Why are we interested in advocating for better health policies?

What are key aspects of clear and compelling communications with legislators?

What are key terms I need to know as a health advocate?

How does a bill become a law?

Download the full Associates for Prevention Teaching and Research (APTR) Advocacy Guide 2010

Why are we interested in advocating for better health policies?

Because every day decisions are made that have a direct impact on preventive medicine and public health. With precious few exceptions, the men and women making those decisions are not health professionals. They rely the views of their constituents, expert opinions, and their own opinions to make important decisions. As we enter the field of preventive medicine and public health, we have a right — and a responsibility — to inform those choices.

What are key aspects of clear and compelling communications with legislators?

  • Clarity. Make sure you are clear on what you want, but also how your desires will benefit him or her both professionally and personally.
  • Impact on voters. If you are trying to make a lawmaker understand why your issue is important, explain how it impacts their constituents.
  • Playing to politics. Never underestimate the powerful instinct of self-preservation when you are dealing with lawmakers; they are well-aware that without the support of their constituents they won’t be voted back in office.

What are some key terms I need to know as a health advocator?

Appropriation: Provision of law that provides authority for federal agencies to obligate funds and to make payments out of the Treasury for specified purposes. Appropriations for the federal government are provided both in annual appropriations acts and in permanent provisions of law.

Authorization: Endorses a program, specifying its general purpose and, broadly, how that purpose is to be achieved; and sets a funding ceiling for the program.

Bill: The principal vehicle used by lawmakers for enacting or repealing laws.

Concurrent Resolution: Generally used to make or amend rules that apply to both chambers and to express the sentiments of both chambers.  Must be passed in the same form by both chambers, but does not require the signature of the president and does not have the force of law.

Committee Report: Testimony by a committee to the full chamber on a piece of legislation.  It generally is accompanied by a written statement that describes the purposes and provisions of the measure.

Constituent: A resident of a district or member of a group represented by an elected official.

Joint Resolution: Generally used for continuing or emergency appropriations, a joint resolution requires the approval of both chambers, in identical form, and the president’s signature to become law.

Laws: Statutes, Acts of Congress

Mark-up: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation.

Rider: A provision added to a bill so that it may “ride” to approval on the strength of that bill.  Riders are generally attached to Senate appropriation bills.

Simple Resolution: Addresses matters entirely within the prerogative of one chamber, such as revising the standing rules or expressing sentiments or it may give “advice” on foreign policy or other executive business. Simple resolutions do not require the approval of the other chamber or the signature of the president; and they do not have the force of law.

Sponsor: The original member who introduces a bill.

Veto: The power of a president or governor to end a piece of legislation by not signing it into law.

How does a bill become a law?

Introduction of a Bill

An idea for a bill can come from anyone, but only members of congress can introduce a piece of legislation, which is known as a bill.  Those who introduce bills are known as “sponsors” of the bill.  A bill can be introduced in the House of Representatives or the Senate whenever Congress is in session.  A bill is given a number, such as “S. 1” for the first bill introduced in the Senate, or “H.R. 92” for the 92nd bill introduced in the House of Representatives.

Referral to Committee

A bill is almost always referred to a committee. The House and Senate committees each have jurisdiction over different areas of public policy.  Most committees have subcommittees, which focus on a subset of areas within the jurisdiction of the full committee.

Committee/Subcommittee Hearings

Proposed bills may be referred to subcommittees, which may hold hearings on a bill. Interested organizations and individuals may be invited to testify at these hearings, stating the reasons for their support or opposition, and suggesting ways in which the bill can be improved.

Once legislation is authorized, funding for the Department of Health and Human Service agencies must be approved by the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies.  This Subcommittee divides its allocations of the overall federal budget among the nation’s health, education, and social welfare programs.

Mark-Up Session

After hearings, the subcommittee typically meets to mark-up the bill.  Legislators debate and vote on amendments and make changes to the legislation by literally “marking-up” the bill.  The subcommittee will vote whether to report the bill to the full committee where the process would basically be repeated.

Bill Goes To the House or Senate Floor

The full committee may vote to approve the bill and send it to the floor of the House or Senate for debate.  After debate, the members vote to pass or defeat the bill.  If one chamber (House or Senate) of Congress approves the bill, it is then sent to the other chamber where the process begins again.

Conference Committee

By the time the bill is voted on in the second chamber, it has usually been modified by amendments, and is somewhat different than the bill passed by the first chamber.  Thus, the bill must now be referred to a conference committee, made up of several members of each chamber, where differences between the two versions are eliminated by compromise and reconciliation.  This committee then issues a conference report, containing the bill with its agreed upon compromises, and is sent to both chambers for final approval.

Presidential Vote

Once both chambers of Congress have passed the identical legislation, the bill is then sent to the President for his or her signature into law.  The President can take one of several possible actions.

  • The president may take no action.

o   If Congress is in session, the bill automatically becomes law after ten days.

o   If Congress is not in session, a pocket veto occurs and the bill dies and does not become the law.

  • The president may veto the bill and send it back to the chamber of origin.
  • The president may sign the bill, and the bill becomes law.

Veto Override

Congress may choose to override the veto by a two-thirds vote, making the bill law, or allow the bill to die.

TIPS from WalkBoston: Here are some of the elements of successful advocacy:

  • Organize. Even small organizations have more clout than individuals, more energy and more expertise.
  • Persist. If public officials know that you are never going away, they will eventually deal with you. Be prepared for it to take a while.
  • Offer solutions. Rather than just oppose a bad project, provide an alternative that improves the status quo.
  • Respect opponents. Try to understand their positions. Be courteous. Challenge ideas; don’t attack people.
  • Develop coalitions. Working with other groups can translate into greater political strength.
  • Get expert help. Technical assistance and support from traffic engineers, planners, landscape architects and lawyers bolsters your position. To better understand the process, talk to your local or regional planning department or agency.
  • Have fun. Enjoy small victories. Share good food. Laugh when things get ridiculous. If you don’t have fun, you won’t last

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