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Congressional Committees and the Legislative Process

U.S. Capitol dome.

Library of Congress

This lesson plan introduces students to the pivotal role that Congressional committees play in the legislative process, focusing on how their own Congressional representatives influence legislation through their committee appointments. Students begin by reviewing the stages of the legislative process, then learn how committees and subcommittees help determine the outcome of this process by deciding which bills the full Congress will consider and by shaping the legislation upon which votes are finally cast. With this background, students research the committee and subcommittee assignments of their Congressional representatives, then divide into small groups to prepare class reports on the jurisdictions of these different committees and their representatives' special responsibilities on each one. Finally, students consider why representation on these specific committees might be important to the people of their state or community, and examine how the committee system reflects some of the basic principles of American federalism.

Guiding Questions

What role do Committees play during the legislative process?

How is Committee membership determined?

What role do Committees play with regard to oversight and checks and balances?

Learning Objectives

Analyze the legislative process of the United States Congress by focusing on the role of Committees. 

Evaluate how Congressional representatives can influence legislation through their specific committee assignments.

Evaluate how Committees uphold the Constitutional responsibilities of the Legislative Branch. 

Lesson Plan Details

NCSS.D2.His.1.9-12. Evaluate how historical events and developments were shaped by unique circumstances of time and place as well as broader historical contexts.

NCSS.D2.His.2.9-12. Analyze change and continuity in historical eras.

NCSS.D2.His.3.9-12. Use questions generated about individuals and groups to assess how the significance of their actions changes over time and is shaped by the historical context.

NCSS.D2.His.12.9-12. Use questions generated about multiple historical sources to pursue further inquiry and investigate additional sources.

NCSS.D2.His.14.9-12. Analyze multiple and complex causes and effects of events in the past.

NCSS.D2.His.15.9-12. Distinguish between long-term causes and triggering events in developing a historical argument.

NCSS.D2.His.16.9-12. Integrate evidence from multiple relevant historical sources and interpretations into a reasoned argument about the past.

Begin this lesson by guiding students through the basic process by which a bill becomes law in the United States Congress. The Schoolhouse Rock cartoon "I'm Just a Bill" below provides a look at the process and can be accompanied by a flow-chart diagram of this process.

A detailed explanation of the legislative process is available through EDSITEment at the CongressLink website. At the website homepage, click "Table of Contents" in the lefthand menu, then look under the heading, "Know Your Congress" for the link to How Our Laws Are Made , which describes lawmaking from the House of Representatives' point of view.

For a corresponding description from the Senate's perspective, look under the "Know Your Congress" heading for the link to "Information about Congress," then select "... The Legislative Process," and click " ... Enactment of a Law ." CongressLink also provides access to a more succinct account of the legislative process: on the "Table of Contents" page, scroll down and click "Related Web Sites," then scroll down again and click THOMAS , a congressional information website maintained by the Library of Congress. Click "About the U.S. Congress" and select "About the U.S. Congress" from the list that follows for a chapter from the U.S. Government Manual that includes this outline of the process:

• When a bill ... is introduced in the House, [it is assigned] to the House committee having jurisdiction.
• If favorably considered, it is reported to the House either in its original form or with recommended amendments.
• If ... passed by the House, it is messaged to the Senate and referred to the committee having jurisdiction.
• In the Senate committee the bill, if favorably considered, may be reported in the form it is received from the House, or with recommended amendments.
• The approved bill ... is reported to the Senate and, if passed by that body, returned to the House.
• If one body does not accept the amendments to a bill by the other body, a conference committee comprised of Members of both bodies is usually appointed to effect a compromise.
• When the bill ... is finally approved by both Houses, it is signed by the Speaker ... and the Vice President ... and is presented to the President.
• Once the President's signature is affixed, the measure becomes a law. If the President vetoes the bill, it cannot become law unless it is re-passed by a two-thirds vote of both Houses.

Point out to students the important role that Congressional committees play in this process. Public attention usually focuses on the debate over legislation that occurs on the floor of the House and Senate, but in order for a bill to reach the floor on either side, it must first be approved by a committee, which can also amend the bill to reflect its views on the underlying issue. Congressional committees, in other words, largely control the legislative process by deciding which bills come to a vote and by framing the language of each bill before it is debated.

Provide students with background on the organization and operation of Congressional committees, using resources available through the U.S. Congress  website. A schedule of Congressional committee hearings can be used to identify topics currently under consideration. 

