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Small Business Employee Benefits and HR Blog

The Federal Legislative and Regulatory Process - Healthcare Reform

Understanding the Healthcare Reform legislative and regulatory process will help you understand healthcare reform. This post walks through the federal legislative process from start to finish.

Overview of the Federal Legislative Process 

Step 1 - A Bill is Introduced

Any member of the House or Senate may introduce a bill.

Step 2 - A Committee Takes Action

Bills are referred to a committee based on the subject. The bill is edited or “marked up”, and the committee votes on approval of the legislation.

Step 3 - The House and Senate Vote: 

Once a committee approves a bill, it is sent to the floor of each chamber for a vote. A bill must pass in both houses of Congress before it can become law.

In the House, most bills require a simple majority (218 of 435) to pass and/or be amended.

In the Senate, most bills require a simple majority (51 of 100) to pass and/or be amended.

Step 4 (Only if Necessary) - Reconciliation via Conference Committee:

If there are differences in the bills passed by the House and Senate, the two bills must be reconciled. The reconciled bill must be voted on again in the House and Senate. The reconciled bill cannot be amended.

Step 5: President Signs the Final Bill Into Law: 

Once a bill passes the House and Senate, the President has 10 days to sign a bill into law or veto it. Note: If the President does nothing, the bill becomes law. 

If the President vetoes the bill, both the House and Senate must secure a 2/3 majority vote to override the veto.

Overview of the Federal Regulatory Process

Regulations are issued by federal agencies to implement new, or modify existing, programs authorized by Congress. It is important to note that:

  1. Regulations have the force of law, and 

  2. Agencies must establish a comment period that permits stakeholders to remark on proposed rules.

Step 1 - Agency Issues Proposed Rule

Agencies issue a Notice of Proposed Rulemaking (NPRM) to add, change, or delete regulatory text. The NPRM must be published in the Federal Register with 60-day public comment period.

Step 2 - Agencies Issues Final Rule

The final rule may be revised based on public comments.

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