Panel 1: Introduction to Congress and the Legislative Process

Allison Jones (00:01):

Great. Thank you so much Lucas and Chris. Good morning and welcome. I’m Allison Jones, director of Program Strategy and Management here at the Alliance. And before we get started, I just want to share a few housekeeping notes. So you’ll find a few things on the tables in front of you today, including of course, the wifi password, but also copies of our agenda along with that QR code to see the more detailed version online along with the speaker bios. And on the flip side, you’ll see that survey code that Chris mentioned. So please take a moment to fill that out. We of course want to hear from you. You’ll also find a few samples of the other type of programming that we do at the Alliance, including a report from last year’s signature series on AI and an insights report from our recent work and listening with expert stakeholders on aging policy.

(00:47):

We also have a stakeholder map that was co-created with our expert community this fall as part of our programming on rare disease. Finally, you’ll see several green cards on the table. And so during the q and a portions, we will have alliance staff walking around with microphones. So feel free to flag them down. But if you’d prefer to write down your question, you’re more than welcome to and just raise that up and we will run it up to the moderator, a recording of today’s panel presentations. We’ll be available to you on the Alliance website after this event. However, we will not be recording the q and a, so feel free and feel comfortable to ask whatever questions that you have. And then before we get started, I just wanted to take a moment to acknowledge a few of our board members who will be in attendance today.

(01:30):

Liz Hall, our board chair. Welcome Liz. Some of you may remember Liz from last year as a speaker and this year we’re thrilled that she’s able to join us as our board chair and our sponsor later today, Mike Park, our vice chair, will be moderating our second panel and we’re so grateful for their leadership and continued support. So now I’m going to turn it over to our wonderful panel, introduction to Congress and the legislative process. I’m so pleased to welcome Rodney Whitlock. Rodney serves as vice president of McDermott, plus he is a longtime health policy professional having worked in a decade in the house, a decade in the Senate, and a decade in outside consulting. So we’re thrilled to have you join us, Rodney.

Rodney Whitlock (02:11):

Thank you. Okay, let’s see. Oh yeah, that’s me. Okay, cool. This is my favorite slide. Okay, thank you Alison for having me here. I’ve been doing this a while. It occurred to me on the walkover that I’ve been moderating these types of events for alliance, and I thought of one particular event as a good place to start the conversation because easily 20, 25 years ago, they asked me to moderate a panel that was on Medicare solvency, the ACT actuarial challenges the program faces right after lunch. There are several of you in the room who just started to nod off hearing that title, so imagine having to do that right after lunch. So I’m like, okay, I can take this challenge. So I went up to the podium and I began by saying as clearly as I could, I am here today to talk to you about sex. Now, there was a point to that story because then I went on to talk about birth rates in the baby boom generation and then talking about how it has changed since and talk about workers to retire. So there was a point to that, but I was trying to keep people awake. Can you believe it took them five years to invite me back?

(03:36):

So I’ll try not to do that today. And we have a much easier conversation to have here amongst ourselves here. So we’re going to talk about Congress and the legislative process, committee leadership, blah, blah, blah. But what we have here really between us over a hundred years of doing this stuff in this town, boy that hurts when you just say it that way, doesn’t it? Yeah, but I mean mostly us, Sarah’s still she’s a child compared to the rest of us all farts. But again, everything you want to know guarantee you we’ve done it at one point. So ask, this is an opportunity again, once we get done blabbing, the engagement here is really important. Join in, ask anything please, because that’s what we’re here for. So I’ll start off with just going over that one thing again, the q and a please talk if you really don’t want to, you got the green card there, you can fill it out.

(04:30):

But let me be clear. If you work from small print, you will not be having your question read because I don’t have my reading glasses up here. Okay, big print. Alright, here. I’m doing this like our own staff. Okay, you walk at me with 12 point font, we are not working well together. Okay, so don’t even think that 16 to start. Alright, all good here. So lemme start with my introductions. I’m going to have to work with what they gave me here, so I’m going to read it if this is the case. Okay, Sarah Levin. She is deputy staff director for the health Subcommittee on the committee of Ways and Means under ranking member Richie Neal. Prior to joining the committee in 2015, she worked for CMS, the Special Committee on Aging in the Senate and a member of Congress from New Hampshire. Sarah holds a masters of public health from John Hopkins and she went to Duke University.