• Although committees are not mentioned in the Constitution, Congress has used committees to manage its business since its first meetings in 1789.
• Committees enable Congress to divide responsibility for its many tasks, including legislation, oversight, and internal administration, and thereby cope effectively with the great number and complexity of the issues placed before it.
• There are today approximately 200 Congressional committees and subcommittees in the House and Senate, each of which is responsible for considering all matters that fall within its jurisdiction.
• Congress has three types of committees: (1) Standing Committees are permanent panels with jurisdiction over broad policy areas (e.g., Agriculture, Foreign Relations) or areas of continuing legislative concern (e.g., Appropriations, Rules); (2) Select Committees are temporary or permanent panels created to consider a specific issue that lies outside the jurisdiction of other committees or that demands special attention (e.g., campaign contributions); (3) Joint Committees are panels formed by the House and Senate together, usually to investigate some common concern rather than to consider legislation, although joint committees known as Conference Committees are formed to resolve differences between House and Senate versions of a specific measure.
• Many committees divide their work among subcommittees, upon which a limited number of the committee members serve. Subcommittees are responsible for specific areas within the committee's jurisdiction and report their work on a bill to the full committee, which must approve it before reporting the bill to its branch of Congress.
• Party leaders determine the size of each committee, which average about 40 members in the House and about 18 members in the Senate, and determine the proportion of majority and minority committee members. The majority party always has more seats on a committee and one of its members chairs the committee. Each party also determines committee assignments for its members, observing rules that have been adopted to limit the number and type of committees and subcommittees upon which one member can serve.
• Each committee's chairperson has authority over its operation. He or she usually sets the committee's agenda, decides when to take or delay action, presides at most committee meetings, and controls the committee's operating budget. Subcommittee chairpersons exercise similar authority over their smaller panels, subject to approval by the committee chair.
• The work of Congressional committees begins when a bill that has been introduced to the House or Senate is referred to the committee for consideration. Most committees take up only a small percentage of the bills referred to them; those upon which the committee takes no action are said to "die in committee." The committee's first step in considering a bill is usually to ask for written comment by the executive agency that will be responsible for administering it should it become law. Next, the committee will usually hold hearings to gather opinions from outside experts and concerned citizens. If the committee decides to move forward with the bill, it will meet to frame and amend the measure through a process called markup. Finally, when the committee has voted to approve the bill, it will report the measure to its branch of Congress, usually with a written report explaining why the measure should be passed.
• Once a bill comes to the floor of the House or Senate, the committee that reported it is usually responsible for guiding it through debate and securing its passage. This can involve working out parliamentary strategies, responding to questions raised by colleagues, and building coalitions of support. Likewise, if the House and Senate pass different versions of a bill, the committees that reported each version will take the lead in working out a compromise through a conference committee.

Activity 1. Research the committees and subcommittees

Begin by viewing the Library of Congress video on Congressional Committees . Have students research the committees and subcommittees upon which their Congressional representatives serve, using library resources or the resources available through the U.S. Congress  website.

• To help students find out who your Congressional representatives are, use the U.S. Congress  website to search by state.
• Click on the name of each representative for a profile, including a photograph, which lists the representative's committee assignments.
• The U.S. Congress  website page provides information pertaining to sponsored and cosponsored legislation, member websites, and allows users to track legislation.
• To find out which committees and subcommittees a representative serves on, use the U.S. Congress Committee Reports page .
• For an overview of Congressional committees and their jurisdictions, use the  U.S. Congress Committee Reports page .

Congressional Committee Activity:

Divide the class into small groups and have each group prepare a report on one of the committees (or subcommittees) upon which one of your Congressional representatives serves, including the size of the committee, its jurisdiction, and whether your representative has a leadership post on the committee. Encourage students to include as well information about legislation currently before the committee. They can find this information using library resources or through the  U.S. Congress Committee Reports page . 

After students present their reports, discuss how committee assignments can affect a Congressional representative's ability to effectively represent his or her constituents.

• Do your representatives have seats on committees with jurisdiction over issues that have special importance for your state or community? If so, how might their presence on these committees help assure that Congress takes action on questions of local interest?
• Do your representatives have seats on committees with jurisdiction over important legislative activities, such as budget-making or appropriations? If so, how might their presence on these powerful committees help assure that your community's views receive careful Congressional consideration?

After exploring these questions, have students debate the extent to which a Congressional representative's committee vote may be more influential than his or her vote on the floor of the House or Senate. Which vote has more impact on legislation? In this regard, have students consider President Woodrow Wilson's observation that "Congress in session is Congress on public exhibition, whilst Congress in its committee-rooms is Congress at work."

Activity 2. How do Congressional committees reflects some of the fundamental principles of federalism?

Conclude by having students consider how the structure and function of Congressional committees reflects some of the fundamental principles of federalism. For a broad discussion of federalism, have students read The Federalist No. 39 , in which James Madison highlights the Constitution's provisions for a federal, as distinguished from a national, form of government.

Have students imagine, for example, that they are members of a Congressional committee that is considering a bill with special importance for the people of your community.

• How would they balance their responsibilities to their constituents with their responsibilities to the nation as a whole?
• To what extent is this a question each Congressional representative must answer individually?
• To what extent is it a question that the mechanisms of our government answer through the legislative process?

Related on EDSITEment

Commemorating constitution day, a day for the constitution, balancing three branches at once: our system of checks and balances.

