• Additional courts included within the judicial branch of
government are: the US Court of Appeals, US district
courts, the US sentencing commission, etc
Topic Review: US Government
• Legislative Branch in detail:
• Purpose: create and establish US laws
• Membership:
• Congress = Senate + House of Representatives
• Senate: equal representation provided for each state,
regardless of state’s population (2 Senators per state, period)
• House of Representatives: representation provided for each
state based upon state’s population (each state may have
several representatives, elected from given districts)
• Agencies: provide support services for Congress
• Architect of the Capitol, Congressional Budget Office, General
Accounting Office, Government Printing Office, Library of Congress
• This is the branch of government we will work most closely
with when we participate in advocacy campaigns, including
writing legislation and lobbying!
Topic Review:
How a Bill Becomes a Law
• A bill always begins with an idea– ours
is to promote funding for the addition
and improvement of osteopathic
graduate medical education (OGME)
programs
• Let’s pretend we already authored our
bill and we now are wanting to make it
into a law…
Topic Review:
How a Bill Becomes a Law
• Anyone may write a bill, but a
bill may only be introduced to
Congress by a Member of
Congress when the House is in
session
• There are 4 types of legislation:
•
•
•
•
Bills
Joint Resolutions
Concurrent Resolutions
Simple Resolutions
• There are also different types
of bills:
• Private: affects a specific
person or organization
• Public: affects the population
at large
Topic Review:
How a Bill Becomes a Law
• The process of introducing a bill depends on if it is being
introduced in the House or in the Senate:
• In the House of Representatives, a bill is introduced by placing it
in the “hopper,” a receptacle near the Speaker’s podium; it is then
assigned a number by a bill clerk
• House bills are abbreviated “H.R.”
• The first reading of a bill in the House means its title is read on the
House Floor; it is then referred to committee for markup
• In the Senate, a bill is introduced by placing it on the presiding
officer’s desk or by formally introducing it on the Senate Floor
• Senate bills are abbreviated “S.”
• Once introduced in the Senate, a bill is also referred to committee for
markup
• Once a bill is formally introduced in either the House or the
Senate, the Library of Congress receives an electronic copy
• The Library of Congress then posts the bill and its status on a
public website named THOMAS, http://thomas.loc.gov/;
updates on bills at each step of the process are also included
on the THOMAS website
Topic Review:
How a Bill Becomes a Law
• There are 19 House Standing
Committees and 16 Senate
Committees, each with jurisdiction over
a specific area of public policy
• Committee Actions:
• Bill is placed on Committee Calendar
• Bill is debated and altered (if deemed
necessary) utilizing parliamentary procedures
• Bill may be “tabled” if it is determined to be
unwise or unnecessary
• Bill may be referred to subcommittee for
further evaluation
• Subcommittee evaluation of a bill mirrors that
of Committee evaluation, but subcommittees
may include hearings to obtain views of
experts, supporters, and opponents
• Once a subcommittee approves a bill, it is sent
back to the full committee for a vote
• Bill is voted upon after it is debated and/or
amended
• Approved bill is reported back to the House
or Senate Floor
Topic Review:
How a Bill Becomes a Law
• The bill is termed “reported” once it
has passed through Committee; the
bill is accompanied by a report
outlining all of its provisions, hence the
term “reported”
Topic Review:
How a Bill Becomes a Law
• A reported bill is then placed on a
House calendar for “consideration”
on the House floor
• Debate ensues according to
established parliamentary procedure
(which may be special rules for the
specific bill)
• After the debate, the second reading
of the bill occurs, allowing the
opportunity for scrutiny and further
amendment
• Following further amendment (if
performed), the bill is read a third
time in preparation for a vote by the
House
Topic Review:
How a Bill Becomes a Law
• House voting:
• The bill is read by title only and put to a vote
• Members of the House who are present vote to
pass or not to pass the bill
• The House has an electronic voting system
• Members may vote to pass the bill (“yea”), not to pass
the bill (“nay”), or abstain (“present”)
• The bill passes with a majority vote of the House
• A bill is termed “engrossed” once it (and its
amendments) has passed the House and has
been certified by the Clerk
• A bill that passes the House is then referred to
the Senate to undergo a similar process again
Topic Review:
How a Bill Becomes a Law
• Senate voting:
• The Senate may decide to vote on a House bill or
to continue its own legislation
• The bill may be sent to committee
• The bill may be voted upon by Senators
• If the bill undergoes revision within and passes
the Senate with language other than what was
introduced, the bill must be sent to a conference
committee for review
• The conference committee is comprised of members
from both the House and the Senate
• Differences must be reconciled before the bill
may be sent to the President for signature
• A bill must pass both the House and the Senate
in order to become a law
Topic Review:
How a Bill Becomes a Law
• A bill is termed “enrolled” when it is
submitted to the President for
signature
• The President may:
• Take no action (if Congress is in
session, the bill automatically
becomes law in 10 days)
• Pocket veto (if Congress is not in
session and the bill is not signed in 10
days, it does NOT become a law)
• Veto the bill
• Sign the bill to make it a law
• A bill becomes a law once it has
passed both the House and the
Senate and has been signed by the
President, or if Congress overrides a
President’s veto
Topic Review:
How a Bill Becomes a Law
• If a Presidential veto occurs:
• The bill returns to either the House or the Senate,
wherever it originated
• Objections to the veto are read and debated
• If enough objections to the veto exist, a vote to
override the veto may be obtained
• If the vote on the veto override passes, the bill
becomes a law
• In order to pass, a 2/3 majority of BOTH the House and
the Senate is required
• If the House or Senate does not vote on a veto
override, or if the vote on the veto override fails,
the bill does not become a law
Topic Review:
How a Bill Becomes a Law
• So, WHY did we time-travel back to fifthgrade social sciences to review all of this
stuff?
• Our brains are currently inundated with medical
jargon
• We got free food for coming to the meeting
• It’s required for induction into the national
osteopathic political action honor society, Omega
Beta Iota (ΩΒΙ)
• It’s important to understand the basics and
the processes behind the legislation we will
be lobbying to support in DC during D.O. Day
on the Hill!
Save the Date
D.O. Day on the Hill
April 26, 2007
Register online now! www.do-online.org
THANK YOU FOR YOUR
ATTENTION!
QUESTIONS???
Notes
• Part II of the SOMA Political Action
Training Course will be coming to you
in the beginning of March!
• Topic: The osteopathic medical student
lobbyist how-to guide
• Part III of the SOMA Political Action
Training Course will be coming to you
in late March or early April!
• Topic: Preliminary introduction and review
of 2007 AOA priority issues to be lobbied
during D.O. Day on the Hill
References
• Licciardone JC. A comparison of patient visits to osteopathic
and allopathic general and family medicine physicians: results
from the national ambulatory medical care survey.
Osteopathic Medicine and Primary Care, 1:2, January 12,
2007.
• AOA 2006 Report, including data from AACOM, accessed online
at https://www.do-online.org/pdf/ost_factsheet.pdf
• www.do-online.org
• AOA’s 110th Congress Legislative, Regulatory, and Advocacy
Agenda, accessed online at https://www.doonline.org/pdf/110thCongressReport.pdf
• http://bensguide.gpo.gov/9-12/government/branches.html
• http://clerkkids.house.gov/laws/bill_begin.html
• Google images search