(05:25):

I had a rough weekend and you’ve had a rough weekend where her eldest daughter’s first true sense was, I’m going to get there, go Duke. Oh man. See they write it down and then I have to say it. So if it wasn’t such a terrible weekend, it wouldn’t hurt so much, but lives in Northern Virginia with her husband and three children. Welcome Sarah. Next then we have Dean Rosen, a partner at Melman Consulting, one of Washington’s foremost experts on America’s health complex healthcare system. A master of both politics and policies shape it. That’s actually quite true. Three decades of experience developing and advancing health policy initiatives on Capitol Hill and the private sector on the hill. He held a series of high level positions including chief advisor to Senate Majority leader Bill Frist, and a leading voice on national medical and health issues. He helped draft and navigate landmark legislation including, oh come on, they ride it here like pepfar.

(06:25):

And let’s see, you’ve held roles with David Winston and Society of Health Policy, young Professionals. I don’t know about that young thing anymore. RWJ Fellowship and List Dean is the man, so it’s good to have Dean here. And then next, Ryan Long, who is the director of Congressional relations and senior research, senior research fellow at Paragon Health Institute. He formerly was a senior health policy advisor and counsel to Speaker McCarthy as he moved from leader to speaker and 25 years on the hill and elsewhere. Began his career working together in Charlie Norwood’s office. Went on to Joe Barton Energy and Commerce under Greg Walden. And then I get to thank God Dean is sitting between the two of them, university of North Carolina and the Columbus School of Law at the Catholic University of America. I had forgotten those miserable years you were doing it. That was horrible.

(07:22):

Rough four years, horrible, horrible. But if you’re thinking about going on to law school at night, here’s someone who has done it. So again, the misery you can put yourself through. Alright, so we’re going to open up with this question here and I’m going to start with Sarah, which means I’m supposed to take it off the wonderful slide of all three of us and then hit it to that one, which goes to Sarah specifically and start with this. Let’s talk about the House of Representatives and particularly healthcare and how jurisdiction operates in the house. Talking a little bit about the back and forth between the committees, those other little committees and what jurisdiction they have. But just talk about sort of the fundamentals of healthcare in the house.

Sarah Levin (08:04):

Well, thanks for having me. This is really fun to be here. I will take what Rodney said and actually bring a sex scandal into this conversation. So I worked for the Ways and Means committee. We are the oldest committee in the house. It is founded in the 17 hundreds. And when you think about the difference between House and Senate, you think about what the powers the founders gave to the house, the power to basically the money, the power of the money. And that’s what Ways and means is tax Committee, tax Trades, social Security and healthcare and Human Services.

(08:50):

In the health world, we at the Ways means committee have jurisdiction over Medicare, private health insurance and health taxes. And we used to have jurisdiction over Medicaid, but then there was a sex scandal involving the chairman, Louise Means committee, Wilbur Mills and a fountain outside the Capitol and Fannie Fox, you can Google it. And as a result, the committee lost its Medicaid jurisdiction. And now Medicaid is part of the Energy and Commerce Committee, which is another committee in Congress that does a lot of healthcare work. They have jurisdiction over most of Medicare, they do B, C, and D, which is the outpatient stuff, the Medicare Advantage kind of stuff, and the drug stuff. And they do public health. So all the C-D-C-F-D-A-N-H kind of work and they do Medicaid. And so those two committees have the majority of the healthcare jurisdiction in the House of Representatives, also on private health insurance education. And what are they called now? Every whoever’s in charge changes it. Workforce, is it Workforce? Workforce, okay. Sometimes it’s labor, sometimes it’s workforce, sometimes it’s something else. So it’s education and workforce.

(10:19):

They do private health insurance. So erisa, all the employer sponsored health insurance, that is the Education and workforce committee. So that’s a lot of people who get healthcare through that and they oversee that work. A lot of other committees touch healthcare at some point. The Veterans Affairs Committee does Veterans Health. DOD does tricare, the oversight committee does federal health employees. So there’s a lot of obviously the appropriations committees that funds a lot of the public health programs and all the appropriated accounts related to healthcare. And so there’s clearly a lot of committees in the house that have jurisdiction over healthcare.

