Why We Advocate to Certain Congressional Committees over Others

The U.S. Congress refers to the bicameral legislature, consisting of the 435 voting and six non-voting members of the House of Representatives and the 100 members of the Senate. When we visit D.C. or express our policy positions to Congress, our message would ideally reach every member. The ultimate goal is to reach all 535 voting members of Congress to educate them about the ACR, who we are, what we do, the diseases treated by our members and the issues affecting our profession and our patients.

As we work toward these goals, lobbying requires maintaining focus on lawmakers who are in positions to have the most impact on legislation that affects members of the ACR and ARHP. These are the lawmakers who serve on a committee that healthcare legislation must get through before it is put to a vote by the full membership of either the House or the Senate. This is why the ACR’s advocacy efforts focus on certain committees, collectively referred to as our committees of jurisdiction.

In the Senate, the Finance Committee handles matters related to taxation and other revenue, U.S. debt, customs, trade agreements, national Social Security and health programs under the Social Security Act, including Medicare, Medicaid and the Children’s Health Insurance Program, among other issues. Cumulatively, the policy handled by the Finance Committee encompasses nearly three-fifths of the federal budget. The Subcommittee on Health Care has significant influence over health-related measures, because it covers Social Security Act amendments affecting Medicare, Medicaid, maternal and child health, as well as public assistance; old age, survivors and disability insurance; and unemployment compensation programs.

The Senate Committee on Health, Education, Labor and Pensions (HELP) also handles health-related issues. The Committee reviews policy related to all of the items listed in its name and has broad jurisdiction over programs authorized under the Public Health Service Act (e.g., clinical laboratories, allied health and nurse training); the Federal Food, Drug and Cosmetic Act; and the Mental Retardation Facilities and Community Mental Health Centers Act. This committee has no jurisdiction over Medicare and Medicaid, but members hold hearings on expanding healthcare access for the medically indigent, healthcare cost containment and workforce issues, including Medicare payment for graduate and medical education, as well as consumer protection, quality and confidentiality issues. The committee also handles legislation dealing with child abuse, adoption, the Community Services Block Grant, adolescent family life and the Head Start program—all of which include a provision for the delivery of health services. HELP does not have a health subcommittee.

In the House of Representatives, the Energy and Commerce Committee has jurisdiction over the nation’s telecommunications, consumer protection, food and drug safety, public health research, environmental quality, energy protection, cybersecurity, and interstate and foreign commerce.

The following healthcare issues are initially referred to the Subcommittee on Health for consideration: private health insurance; medical malpractice and medical malpractice insurance; programs authorized under the Social Security Act, including Medicaid, Medicare Part B, child health, long-term care and peer review; and programs authorized under the Public Health Service Act, including hospital construction, biomedical research, allied health and nurse training, medical devices, mental health research, alcoholism, drug abuse, maternal and child healthcare, the Department of Health and Human Services, the National Institutes of Health, the Centers for Disease Control & Prevention, Indian Health Service and issues related to the above-referenced jurisdiction related to the Department of Homeland Security.

Finally, and also in the House of Representatives, the Ways and Means Committee is the chief tax-writing committee in the House and has jurisdiction over revenue, debt and revenue-related aspects of the Social Security system, Medicare and social service programs. The Subcommittee on Health handles bills and matters that relate to programs providing payments (from any source) for healthcare, health delivery systems or health research, including bills and matters that relate to the healthcare programs of the Social Security Act and, concurrent with the full Committee, tax credit and deduction provisions of the Internal Revenue Code dealing with health insurance premiums and healthcare costs.

To learn more about legislative action, policy priorities and how you can help ensure the voice of rheumatology is heard in Washington, D.C., visit Rheumatology.org/advocacy.