The House Explained

We the People of the United States…

As per the Constitution, the U.S. House of Representatives makes and passes federal laws. The House is one of Congress’s two chambers (the other is the U.S. Senate), and part of the federal government’s legislative branch. The number of voting representatives in the House is fixed by law at no more than 435, proportionally representing the population of the 50 states.

Learn About:

What is a representative.

Also referred to as a congressman or congresswoman, each representative is elected to a two-year term serving the people of a specific congressional district. Among other duties, representatives introduce bills and resolutions, offer amendments and serve on committees. The number of representatives with full voting rights is 435, a number set by Public Law 62-5 on August 8, 1911, and in effect since 1913. The number of representatives per state is proportionate to population.

Article 1, Section 2 of the Constitution provides for both the minimum and maximum sizes for the House of Representatives. Currently, there are five delegates representing the District of Columbia, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. A resident commissioner represents Puerto Rico. The delegates and resident commissioner possess the same powers as other members of the House, except that they may not vote when the House is meeting as the House of Representatives.

To be elected, a representative must be at least 25 years old, a United States citizen for at least seven years and an inhabitant of the state he or she represents.

Go to the Clerk’s site for more information about representatives.

View the list of House members.

Find Your Representative

Enter your ZIP code in the banner of this page to find the representative for your congressional district.

Did You Know?

After extensive debate, the framers of the Constitution agreed to create the House with representation based on population and the Senate with equal representation. This agreement was part of what is referred to as The Great Compromise .

House leadership includes the speaker, majority and minority leaders, assistant leaders, whips and a party caucus or conference. The speaker acts as leader of the House and combines several institutional and administrative roles. Majority and minority leaders represent their respective parties on the House floor. Whips assist leadership in managing their party's legislative program on the House floor. A party caucus or conference is the name given to a meeting of or organization of all party members in the House. During these meetings, party members discuss matters of concern.

The majority party members and the minority party members meet in separate caucuses to select their leader. Third parties rarely have had enough members to elect their own leadership, and independents will generally join one of the larger party organizations to receive committee assignments.

Learn more about the history of the majority and minority leaders from the Office of the Clerk .

Leadership List

View the list of leadership offices and links to the websites.

Past Leadership

Curious about who else has been Speaker of the House or Majority Leader?  Read more about  past house leadership .

Do You Know?

How many people have served as Speaker of the House? Has the Speaker ever become President? Find out more about the history of the Speakership!

The House’s standing committees have different legislative jurisdictions. Each considers bills and issues and recommends measures for consideration by the House. Committees also have oversight responsibilities to monitor agencies, programs, and activities within their jurisdictions, and in some cases in areas that cut across committee jurisdictions.

The Committee of the Whole House is a committee of the House on which all representatives serve and which meets in the House Chamber for the consideration of measures from the Union calendar.

Before members are assigned to committees, each committee’s size and the proportion of Republicans to Democrats must be decided by the party leaders. The total number of committee slots allotted to each party is approximately the same as the ratio between majority party and minority party members in the full chamber.

Get answers to frequently asked questions about committees from the Clerk of the House.

Committee Websites

All committees have websites where they post information about the legislation they are drafting.

What's a Select Committee?

The House will sometimes form a special or select committee for a short time period and specific purpose, frequently an investigation.

Each committee has a chair and a ranking member. The chair heads the full committee. The ranking member leads the minority members of the committee.

Congress has created a wide variety of temporary and permanent commissions to serve as advisory bodies for investigative or policy-related issues, or to carry out administrative, interparliamentary, or commemorative tasks. Such commissions are typically created by either law or House resolution, and may be composed of House members, private citizens, or a mix of both. In some cases, the commissions are entities of the House or Congress itself; in other cases, they are crafted as independent entities within the legislative branch.

Examples of commissions

• Financial Crisis Inquiry Commission: a temporary, independent investigative body created by law and made up of private citizens.
• Commission on Security and Cooperation in Europe (also known as the Helsinki Commission): an independent U.S. government agency composed of nine members of the United States Senate, nine from the House of Representatives, and one member each from the Departments of State, Defense and Commerce.
• House Page Board: a permanent, Congressional advisory group created by law and made up of House members, Officers, and private citizens.

House Commissions

• Congressional Executive Commission on China
• Commission on Security and Cooperation in Europe (Helsinki Commission)
• House Democracy Partnership Commission
• Tom Lantos Human Rights Commission
• U.S.-China Economic and Security Review Commission

Whether working on Capitol Hill or in his / her congressional district, a representative’s schedule is extremely busy. Often beginning early in the morning with topical briefings, most representatives move quickly among caucus and committee meetings and hearings. They vote on bills, speak with constituents and other groups, and review constituent mail, press clips and various reports. Work can continue into the evening with receptions or fundraising events.

Key Concept

Representatives carry out a broad scope of work in order to best represent their constituents.

Contact Your Representative

Share your thoughts with your representative. Use the Find Your Representative box in the banner of this site to identify your representative, then use the contact form to share your thoughts.

Representatives’ schedules are sometimes planned out in increments as short as five minutes.