(11:05):

But I would say when you’re talking about private health insurance, you often hear try committees because the Ways and Means Committee, energy and Commerce Committee and Educational Workforce Committee work together on those issues because they touch each of those committees since you have to go through all of them to get your legislation done. It’s different than in the Senate where bills are just given jurisdiction to one committee. So even if something touches other parts of other, it could be referred to only one committee in the house. It could be referred to many, many, many committees. Anything else you wanted me to touch on that?

Rodney Whitlock (11:48):

That’s a good opener. And then let me, we will build out from there, but let’s go to Dean next. Oh cool. I love this. This is as cool as like I’m at home sitting on, alright, go ahead Dean.

Dean Rosen (11:59):

That’s great. Well, I’m still kind of blown away by the fact there was a sex scandal and all you lost was your Medicaid jurisdiction.

Sarah Levin (12:06):

There were other things in that healthcare space. It was just

Dean Rosen (12:10):

Medicaid and I’m sitting between a Republican and Democrat, which you told me, but also between Duke and UNC, which I didn’t bargain for, so Well, thank you. We’re so close. Thank you. The alliance and my team didn’t even make it this year. And thank you Rodney. Thanks Liz and everyone for your support, which makes this possible in the Catholic Health Association and others. So on the Senate side, as Sarah sort of implied things are a little bit easier in some ways because there’s not some of the overlapping or sequential referral bills and things like that. And so I would say in terms of committee jurisdiction, there’s a number of the committees that are very similar to the house. So for example, the Veterans Affairs Committee in the Senate and the Veterans Affair Committee in the house, if you’re interested in Veterans Health, the Foreign Affairs and Defense, the appropriations committees each have a labor education and health subcommittee.

(13:12):

They also, the ag committees, ag subcommittees in appropriations deal with FDA. So there’s a lot of similarity in a lot of ways between some of the committees that deal with healthcare or touch on healthcare. But the two budget appropriations. But the two probably biggest ones in the Senate where most of the health policy sort of flow through are the Senate Finance Committee and the Senate health Committee health education, labor and pensions. And their jurisdiction is a little bit different, which I think makes things really interesting. And I know we’re going to get into this a little bit, but you can see some of this playing out in reconciliation, budget reconciliation because one of the big things that the House and the Senate are debating now are some of these different instructions to the committees go find X amount of savings or Y amount of savings.

(14:10):

And part of that you see playing out is that in the house, as Sarah said, you’ve got jurisdiction over Medicaid that’s solely in the Energy and Commerce Committee, but Medicare is divided between ways and means in energy and commerce. So depending on the specific Medicare bill, it might be referred to one committee, but it’s probably going to be in a lot of cases referred to both. Whereas in the Senate, the finance committee has sold jurisdiction over Medicaid Medicare taxes, so all the healthcare taxes and a whole bunch of other issues too. Social security trade. So that’s one issue. And the health committee is really private insurance, although there’s a piece of private insurance, which because of the way the Affordable Care Act was drafted, the Health Insurance Portability and Accountability Act was drafted in others where it was drafted in three committees jurisdictions intentionally. There’s a tax enforcement piece, there’s a public Health Service Act enforcement piece, there’s an ERISA enforcement piece.

(15:12):

So finance as well as Ways and means has jurisdiction over that, over a little bit of private insurance and obviously through the tax code, but mostly think about Medicare, Medicaid, the help committee has jurisdiction over all the public health programs, public Health Service Act, and then the private insurance. So that’s a little bit of the basic breakdown there. And I think again, the bigger issues are theoretically things are a little bit more streamlined in the sense of if you have a bill, the parliamentarian will make a call one way or another. And usually if it’s got a tax piece in it, it’ll go to finance. If it’s got a Medicare piece in it, it’ll go to finance even if it’s got public health, but they’ve got to make a call one way or another so it doesn’t have to go through two committees. Maybe the last thing, Rodney, I just note, and this is a little bit more beyond just the jurisdictional issue, is I think what you tend to find is that in the house, and this may affect you if you’re looking for a job or if you’re working there or the kind of work you do in the house, I think the subcommittees on health of ways and means and energy and commerce and some of the other committees tend to be a little bit more robust in the work they do, whereas there are various subcommittees at health and finance that focus on health and sometimes they’ll do hearings, but they usually don’t produce legislation like they do in the house where you market up at the subcommittee level and then you go to the full committee level, et cetera.

