Seeing as this is my last week of school ever, I have some extra time to write up another post. Ideally, I’d like to write up one post each week, hopefully two. If you have any interesting topics to discuss, let me know below in the comments or on twitter (@tylerspt).
Anyway, before we discuss detailed issues in PT and health policies, I’d like to provide a quick o
verview of just what the “legislative process” is. In my opinion, politics and making legislation are different ideas, but are both powerful in creating laws that govern all facets of American life. Politics tends to involve the actions necessary to get votes to pass legislation. This fits nicely into the democratic system of the legislative process.
The process of a bill becoming a law can be quite long and tedious. Both the Senate and House of Representative must discuss and pass the bill. No matter which chamber introduces this bill, it must pass through both chambers. I made a nifty table below showing the differences in each chamber. Obviously my technological prowess is increasing.
| Chamber of Congress | Representation | Length of Term | Current Party Rep. |
| House of Representatives | District within state of election, based on state population | Two years |
Republicans – 234 Democrats – 199 Vacancies – 2 |
| Senate | State-wide, 2 Senators per state | Six years |
Democrats – 53 Republicans – 45 Independent – 2 |
Each Congress lasts for two years, and we are currently in our country’s 113th Congress. With upcoming midterm elections for both House and Senate seats, right now is the perfect time to read up on legislators and form your voting opinion. Personally, I like to use Politico for my election information, but there are tons of other websites dedicated to Congressional elections.
Unfortunately, Congress has been gridlocked for several years, for several reasons I won’t get into. I mention political gridlock mainly because it has implications for lobbying efforts, discussed below, put forth by organizations like the APTA. Check out these stories on Congressional productivity at the Washington Post, NBC News, and Politico.
Because there are an incredible number of issues our country faces daily, each chamber has committees and subcommittees that have legislators that are ideally more educated in that particular area. For example, say a Senator introduces a bill associated with healthcare. This bill is formally introduced in that chamber, then referred to the appropriate committee. In this case, it will likely be sent to the Committee on Health, Education, Labor, and Pensions (HELP). From there, the bill is often sent to a subcommittee that is more specialized than the larger committee. Let’s say our bill is asking for allocating more federal fund for Alzheimer’s research. This will likely be sent to the Senate Subcommittee on Primary Health and Aging. Members of the subcommittee then read the bill on its hearing date. Members are bipartisan, and have several options on what to do with the bill.
Subcommittees can kill a bill in two ways: refusing to hold a hearing, or defeating the bill by a simple vote. Usually decisions are made after individuals have testified, or at least given the option. Members of the subcommittee can also add amendments to the bill, and can be re-submitted as a “clean bill” with these amendments added. After hearings are held, amendments added, and debates have ended, the subcommittee then votes and approves the bill to be sent back to the larger committee to repeat this process. The larger committee can also refuse to hold a hearing, or they can kill or approve the bill through a vote.
Let’s say our bill is so great both the subcommittee and full committee pass it with no substantial amendments. From here, the Senate Majority Leader (D-Harry Reid) schedules the bill to be heard on the Senate floor. At the time of the hearing, Senators can debate, add amendments that may or may not be associated with the bill’s topic (see Riders) or invoke other procedural methods such as cloture or filibusters. Once everyone has had their say, the full Senate votes on the bill. Given, that the Senate passed our bill, the bill is then sent to the House of Representatives and this process is repeated entirely. If at any point in this process the bill is voted down, it is killed. Because of the lengthy process of a bill becoming a law, it is essential for individuals or organizations with a vested interest in the outcome of the bill to have an outlet to speak to legislators to vote their way. This outlet is commonly known as lobbying.
So what exactly is lobbying? We hear stories of how lobbyists and pundits are fighting for votes on this and that, but why? Before we go in-depth on the finer points of lobbying, note that the APTA is our profession’s authority that has a lobbying arm in Congress. They know much more than I do, and I am by no means an expert on this subject.**
**I’m going to be as objective as possible, but feel free to voice your opinion professionally if you feel inclined to do so!
In its simplest sense, lobbying is how organizations persuade legislators to vote for the cause for which they are advocating. Large organizations that have either a national reach and/or a large political interest hire lobbyists to speak to legislators for them. For instance, the APTA is leading a strong lobbying effort to persuade legislators to repeal the Medicare Therapy Cap. Some of our membership dollars go to paying lobbyists to work with legislators in a way to persuade them to side with the APTA. These lobbyists are professionals, and may or may not be involved with the organization they are hired to lobby for. However, they are very well read on the current political climate, legislators they may be able to persuade, and any prior precedents for their bill to fall back on.
Average citizens can also lobby for their own causes. Writing, emailing, and speaking to their legislators are small but effective methods of lobbying. Since many individuals have different interests they want to lobby for, this method is less reliable on getting a response from each legislator. However, if individuals were to gather together and collectively lobby for a specific issue, their voice would be much louder. Speaking of….
It’s that time of year for our second Flash Action Strategy! This is a student-led effort to simultaneously send our opinion of a topic of legislation to our representatives in Congress. This year, the focus is to persuade legislators to allow physical therapists to take an active role in youth concussion management. This Flash Action Strategy starts today (September 8) and will go through September 10, so please email your legislators from the APTA Website. It literally takes one minute!
Hopefully this brief overview gave you some insight into how legislation works, why lobbying is so important in the legislative process, and how the APTA fits into all of this. Next time, I will focus the topic on the Affordable Care Act, and what physical therapists can expect in regards to practice and reimbursement changes in the very near future.
an exercise in politics 