House Rules

The Rules of the House of Representatives for the 118th Congress were established by the House with the adoption of H. Res. 5 (PDF) on January 9, 2023. A section by section analysis is also available.

Rules of Conduct

The Committee on Ethics has jurisdiction over the rules and statutes governing the conduct of members, officers and employees while performing their official duties.

The Rules Committee controls what bills go to the House Floor and the terms of debate.

Majority Rules

The makeup of the Rules Committee has traditionally been weighted in favor of the majority party, and has been in its current configuration of 9 majority and 4 minority members since the late 1970s.

The Rules Committee has an online Parliamentary Bootcamp that gives an overview of House Floor procedures, process and precedents.

As outlined in the Constitution , the House represents citizens based on district populations, while the Senate represents citizens on an equal state basis. This agreement was part of what is called The Great Compromise which, in turn, led to the Permanent Seat of Government Act establishing the nation’s federal capital in Washington, DC. In 1789, the House assembled for the first time in New York. It moved to Philadelphia in 1790 and then to Washington, DC, in 1800.

Each member of the House represents a set number of constituents.

More House History

Learn more about the History of the House from the Clerk’s website.

The House of Representatives moved into the House wing on the south side of the Capitol in 1807, four years before the wing was fully completed.

What the 21 McCarthy holdouts got in committee assignments

WASHINGTON — The 21 House Republicans who initially blocked Rep. Kevin McCarthy from winning the speakership had demanded big changes to House rules, but they also wanted more influence on the congressional committees that will set the GOP agenda over the next two years.

While not every holdout got exactly what he or she had asked for, some won plum committee assignments from McCarthy, R-Calif., and his allies after they helped him secure the speaker's gavel , a process that took 15 rounds of voting.

As part of his deal with detractors, McCarthy named three conservative rabble rousers — Reps. Chip Roy of Texas, Ralph Norman of South Carolina and Thomas Massie of Kentucky — to the influential Rules Committee, which decides how exactly bills come to the House floor.

Here's what we know so far:

• Rep. Andy Biggs of Arizona , a former head of the Freedom Caucus and one of the five so-called Never Kevins , will keep his spots on the powerful Judiciary and Oversight committees. He was also named chairman of Judiciary's subcommittee on Crime and Federal Government Surveillance. Biggs changed his vote to "present" on the final ballot for speaker, helping push McCarthy over the finish line.
• Rep. Dan Bishop of North Carolina , one of 13 holdouts who flipped to back McCarthy on the 12th ballot, will continue to serve on both the Judiciary and Homeland Security committees. McCarthy also named Bishop to Judiciary's new subcommittee on the "Weaponization of the Federal Government."
• Rep. Lauren Boebert of Colorado , a vocal McCarthy critic who voted "present" on the 14th and 15th ballots, was awarded a seat on the Oversight and Accountability Committee, which plans to launch numerous investigations into the Biden administration. She will continue to serve on the Natural Resources panel, on which she served in the previous Congress.
• Freshman Rep. Josh Brecheen of Oklahoma , who flipped to McCarthy on the 12th ballot, won seats on the Homeland Security Committee and Budget committees.
• Rep. Mike Cloud of Texas , who also flipped to McCarthy on the 12th ballot, won a new seat on the powerful Appropriations Committee, which controls federal spending. McCarthy also named him to the new select committee investigating the origins of the Covid pandemic.
• Rep. Andrew Clyde of Georgia , another lawmaker who flipped to McCarthy on the 12th ballot, will serve for the first time on Appropriations.
• Freshman Rep. Eli Crane of Arizona , who voted "present" on the 15th ballot, will serve on the Homeland Security Committee.
• Rep. Byron Donalds of Florida , who was nominated to run against McCarthy for speaker and flipped to him on the 12th ballot, was named by McCarthy as the "speaker's designee" on the influential Steering Committee, which decides which lawmakers get committee gavels and seats. Donalds also won a coveted spot on the Financial Services Committee, a top panel known on Capitol Hill as an "A" committee.
• Rep. Matt Gaetz of Florida , perhaps the most vocal McCarthy foe during the speaker fight, who flipped to "present" in the 14th round, will continue to serve on the Judiciary panel and was appointed by McCarthy to the new weaponization subcommittee .
• Rep. Bob Good of Virginia , one of the Never Kevins who flipped to "present" in the last round of voting, will serve on the Budget and Education and Workforce committees.
• Rep. Paul Gosar of Arizona , who flipped to McCarthy on the 12th ballot, was reinstated by Republicans on two committees —Oversight and Natural Resources panels — after Democrats removed him two years ago for posting threats to lawmakers on social media. He was named chairman of the Natural Resources subcommittee on Oversight and Investigations.
• Rep. Andy Harris of Maryland , who flipped to McCarthy on the 13th ballot, will continue to serve on the Appropriations panel. Harris, a physician, will be the chairman of the Agriculture, Rural Development, Food and Drug Administration subcommittee.
• Freshman Rep. Anna Paulina Luna of Florida , who flipped to McCarthy on the 12th ballot, won a seats on the Oversight and Natural Resources panels.
• Rep. Mary Miller of Illinois , who flipped to McCarthy on the 12th ballot, will remain on the Agriculture Committee.
• Rep. Ralph Norman of South Carolina , one of the Never Kevins who flipped to McCarthy on the 12th ballot, was named by the speaker as one of nine Republicans on the Rules Committee. Norman also will remain on the Financial Services panel, which he joined in June, and will serve on the Budget Committee too.
• Freshman Rep. Andy Ogles of Tennessee , who flipped to McCarthy on the 12th ballot, also won a seat on Financial Services.
• Rep. Scott Perry of Pennsylvania , the chairman of the far-right House Freedom Caucus who brokered a deal between conservatives and McCarthy, will remain on the Foreign Affairs Committee. A subject of Jan. 6 investigations , Perry won a new seat on the Oversight committee.
• Rep. Matt Rosendale of Montana , a Never Kevin who flipped to "present" on the final ballot, will continue to serve on Natural Resources.
• Rep. Chip Roy of Texas , who along with Perry helped negotiate a deal with McCarthy, was tapped to serve on the Budget committee and the influential Rules Committee. Roy will also keep his seat on the Judiciary panel.
• Freshman Rep. Keith Self, R-Texas , who flipped to McCarthy on the 12th ballot, will serve on the Foreign Affairs panel.
• Rep. Victoria Spartz of Indiana , who flipped from "present" to vote for McCarthy on the 12th ballot, will continue to serve on the Judiciary panel.