(16:42):

So that’s I think the basic jurisdiction, a couple of the differences, and I’ll pause there.

Rodney Whitlock (16:47):

Okay. And then Ryan, let’s take your recent experience at the leadership level playing air traffic controller and particularly working with the inside and the outside. Talk a bit about the challenge of that role and how particularly for the purposes of the house that works for determining what moves forward and what doesn’t.

Ryan Long (17:13):

Yeah, thanks Rodney. Well, I guess I’ll say a few things that will sort of illustrate the issues that leadership has to deal with. Committees from the energy and commerce perspective, and I worked there for about 12 years in various roles. We would say that Energy and Commerce is the oldest permanent standing committee in Congress. And so there is this friendly rivalry between ways and means and energy and commerce when it comes to healthcare. Little known trivia fact is Dean was mentioning, so in the house you have a committee that has primary jurisdiction and then you have committees that have subsequent jurisdiction. Every bill has a committee that has primary, except there’s one bill in history that both Rodney and Dean were very involved in writing. The Medicare Modernization Act actually is the only bill that got referred primarily to two different committees in the house. And that was mainly because they couldn’t decide, I mean from a leadership perspective, like well, this is going to create headaches if we give it to one committee or another. And so that really is a lot of what leadership has to deal with is managing the priorities of different committees with the fact that there’s overlapping jurisdiction.

(18:25):

Dean mentioned drafting in triplicate. One word I never want to hear ever again is drafting in duplicate, because I thought we were over that, but that was something back when I was with the speaker that we dealt a lot with as it related to healthcare transparency and the lower cost more transparency act. So from a leadership perspective, I think that there is this perception that everything is top down and we tell the committees what to do, and that’s really a false image of what happens. The committees are really the incubators of legislation. I think it’s the leadership’s role to one, let them know sort of what the timeline of potential floor action is and what sort of the conference writ large, what we want to move through the house floor and the timing of that. And it’s also to provide committees sort of a snapshot of where the conference is as they’re marking things up.

(19:21):

They obviously have to take into consideration where are their members, but eventually a bill that goes through committee has to go to the floor. And so you need to make sure that whatever the committee passes is something that you can get the votes for on the house floor. And then it obviously comes down to leadership. Mainly the majority leader’s office is in charge of timing of floor, consideration of bills, but it is a lot of sort of management of making sure that the committees are working together with sort of a singular purpose. Because at the end of the day, if they come up with different products, then that delays the process because then we have to get all the committees together, come up with a unified bill before we can take it to the floor. So it’s a lot of air traffic controlling.

Sarah Levin (20:10):

So if I could say just explaining what the trip thing is, because this is a big part of drafting and private health insurance, there are three parts of the government that oversee private health insurance depending on the types of private health insurance you as a individual have except for federal employee. We’ll ignore federal employees for a second. So there’s the Public Health Service Act, which is under the jurisdiction of the Energy and Commerce Committee, and that is generally group and individual market. There is erisa, which is the employer part, and that is education and workforce. And then there’s the Internal Revenue Code, which works with erisa, but also has to do with plans that aren’t in the Public Health Service Act or IO. And really it’s a lot of church plans, religious based plans. So those are the three sets of laws that govern the private health insurance market. And when you hear triplicate, it’s essentially you have to have the same words in all three sections of the law so that the governing statutes can provide the same kind of policy across those different kinds of private health insurance. And so I just want to say that when you hear, oh, you’re giving us this bill, it needs to be in triplicate, and you’re like, what in the world is that? That is what that means. Making sure that you have your language in all three statutes of public health service sector and Internal Revenue code.

