US Government: A Case Presentation

1
US Government A Case Presentation

• Dana M. Block, OMS-IV
• SOMA National Director of Political Affairs

2
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 (O??), the
  national osteopathic political action honor
  society (exceptions will be made for 2007 O??
  inductees, as this is the first SOMA PATC to be
  given)

3
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)

4
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 (-).

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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 hospital-affiliated OGME programs
• PSHx OGME programs have been restructured in
  the past to assure compliance with current
  legislation
  
• Soc Hx
• Medications none
• NKDA

6
Pertinent Physical Exam Findings(a.k.a.
Pertinent Statistics)

• 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

• 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
  

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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

8
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!!!

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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

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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.

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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

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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 states population (2
  Senators per state, period)
  
• House of Representatives representation
  provided for each state based upon states
  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!

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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
• Lets pretend we already authored our bill and we
  now are wanting to make it into a law

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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

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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 Speakers 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 officers 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

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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

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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

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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

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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

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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

21
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 Presidents
  veto

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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

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Topic Review How a Bill Becomes a Law

• So, WHY did we time-travel back to fifth-grade
  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
• Its required for induction into the national
  osteopathic political action honor society, Omega
  Beta Iota (O??)
  
• Its 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!

24
Save the Date
D.O. Day on the Hill April 26, 2007 Regis
ter online now! www.do-online.org
25
THANK YOU FOR YOUR ATTENTION!
QUESTIONS???
26
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

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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, 12, January 12,
  2007.
• AOA 2006 Report, including data from AACOM,
  accessed online at https//www.do-online.org/pdf/o
  st_factsheet.pdf
  
• www.do-online.org
• AOAs 110th Congress Legislative, Regulatory, and
  Advocacy Agenda, accessed online at
  https//www.do-online.org/pdf/110thCongressReport.
  pdf
• http//bensguide.gpo.gov/9-12/government/branches.
  html
  
• http//clerkkids.house.gov/laws/bill_begin.html
• Google images search