In addition to committee assignments, McCarthy had made other concessions to his right flank.

In the package of rules changes McCarthy and the Freedom Caucus negotiated for the 118th Congress was a provision allowing a single lawmaker to force a floor vote to oust McCarthy as speaker. They also agreed to make it harder to raise federal spending, taxes and the debt ceiling, and to create select committees to investigate the Chinese Communist Party and the "weaponization of the federal government."

Some Freedom Caucus members who stuck with McCarthy from the very start also did well for themselves. Rep. Marjorie Taylor Greene, R-Ga., a McCarthy ally whom Democrats stripped of her committee assignments two years ago, won seats on the Oversight and Homeland Security committees.

Meanwhile, Rep. Warren Davidson of Ohio, a Freedom Caucus member who nominated McCarthy on the fifth ballot , was named chairman of the Financial Services subcommittee on Housing and Insurance.

Scott Wong is a senior congressional reporter for NBC News.

Kyle Stewart is a field producer covering Congress for NBC News.

The independent source for health policy research, polling, and news.

Congress and the Executive Branch and Health Policy

Published: May 28, 2024

KFF Author:

Julie Rovner

Table of Contents

Introduction.

The federal government is not the only place health policy is made in the U.S., but it is by far the most influential. Of the $4.5 trillion the U.S. spent on health in 2022, the federal government was responsible for roughly a third of all health services. The payment and coverage policies set for the Medicare program, in particular, often serve as a model for the private sector. Many health programs at the state and local levels are also impacted by federal health policy, either through direct spending or rules and requirements. Federal health policy is primarily guided by Congress, but carried out by the executive branch, predominantly by the Department of Health and Human Services.  

The Federal Role in Health Policy 

No one is “in charge” of the fragmented U.S. health system, but the federal government probably has the most influence, a role that has grown over the last 75 years. Today the federal government pays for care, provides it, regulates it, and sponsors biomedical research and medical training.   

The federal government pays for health coverage for well over 100 million Americans through Medicare , Medicaid , the Children’s Health Insurance Program (CHIP), the Veterans’ Health Administration, the Indian Health Service, and the Affordable Care Act (ACA) .  It also pays to help provide insurance coverage for tens of millions who are active-duty and retired military and for civilian federal workers. 

Federal taxpayers also underwrite billions of dollars in health research, mainly through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).   

Federal public health policy is spearheaded by the Centers for Disease Control and Prevention . Its portfolio includes tracking not just infectious disease outbreaks in the U.S. and worldwide, but also conducting and sponsoring public health research and tracking national health statistics.  

The Health Resources and Services Administration (HRSA) funds critical health programs for underserved Americans (including Community Health Centers) and runs workforce education programs to bring more health services to places without enough health care providers.  

Meanwhile, in addition to overseeing the nation’s largest health programs, the Centers for Medicare and Medicaid Services (CMS) also operates the federal insurance Marketplaces created by the ACA and enforces rules made by the law for private insurance policies.  

While the federal government exercises significant authority over medical care and its practice and distribution, state and local governments still have key roles to play.   

States oversee the licensing of health care professionals, distribution of health care resources, and regulation of health insurance plans that are not underwritten by employers themselves. State and local governments share responsibility for most public health activities and often operate safety-net facilities in areas with shortages of medical resources.  