Rodney Whitlock (21:56):

So let me dig in a little bit on the house a little bit and then I’m going to come to you with the next one, Dean, but this is a great place to talk about process and how process works because the language has to be the same, right? Well, ways and means wants to do it the way, ways and means wants to do it. ENC wants to do it the way ENC wants to do it and oh, heaven knows what ED and workforce Ed and Labor is doing because whatever they’re doing, and you got to have the exact same thing. What is the process for working it out? Or you depend on somebody like a mean old man in leadership. I wasn’t pointing generally at Ryan, but I was pointing in his direction. Generally, did you just wait for somebody at leadership to work it out? I mean, talk about how the house has to get there and how you, when ENC is over there and y’all are in a pissing match again because they’re Duke in North Carolina, I mean, how do you get there without involving leadership?

Sarah Levin (22:51):

Well, I mean because there’s a lot of shared jurisdiction over these, the many committees that deal with healthcare, there’s a lot of conversations that happen saying we’re going to do, there’s this issue. There’s different ways that can happen. One is like, we’re going to work on this kind of issue. You’re going to work on this issue. We’ll split these up so that we can divide and conquer. That is one way to do it. And then everyone kind of agrees and you can pass it off to leadership to figure out if there’s for consideration with that. The other way that is often happens is that one committee takes up the legislation, the other committee has views about the legislation, and the other committees either take it up or have conversations with the committee that takes it up and they work it out or don’t work it out, and leadership has to get involved. So there’s basically three different paths, one, divide and Conquer. Two, they have different views and they either consider it or have conversations about what their members want and agree. Or the other one is that they don’t agree and leadership is involved. Is that fair, Ryan?

Ryan Long (23:58):

No, that’s fair. I would think from a leadership perspective, you want the committees to work it out because you don’t want to be put in the position of saying, okay, we’re going with them and not with you on that. And that just puts your relationships with the various committees in a tough position. So that would be the preference. They work it out. It doesn’t always work that way and leadership has to intervene and start to make choices from a truly processed standpoint. What happens is you’ll have different versions. It’ll go to the House Rules Committee. The House Rules Committee is the committee that determines how the house floor will actually consider a bill. You’ll have a unified package that is presented at rules and then it goes forward. But that by the time you get to rules committee, there’s a lot that’s gone into behind the scenes to actually get everyone on the same page.

Rodney Whitlock (24:49):

Then Dean in the Senate, you don’t have anything at all like that in terms of the fighting for jurisdictional control in that finance does something or help does something. The challenge in the Senate, and again speaking from a leadership role is that it’s about floor access at that point, because anyone in the Senate can come play Ball, unlike the House where as Ryan discussed rules committee basically determines who gets access under what circumstances and literally the amount of time versus the Senate where everything’s got to be well, can we all agree? I mean, talk about the difference just in that?

Dean Rosen (25:33):

Yeah, I think in many ways a lot of this back and forth fighting or working out or compromise between committees that happens in the House doesn’t work in the Senate because of the pretty simple way that just has to go to one committee or another. But Rodney’s, right, I think one of the tools that leadership has is you’ve got this really significant rate limiting factor of floor time. And because all 100 senators can offer unlimited amendments theoretically, unless it’s a privileged motion like reconciliation or other things, floor time is at a premium and there’s only so much you can do and it’s a narrow funnel. So one of the roles of leadership having been both in leadership and in committee is to schedule things. Rodney talked about that earlier. That’s one of the reasons you see things kind of backed up sometimes against a recess.

(26:28):

Got to get this done in the two weeks before July 4th or August because no one wants to be here then, and that is an issue. The other thing I would say is at times I think this is true of the House and the Senate. In the Senate, I would say legislation can sometimes just come organically through committee like this is really important to Chairman Cassidy for example, or ranking member Widen and Chairman Creo and they’re working on things together and they put out a request for information. They’re working on a bill, but at other times there are things that are a little bit more top down or at least coordinated. Oftentimes those are some of the big bills that we’re seeing this now tend to be a priority for the president and the leadership in the house and the leadership in the Senate. And that takes a lot more coordination and it’s not necessarily dictating to them.

