The legislative process starts with the introduction of a bill into the House or Senate by a member the chamber, and then can continue through to presidential approval or veto. Many bills are stopped somewhere in the process and never become law. The legislative history of a bill can be traced through the “paper trail” that is generated as the bill winds its way through the process. The importance of the legislative history of a law is that it provides an understanding of the intent behind the law.

Upon introduction, a bill is usually referred to committee where it may or may not be acted upon. Inaction results in the bill’s “death”; most bills suffer this fate! If the committee acts, it will study the bill, and may hold public legislative hearings and/ or commission special reports (known as “prints” when published). Official transcripts of committee hearings are usually (although not always) published by the Government Printing Office several months or up to several years later. The committee may amend the bill or completely re-write it (committee “mark-up”), or it may not change the bill at all. If approved by the full committee, a report for the bill is ordered.

The House Committee with jurisdiction over many health care topics is the Committee on Commerce. There is a list of health topics currently before the committee on their web page. The Senate Committee with jurisdiction over many health care topics is the Committee on Health, Education, Labor, and Pensions.

 

After the committee orders the bill reported, a report is written and filed with the clerk of the chamber. If all of these steps are not taken, and sometimes they are not, the bill dies. The committee report contains a description of the bill, a summary of the committee’s opinion, a cost estimate for the current and five successive fiscal years, and a discussion of the issues. Committee reports are numbered with the number of the Congress and then a chronological number (e.g. H.Rpt. 105-68; S.Rpt. 105-34). Reports are a good place to research the intent of a piece of legislation.

 

After the bill is reported from committee and filed in the House or Senate, it will be placed on the calendar of that chamber, debated on the floor, amendments can be offered, and a vote is taken. The rules governing this process are different in the Senate and the House. When passed by one chamber, a bill is sent to the other for floor action. If the bill is passed in the second chamber without any amendments, it is sent on to the President. But if the bill is amended before being passed in the second chamber, it must return to the first chamber for another vote. This process continues until the same version passes in both houses. Irreconcilable differences can be referred to a conference committee.

Records of Congressional debates can reveal the variety of opinions and positions surrounding a piece of legislation. Floor action is reported verbatim in the Congressional Record (CR) making it a comprehensive source for the daily activities of both chambers. An informative overview of this publication is available at THOMAS.

 

A conference committee can be formed when the House and Senate insist on different versions of the same bill. Members from both chambers meet to attempt to resolve the differences. If agreement is reached, a conference committee report is issued and the compromise bill is then sent again through both chambers. It must be passed without amendement by both chambers in order to proceed to the President. Conference reports are printed as House Reports and in the Congressional Record.

 

Legislation from Congress

Within ten days of receiving a bill the president can veto it, sign it into law, or not take any action. When Congress is in session, any bill not signed or vetoed within ten days becomes law without the President’s signature. A vetoed bill is returned to the Congress. A positive vote by two-thirds of both chambers is required to override a veto. After Congress has adjourned, if the President does not act on a bill, it is the same as a veto, and the bill does not become law. Any statements the President issues to Congress when signing or vetoing a bill are recorded in the Congressional Record, the Weekly Compilation of Presidential Documents, and are also available on the White House web site.

Presidential Orders

The President also has the power to issue Executive Orders which have the same effect as laws. Presidential Orders are published in the Federal Register and then codified in Title 3 of the Code of Federal Regulations.

 

After the President signs the bill, or after a Presidential veto is overridden, the bill is said to have passed and it becomes a law. Laws are first published in pamphlet form, known as slip laws, and include a brief legislative history. They are given a public law number, for example, Public Law 100-77, where the first number is the Congress and the second is chronological. At the end of each Congress, all of the slip laws are bound together by enactment date and published as the U.S. Statutes at Large.

Official and permanent laws (appropriation laws are not included, for example, because they are not permanent) become part of the U.S. Code where they are arranged by subject. The U.S. Code is published every six years, with annual cumulative supplements. The titles of the code that deal with health are Title 21 Food and Drugs, Title 24 Hospitals and Asylums, and Title 42 Public Health and Welfare.