The Three Branches of Government and How They Impact Health Policy 

All three branches of the federal government – Congress, the executive branch, and the judiciary – play important roles in health policy.  

Congress makes laws that create new programs or modify existing ones. It also conducts “oversight” of how the executive branch implements the laws Congress has passed. Congress also sets the budget for “discretionary” and “mandatory” health programs ( see below ) and provides those dollar amounts.  

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations. Federal workers in the health arena may provide direct patient care, regulate how others provide care, set payment rates and policies, conduct medical or health systems research, regulate products sold by the private sector, and manage the billions of dollars the federal government spends on the health-industrial complex.   

Historically, the judiciary has had the smallest role in health policy but has played a pivotal role in recent cases. It passes judgment on how or whether certain laws or policies can be carried out and settles disputes between the federal government, individuals, states, and private companies over how health care is regulated and delivered.  Recent significant decisions from the Supreme Court have affected the legality and availability of abortion and other reproductive health services and the constitutionality of major portions of the ACA. 

The Executive Branch – The White House 

Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself has taken on a more prominent role in policy formation. The White House Office of Management and Budget not only coordinates the annual funding requests for the entire executive branch, but it also reviews and approves proposed regulations, Congressional testimony, and policy recommendations from the various departments. The White House also has its own policy support agencies – including the National Security Council, the National Economic Council, the Domestic Policy Council, and the Council of Economic Advisors, that augment what the President receives from other portions of the executive branch. 

How the Department of Health and Human Services is Structured

Most federal health policy is made through the Department of Health and Human Services . Exceptions include the Veterans Health Administration , run by the Department of Veterans Affairs; TRICARE , the health insurance program for active-duty military members and dependents, run by the Defense Department; and the Federal Employees Health Benefits Program (FEHB), which provides health insurance for civilian federal workers and families and is run by the independent agency the Office of Personnel Management.   

The health-related agencies within HHS are roughly divided into the resource delivery, research, regulatory, and training agencies that comprise the U.S. Public Health Service and the health insurance programs run by the Centers for Medicare and Medicaid Services (CMS).  

Nine of the 12 operating divisions of HHS are part of the U.S. Public Health Service, which also plays a role in U.S. global health programs. They are:  

• The Administration for Strategic Preparedness and Response (ASPR)  
• The Agency for Healthcare Research and Quality (AHRQ)  
• The Agency for Toxic Substances and Disease Registry (ATSDR)  
• The Centers for Disease Control and Prevention (CDC)  
• The Food and Drug Administration (FDA)  
• The Health Resources and Services Administration (HRSA)  
• The Indian Health Service (IHS)  
• The National Institutes of Health (NIH)  
• The Substance Abuse and Mental Health Services Administration (SAMHSA)  

The Centers for Medicare and Medicaid Services (CMS) is by far the largest operating division of HHS. It oversees not just the Medicare and Medicaid programs, but also the federal Children’s Health Insurance Program (CHIP) and the health insurance portions of the Affordable Care Act. Together, the programs under the auspices of CMS account for nearly a quarter of all federal spending in fiscal 2023 , cost an estimated $1.5 Trillion in fiscal 2023, and served more than 170 million Americans – more than half the population.  

Who Makes Health Policy in Congress?

How Congress oversees the federal health care-industrial complex is almost as byzantine as the U.S. health system itself. Jurisdiction and responsibility for various health agencies and policies is divided among more than two dozen committees in the House and Senate (see Table 1 and Table 2 below).  

In each chamber, however, three major committees deal with most health issues.   

In the House, the Ways and Means Committee , which sets tax policy, oversees Part A of Medicare (because it is funded by the Social Security payroll tax) and shares jurisdiction over other parts of the Medicare program with the Energy and Commerce Committee. Ways and Means also oversees tax subsidies and credits for the Affordable Care Act and tax policy for most employer-provided insurance.   

The Energy and Commerce Committee has sole jurisdiction over the Medicaid program in the House and shares jurisdiction over Medicare Parts B, C, and D with Ways and Means. Energy and Commerce also oversees the U.S. Public Health Service, whose agencies include the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention.   

While Ways and Means and Energy and Commerce are in charge of the policymaking for most of the federal government’s health programs, the actual amounts allocated for many of those programs are determined by the House Appropriations Committee through the annual Labor-Health and Human Services-Education and Related Agencies spending bill.   

In the Senate, responsibility for health programs is divided somewhat differently. The Senate Finance Committee , which, like House Ways and Means, is in charge of tax policy, oversees all of Medicare and Medicaid and most of the ACA.   

The Senate counterpart to the House Energy and Commerce Committee is the Senate Health, Education, Labor and Pensions Committee , which has jurisdiction over the Public Health Service (but not Medicare or Medicaid).   

The Senate Appropriations Committee , like the one in the House, sets actual spending for discretionary programs as part of its annual Labor-HHS-Education spending bill.  