(27:22):

By the way, one quick historic note, because I think I’m probably the oldest or longest serving anyway here, is that the whole reason for the triplicate or duplicate or whatever I was involved with, and it’s just important to remember the reason that happened is that back a thousand years ago when Bill Clinton was president, you’ve ever heard Bill Clinton, he had a major initiative, which was his healthcare reform plan that Hillary Clinton was working on out of the White House. One of the big reasons that that died and got delayed was there was a months long fight in the house and frankly more in the Senate over who would’ve jurisdiction which committee chair. And we were two powerful committee chairs at the time, Patrick Moynihan at the finance committee and Ted Kennedy at what was then the Labor Committee and now is the health committee.

(28:12):

And so when the Health Insurance Portability Act, the HIPAA came around, they were trying to regulate private insurance, the leadership made the decision, let’s just give it to all the committees, let’s just draft it in all their jurisdictions. That way it’s a little bit more of a challenge to try to get it through more committees, but we want this fight among chairman as to who gets it. And that was actually the initial reason that then the Affordable Care Act and all these other templates have to go through those different committees on private insurance. So you can blame me

Rodney Whitlock (28:46):

And we will. Good, so we know who to blame, Dean. Alright, and this is reminder a couple more and then I’m going to turn it over to you guys to engage. So be thinking, writing down in big print, okay,

(29:00):

You talk about the difference between or talking about big bills and we all know those and we can talk if you want to ask us about any bill and any process, we were all there in varying degrees. We can answer, but talk about getting little things done. I mean, you guys do hold hearings and hold markups that lead to movement on bills that aren’t a one. And for those of you who don’t grasp that, that’s called a newspaper. These are these things with paper and they had the front section called a and one. So A one. We don’t read about the big stuff, but you guys accomplish little stuff all the time. I mean, talk about just the nuts and bolts of that.

Sarah Levin (29:36):

Sure, I can start with that. So there are different avenues for bills to become law, right? Certainly the process that you see in Schoolhouse Rock, it should go through a certain process. A member introduces the bill, a committee or multiple committees consider the bill, the bill goes to the floor for consideration. The Senate does the same and that goes the House or the Senate. They come together, either there’s a conference committee to work out any differences and that’s voted upon or they each, somehow the agreed upon text comes together and it becomes law and signed by the president. And so that is the traditional pathway of how things are done. Typically in healthcare, much more recently, what happens though is that there are bills that are considered in committees and either taken up on the floor or not depending on house or Senate or depending on whether things get taken up or not.

(30:41):

And then they ended up traveling along with some big omnibus kind of package, typically at an appropriations vehicle. But I will say through the start of my, and maybe that’s why I’m still here, is that I was able to go through one of a healthcare bill and typically healthcare bills are really hard to go through the regular order of not being part of a larger package because there’s a lot of controversial aspects of healthcare that could become on the Senate floor that could be germane and lead to amendments that Dean had described. And so that is why in healthcare it usually is attached to some larger package to limit the types of amendments that may come across. But when I was a very young staffer, it’s like literally this is how laws are supposed to be. There was a problem in the state and there was a woman who’s very sad, a very terrible sad story.

(31:44):

Her daughter was in college. This was pre a CA. In order to have healthcare when you were in college, you had to have full, you had to be in college full-time, right? You couldn’t be part-time because then you couldn’t stay on your parents’ health insurance. You got kicked off at 18. And so the idea, this woman’s daughter, she was diagnosed with cancer in college and she couldn’t take with chemo, full load of chemo and a full load of classes. So she was going to lose her health insurance when she had cancer. It was a terrible tragedy that the mother never wanted any other family to face. So she took all of her energy, got everyone together and said, this needs to change. So my boss says, I agree. They has this bill says, okay, if you’re in college and you need health insurance and you get sick, you should able to keep your health insurance.

(32:40):

Okay? This goes through the Energy and Commerce Committee raise a means in education and labor at the time probably and now workforce. And it passes, I think through one or more of the committees. I don’t remember. It was a long time ago. And goes to the house floor has passed the house floor, it gets hotlined individually through the Senate hotline means unanimous. The senators unanimously agree upon it, and it is signed to law individually by the president of the United States at the time. And so that was a bill that went through the process because of this one woman who had a tragedy happen to her family, wanted to make sure it didn’t happen to any other families, was passed into law so that students could stay on their health insurance if they got sick when they’re in college, obviously they see it came in after that and said, you can stay on your health insurance, parents health insurance until year 26.

