It seems you cannot pick up a newspaper or turn on a TV these days without finding some message about health care reform.  With all the talk of town hall meetings, tea parties, and heated protests on all sides of the debate, it's difficult to decipher fact from fiction.  The simple reason for all the confusion is that the legislative process itself is confusing.  Though few will admit it, even Members of Congress do not know for sure what the final health reform package will look like.                                                     


President Obama took a lesson from former President Clinton's failed attempt to reform the health care system in 1993.  Rather than get bogged down by a specific plan that could easily be targeted by opponents, the Obama administration tasked Congress with hashing out the details.  As a result, no one really knows what the final legislation will look like until all of the players on Capitol Hill arrive at a consensus.  This sort of uncertainty breeds mass confusion, but it also presents an opportunity for individuals who are interested in influencing the legislative process.  When Congress reconvenes in September, oral health advocates will have more than one chance to push for the inclusion of key provisions that have not yet been included in the legislation, like dental benefits for adults.  Similarly, absent a strong showing of support, we stand to lose ground on the victories that we have made so far.  (See CDHP's side-by-side analysis for a list of oral health provisions included in the health reform bills).
 
Understanding the legislative process is critical to discovering key entry points where changes can be made.  For this reason, we are using this week's update to give you an insider's guide to the procedural framework that Congress will follow as it crafts health care reform. 

If you have any questions, please feel free to contact Meg Booth or Danielle Grote Erbele.

In the House of Representatives, the process is nearly complete.  The three committees of jurisdiction, the Education and Labor Committee, the Ways and Means Committee and the Energy and Commerce Committee, joined together to introduce a single, "Tri-Committee" bill.  Just before Congress adjourned for the month of August, all three Committees made changes to the bill in preparation for a floor vote.  As the clock ran out, the chief committee of jurisdiction, the Energy and Commerce Committee, did not have time to consider more than 50 amendments, including a key CDHP-supported amendment to add oral health expertise to the health benefits advisory committee.  As a result, Chairman Henry Waxman made the unusual decision to reconvene his committee in September to finish up its work on the bill.  That meeting will present oral health advocates with an opportunity to amend the bill, though only amendments that were offered prior to the August adjournment are likely to make it onto the docket.  Notably, we are hearing that the oral health expertise amendment will be included.
 
Once the Energy and Commerce Committee finishes its business on the bill, the three House committees will reconcile the changes they have made and send a final version to the Rules Committee.  This Committee literally establishes the "rules" for floor debate, including how long the bill will be debated, how many amendments will be considered and, most importantly, which amendments will be considered.  This too presents an opportunity for Members to offer amendments that were not made in any of the Committees of jurisdiction.  Of course, the Rules Committee is heavily controlled by Leadership, which in the interest of ensuring swift passage of the bill may decide to consider only a few non-controversial amendments-or none at all.  From the Rules Committee the bill will be sent to the House floor, where it will receive an up or down vote.

On the Senate side, the process is further from completion.  In contrast to the House, the Senate has two committees of jurisdiction:  the Health, Education, Labor and Pensions (HELP) Committee and the Finance Committee.  The HELP Committee passed its version of the bill in July.  The Finance Committee is working to craft a different bill, which Chairman Max Baucus says will be complete by September 15.  What happens in this committee is critical for two reasons.  First, though the HELP Committee included many provisions in its bill regarding health benefits, the Finance Committee has primary jurisdiction over those issues.  As such, it will be crafting all the major provisions regarding public and private insurance-including dental insurance.  In addition, the Finance Committee will likely craft the most bipartisan of all of the bills under consideration.  As a result, the bill will likely provide a benchmark for conservatives that will serve as a negotiating point when all of the final bills are reconciled.

Once both chambers have passed legislation, a Conference Committee will be convened to reconcile the differences and craft a final bill to be sent to the President.  Leadership from the House and Senate will appoint members of the Committee, who will be chosen from key Chairmen, Ranking Members and rank-and-file members from both chambers.  Alternatively, an unofficial group of key members may meet to finalize the bill.  Either way, this process presents a final opportunity for oral health advocates to push for their key priorities.  It is unlikely that any new provisions will be added at this point-but it will be a critical time for advocates to fight to maintain the strongest provisions in the various bills.  After the Conference Committee convenes, the House and Senate will vote on the agreed upon language and, if the new bill passes both chambers, it will be sent to the President for his signature.