The Federal Budget Process

Under Article 1 of the U.S. Constitution , Congress is granted the exclusive power to “lay and collect Taxes, Duties, Imposts and Excises, and to pay the Debts and provide for the common Defence and General Welfare of the United States.”   

In 1974, lawmakers passed the Congressional Budget and Impoundment Control Act in an effort to standardize the annual process for deciding tax and spending policy for each federal fiscal year and to prevent the executive branch from making spending policy reserved to Congress. Among other things, it created the House and Senate Budget Committees and set timetables for each step of the budget process.   

Perhaps most significantly, the 1974 Budget Act also created the Congressional Budget Office (CBO). This non-partisan agency has come to play a pivotal role in not just the budget process, but in the lawmaking process in general. The CBO issues economic forecasts, policy options, and other analytical reports, but it most significantly produces estimates of how much individual legislation would cost or save the federal government. Those estimates can and do often determine if legislation passes or fails.  

The annual budget process is supposed to begin the first Monday in February, when the President is to present his proposed budget for the fiscal year that begins the following Oct. 1. This is one of the few deadlines in the Budget Act that is usually met.  

After that, the action moves to Congress. The House and Senate Budget Committees each write their own “Budget Resolution,” a spending blueprint for the year that includes annual totals for mandatory and discretionary spending. Because mandatory spending (roughly two-thirds of the budget) is automatic unless changed by Congress, the budget resolution may also include “reconciliation instructions” to the committees that oversee those programs (also known as “authorizing” committees) to make changes to bring the cost of the mandatory programs in line with the terms of the budget resolution. The discretionary total will eventually be divided by the House and Senate Appropriations Committees between the 12 subcommittees, each responsible for a single annual spending (appropriations) bill. Most of those bills cover multiple agencies – the appropriations bill for the Department of Health and Human Services, for example, also includes funding for the Departments of Labor and Education.   

After the budget resolution is approved by each chamber’s Budget Committee, it goes to the House and Senate floor, respectively, for debate. Assuming the resolutions are approved, a “conference committee” comprised of members from each chamber is tasked with working out the differences between the respective versions. A final compromise budget resolution is supposed to be approved by both chambers by April 15 of each year. ( This rarely happens .) Because the final product is a resolution rather than a bill, the budget does not go to the President to sign or veto.   

The annual appropriations process kicks off May 15, when the House may start considering the 12 annual spending bills for the fiscal year that begins Oct. 1. By tradition, spending bills originate in the House, although sometimes, if the House is delayed in acting, the Senate will take up its own version of an appropriation first. The House is supposed to complete action on all 12 spending bills by June 30, in order to provide enough time to let the Senate act, and for a conference committee to negotiate a final version that each chamber can approve by October 1.  

That October 1 deadline is the only one with consequences if it is not met. Unless an appropriations bill for each federal agency is passed by Congress and signed by the President by the start of the fiscal year, that agency must shut down all “non-essential” activities funded by discretionary spending until funding is approved. Because Congress rarely passes all 12 of the appropriations bills by the start of the fiscal year (the last time was in 1996, for fiscal year 1997), it can buy extra time by passing a “continuing resolution” (CR) that keeps money flowing, usually at the previous fiscal year’s level. CRs can last as little as a day and as much as the full fiscal year and may cover all of the federal government (if none of the regular appropriations are done) or just the departments for the unfinished bills. Congress may, and frequently does, pass multiple CRs while it works to complete the appropriations process.  

While each appropriations bill is supposed to be considered individually, to save time (and sometimes to win needed votes), a few, several, or all the bills may be packaged into a single “omnibus” measure. Bills that package only a handful of appropriations bills are cheekily known as “minibuses.”   

Meanwhile, if the budget resolution includes reconciliation instructions, that process proceeds on a separate track. The committees in charge of the programs requiring alterations each vote on and report their proposals to the respective budget committees, which assemble all of the changes into a single bill. At this point, the budget committees’ role is purely ministerial; it may not change any of the provisions approved by the authorizing committees.   

Reconciliation legislation is frequently the vehicle for significant health policy changes, partly because Medicare and Medicaid are mandatory programs. Reconciliation bills are subject to special rules, notably on the Senate floor, which include debate time limitations (no filibusters) and restrictions on amendments. Reconciliation bills also may not contain provisions that do not pertain directly to taxing or spending.  

Unlike the appropriations bills, nothing happens if Congress does not meet the Budget Act’s deadline to finish the reconciliation process, June 15. In fact, in more than a few cases, Congress has not completed work on reconciliation bills until the calendar year AFTER they were begun.    

A (Very Brief) Explanation of the Regulatory Process

Congress writes the nation’s laws, but it cannot account for every detail in legislation. So, it often leaves key decisions about how to interpret and enforce those laws to the various executive departments. Those departments write (and often rewrite) rules and regulations according to a very stringent process laid out by the 1946 Administrative Procedure Act (APA). The APA is intended to keep the executive branch’s decision-making transparent and to allow public input into how laws are interpreted and enforced. 