(33:36):

So even more protections. But that was an example of a bill that went through the Schoolhouse Rock kind of process through the committee on the floor consideration in the Senate passed assigned by the president. I don’t know how many I remember of bills that I’ve worked on since being on the committee that that’s happened to again, because most of its time the bills, what happens is the committees consider the bills and they get them ready to attach to a vehicle at any time. We’ve also been a part of processes where people are fishing for money. They say on Friday you get a letter from leadership in the House and Senate saying, we need X billions of dollars come together. We need it by Monday. Have a fun weekend. And so you have to come up and draft and come up with a bill and get that kind of money, and that becomes law.

(34:27):

That’s happened. That happens too. And so there’s different avenues. There’s the one that’s supposed to happen, the one, the longer process where committees consider the bills and they get attached to a larger piece of legislation, usually an appropriations bill. And then there’s the we need money. We need money now come to, we are in a deficit of X. We need 10 billion to get this deal together, to keep the government open, come to us with a $10 billion idea. And that becomes law too. So those are the three general avenues I’ve seen most recently of how healthcare bills become law. Any

Ryan Long (35:08):

Yeah, I was just going to say, I don’t want to sugarcoat it. Healthcare is a partisan issue. Can be, and I think anytime you’re talking about things that cost mandatory money and you have to find savings for it, that tends to be how it happens in a larger vehicle. One of the things that I did appreciate when I was at Energy and Commerce is we had our fair share of partisan battles, there’s no doubt, but the jurisdiction over C-D-C-N-I-H-F-D-A did present a lot of opportunities to pass bipartisan legislation, get standalone bills into law. But the rate limiting factor, I think is something that Rodney, Sarah, and Dean have alluded to because of the senate rules, you either can do what’s known as YA’S consent, and that means all hundred have to agree, which is very difficult. Or you have to spend two weeks of Senate floor time debating a bill.

(36:07):

And when you’re talking about, let’s say an FDA bill or a CDC bill, NIH bill, it really doesn’t make sense whether or not the Democrats are in charge or the Republicans are in charge to have two weeks of Senate floor time, which is extremely precious to do that. And so then what tends to happen is towards the end of the year, usually in lame duck, we find a way to get some of those holds lifted. But I think if there was a different senate process, maybe you’d have more standalone bills in that public health space. But really that senate process really does sort of limit how much you can get done on the standalone bills.

Rodney Whitlock (36:46):

Alright, so this is the last one, and then I’m going to turn it over to you all. I see you writing there, big print. I’m paying attention to you. Okay. Alright. So as you all have gathered by now, we know everything, right? Because we’re all, we’ve been doing this forever, so we know everything. I mean, not as much as board member Mike Park, who you’ll be hearing from later who just arrived. And so I have to call him out for being late. But we don’t just wake up and we’re omniscient. We learn stuff just as you guys do. We’ve just done it for a lot longer. And Ryan, I’ll toss it your way. First, think about your career and even today, how do you learn? How do you gather information to help you be the smart guy you are?

Ryan Long (37:35):

Well, I mean, I don’t think any of us are omniscient on healthcare. I’m still learning day to day. I mean, the different sectors of healthcare are just so wide and expansive that it’s hard to know everything. But as Rodney mentioned, my first job on the Hill was as a legislative correspondent in the same office where Rodney was the longtime healthcare policy aid, talk about intimidating. It was extremely intimidating. We worked for a member who, he was sort of a rank and file member, but very involved in healthcare and he was somewhat opinionated, I think Rodney Fair.

(38:16):

So I did that for about a year and a half. Then I became a health legislative assistant for another member of Energy and Commerce. And I still remember the first briefing that I walked into in preparation, I think it was for a markup. And there was a friend of mine who was about the same level of experience and this sort of cabal of five or six health lass that have been doing it for five or six years. And they’re asking these questions, they’re using acronyms, and you’re just like, I’m never going to learn this stuff. I mean, it’s just what’s a sniff f? What’s an rf? And so it was really intimidating, but the way that I approached it and the way that I provide advice to people, you’re going to work for a member, they’re going to have certain priorities in the healthcare space.

