Health Policy and Law

Chapter 2

Policy and the Policymaking

Process

Chapter Overview

• Provides a basic overview of policy and the policymaking process

• Focuses on: – Defining policy – Public policymaking structure and process – Federal, state, and local health bureaucracy – Interest groups

Defining Policy • Who makes policy?

– Private actors – Government (federal, state, local) – Authoritative decision makers

• Public policy problems – Beyond individual concerns – Determine if a “decision” represents a “policy”

• Structuring policy options – Mandatory/voluntary – Take action/refrain from acting

Federal Policymaking Structure

• Legislative branch – House – Senate

• Executive branch – White House – Administrative agencies

• Judicial branch (discussed in chapter 3)

Federal Legislative Branch

• Congress is lawmaking body of federal government.

• Congress consists of Senate and House. – Senate: statewide; two senators from each

state – House: by district; proportional to

population, at least one representative per state

Legislative Branch: Committees

• Workhorse of Congress • Examples of key health committees

– Senate Finance, subcommittee on health care – Senate Health, Education, Labor, and Pensions – House Ways and Means – House Appropriations, subcommittee on Labor,

Health and Human Services, Education, and Related Agencies

Legislative Branch

• Constituents – Voters in state or district – Voters in nation if have leadership role or national

aspirations – Political party – President

Federal Executive Branch (1 of 4)

• White House – President – Executive offices assist and advise president

• 15 cabinet departments – Interpret and implement laws passed by Congress

Federal Executive Branch (2 of 4)

• Presidential powers/duties – Chief of State—symbol of the country and its

citizens – Chief Executive Officer—manages cabinet and

executive branch – Commander in Chief of the Armed Forces—top

ranking military official in the country – Other powers: agenda setting, budget proposals,

persuasion, sign or veto bills, executive orders

Federal Executive Branch (3 of 4)

• Presidential constituents – Nation (all voters) – Public who voted for president – Political party – Other nations – International organizations

Federal Executive Branch (4 of 4)

• Administrative agencies – Duties/powers: implement statutes through

rulemaking – Constituents

• President • Congress • Individuals and entities regulated by agency • No one?

Federal Health Bureaucracy

• Key agencies – Department of Health and Human Services (HHS) – Department of Veterans Affairs (VA) – Department of Defense (DOD)

Federal Health Bureaucracy—HHS: Key Agencies

(1 of 2)

• Administration for Children and Families • Administration on Aging • Agency for Healthcare Research and Quality • Agency for Toxic Substances and Disease

Registry • Centers for Disease Control and Prevention

Federal Health Bureaucracy—HHS: Key Agencies

(2 of 2)

• Centers for Medicare and Medicaid Services • Food and Drug Administration • Health Resources and Services Administration • Indian Health Service • National Institutes of Health • Substance Abuse and Mental Health Services

Administration

Federal Health Bureaucracy— VA and DOD

• VA – Provides comprehensive care to veterans who were

not dishonorably discharged • DOD

– TRICARE provides health insurance to current and retired military personnel and their families

State and Local Policymaking and Health Bureaucracy

• State-level policymaking is important. – Key decisions are made on state level. – The Constitution gives states primary

responsibility for protecting the public’s health. – There is variation among states in how

policymaking process is structured. • State and local health bureaucracy

– State-level agencies (e.g., Medicaid, public health) – Local public health agencies

Interest Groups

• Interest group: general term for a variety of organizations that focus on an issue or issues and have the goal of influencing and educating policymakers and the general public

• Interest groups do not make policy • Types of interest groups: trade associations,

think tanks, advocacy groups, lobbying firms