Most federal regulations use the APA’s “informal rulemaking” process, also known as “notice and comment rulemaking,” which consists of four main parts:  

• Publication of a “Notice of Proposed Rulemaking (NPRM)” in the Federal Register , a daily publication of executive branch activities.  
• Solicitation to the public to submit written comments for a specific period of time (usually from 30 to 90 days).  
• Agency consideration of public reaction to the proposed rule; and, finally  
• Publication of a final rule, with an explanation including how the agency took the public comments into account and what changes, if any, were made from the proposed rule. Final rules also include an effective date, which can be no less than 30 days but may be more than a year in the future.  

In situations where time is of the essence, federal agencies may truncate that process by issuing “interim final rules,” which can take effect even before the public is given a chance to comment. Such rules may or may not be revised later.   

Not all federal interpretation of laws uses the APA’s specified regulatory process. Federal officials also distribute guidance, agency opinions, or “statements of policy.”  

Future Outlook

Given how fragmented health policy is in both Congress and the executive branch, it should not be a surprise that major changes are difficult and rare.  

Add to that an electorate divided over whether the federal government should be more involved or less involved in the health sector, and huge lobbying clout from various interest groups whose members make a lot of money from the current operation of the system, and you have a prescription for inertia. 

Another problem is that when a new health policy can dodge the minefield of obstacles to become law, it almost by definition represents a compromise that may help it win enough votes for passage, but is more likely to complicate an already byzantine system further. 

Unless the health system completely breaks down, it seems unlikely that federal policymakers will be able to move the needle very far in either a conservative or a liberal direction. 

• FAQs on Health Spending, the Federal Budget, and Budget Enforcement Tools  
• Medicare 101 
• Medicaid 101
• The Affordable Care Act 101
• Employer-Sponsored Health Insurance
• The Regulation of Private Health Insurance
• The U.S. Government and Global Health  
• The U.S. Congress and Global Health: A Primer  

Rovner, Julie, Congress, the Executive Branch, and Health Policy. In Altman, Drew (Editor), Health Policy 101, (KFF, May 28, 2024) https://www.kff.org/health-policy-101-congress-and-the-executive-branch-and-health-policy/ (date accessed).

House Committees: Assignment Process

Internet divided as Nicole Mitchell's party demands resignation after she allegedly breaks into stepmother's house

M INNEAPOLIS, MINNESOTA: Democratic Minnesota state Senator Nicole Mitchell 's party is demanding that she resign more than a month after she was accused of breaking into her stepmother's house to take her late father's ashes and some of his personal belongings. 

"Elected officials should be held accountable, including members of our own party," stated Ken Martin, the chairman of the Minnesota Democratic-Farmer-Labor Party in a statement released on Thursday, May 30. 

What did Ken Martin say?

"While Senator Mitchell is entitled to her day in court, her continued refusal to take responsibility for her actions is beneath her office and has become a distraction for her district and the Legislature," Martin said, yas per Fox News . "Now that her constituents have had full representation through the end of the legislative session, it is time for her to resign to focus on the personal and legal challenges she faces," Martin added.

Nicole Mitchell was removed from committee assignments and caucus meetings 

Minnesota Governor Tim Walz , a Democrat, also said last week that Mitchell should resign, FOX9 Minneapolis reported. After Mitchell was arrested on April 22 at her stepmother's house, she was barred from committee assignments and caucus meetings. A first-degree burglary charge was later brought against the state senator.

Mitchell has refuted the accusations, saying she was just taking care of a sick loved one.

What does the criminal complaint against Nicole Mitchell state?

According to a criminal complaint, Mitchell admitted to investigators that she had entered through a window to retrieve sentimental items such as a flannel shirt, photos, and her late father's ashes. She claimed her stepmother had stopped talking to her after her father passed away and had refused to give her the items. 

Mitchell appeared in front of an ethics panel on May 7, but invoked her Fifth Amendment rights  and refused to speak. 

Republican lawmakers in Minnesota had called for Mitchell's resignation shortly after her arrest. Mitchell's next court hearing is set for June 10.

Nicole Mitchell was elected to the state Senate in 2022

Mitchell, a resident of Woodbury, Minnesota, was chosen to serve as the state senator for District 47 in 2022. She is a lieutenant colonel in the Air National Guard and was formerly a meteorologist for KSTP-TV and Minnesota Public Radio.

Internet says 'no one is above the law'

Netizens also gave their own opinions after news concerning Mitchell's resignation from her party broke out. One user opined, "No one is above the law. Most Democrats realize this. It is sad the party of law and order does not." Another wrote, "Dems used her up in MN to get her to Vote, after that was done Dems are trying to get rid of her." 

"It appears Democrats are now the party of law and order," added one user while another tweeted, "Wait . . . we've all been burgled by politicians. . . . Since when is this not acceptable." "Of course, this makes way too much sense, so she'll never resign," penned a user. 

This article contains remarks made on the Internet by individual people and organizations. MEAWW cannot confirm them independently and does not support claims or opinions being made online.