(39:04):

Focus your attention on learning those over time, through osmosis, through hearings, through conversations. You will learn more and more and sort of begin to cover that waterfront. But in terms of things that I would recommend doing, read the MedPAC Payment basics. If you want to know the 26 different payment systems in Medicare, they’re like four pages each. Doesn’t take long. And that gives you a good foundation. I would say. The other thing, I’ll too paragons horn, read all Paragon stuff, it’s great, but also take the time to read Kaiser Family Foundation materials. You may agree with our stuff, you may disagree, you may agree with the kff stuff or disagree, but being able to see how different perspectives approach a certain issue, I think allows you to develop your ability to sift through information and sort of make your own opinions on issues and talk to as many people as you can, network with as many people as you can. You will find sources of information from people through conversations that you weren’t expecting and it’ll give you an idea and then you’ll go down a rabbit hole and you’ll end up being an expert in that particular area.

Dean Rosen (40:20):

I would just add one quick thing, Rodney, if I could. I think all of Ryan’s advice about that is really important. And I would say the way I would almost think about it is you’ve got this great opportunity. It’s almost like you’re back in school to read and absorb as much as you can. And you’ve got resources all around you, be it advisory groups like MedPAC or support groups on the hill, like the Congressional Research Service or the general accounting office. And so I think on the substantive end, I really would do that. I’ll tell you two related piece of advice. When I moved from committee staff to leadership, all of a sudden your email inbox gets inundated. The best piece of advice I got from another leadership staff was, I know you’re going to be busy. I know you’re going to be 10 times as busy as you were, but try to return every call, try to return every email, try to take every meeting you can because number one, it’s just your responsibility as a public servant to try to do that.

(41:25):

And number two, you’re going to learn something from those people. So some of it may be a source like Sarah’s where it was a constituent of, it may be somewhat a hospital in your jurisdiction or a think tank. But that’s where the second thing I would say in addition to substance, I remember being one of my first jobs and being worried about how am I going to get this done? And I use some of those resources, but I was really worried about, well, what if this bill actually goes to the floor of the Senate? I don’t know anything about what this looks like. They barely let me onto the Senate floor. So I would say in addition, and this is one of the great things about what the Alliance is doing today, but also does and others is really try to learn the process. I think I became much more of a student of the House and the Senate process because the process is so important sometimes to getting things done. Back to our example of do you draft this in one committee’s jurisdiction or three committee’s jurisdiction? Does it amended this way or amended that way? A lot of those things, even at the beginning of creating your policy goal, will maybe dictate your outcome because process can dictate a lot of that. So that would just be the one thing I would add to what Ryan said.

Sarah Levin (42:37):

I would just say that these are the best jobs in the world because you get to learn every day. I’m the same job for 10 years, and every day I come in and I learn something new. And that is great. And it’s so fun because you have all these people, there’s a topic, there’s always something in healthcare that comes up that you have no idea anything about. And you get to call you Google, who is an expert in this issue, and you call them and they will call you back. You email them and they will email you back and take the time to explain the issues to you. And that’s amazing. That’s just so, it’s such a privilege. And I know that the Alliance does a really great job in getting those experts together. I mean, I certainly have been to my share of Alliance events over the years, and I would really encourage you to do events like that at the Alliance and other organizations that put on these events because you get to see a variety of different viewpoints and really learn a lot from those and figure out, okay, I have no idea what these means.

(43:41):

Let me look up this. Or I heard this once before, now that my boss is coming to me with this issue, maybe I can figure out what this is going on. Now I can talk to this person or talk to that person, or I can look back at these materials and it’s really useful. But again, the best part is that there is so many people there, whether they’re the governmental and the legislative, the CRSs, congressional Budget Office help you think about how things cost and the agencies help you think about how things are operationalized. There is just so many different folks out there to help you do better work for your bosses, for the members of Congress. And it’s a great opportunity to have those resources available for you to learn and grow in your role.

Rodney Whitlock (44:29):

And I’ll just sum all that up, and particularly the networking point, which is to make the case for you. You have made such a good decision being in this room today because you’re engaged, you’re talking to other folks, you’re hearing from Yahoos like us and Mikey next. I mean, it’s such versus sitting at your desk surfing. You have made a much better decision than the folks in these empty chairs.