Health Care for America NOW

Steps To Win

On this page:

The Lay of the Land: The Structure of Congress

CURRENT STEP - Step 4: Congress Passes Legislation

Where We Are Now

Where We Are Going

What You Can Do To Help

Winning quality, affordable health care for all is about more than having the right principles. You need a plan to win. Here's how Health Care for America Now is going to do it, step by step.

The Lay of the Land

First, let's take a look at the structure of Congress. There are specific committees in both the House and the Senate that have jurisdiction over health care reform, and therefore will play a big role in the process. The members of these committees - their Democratic chairs, the ranking Republican members, and general membership - will all be key players. This explains our focus - both now and in the future - on these Members of Congress.

Mouse over the graphic below to view the members of each of the primary committees of jurisdiction in both the House and the Senate, as well as an outline of the basic process by which a health care bill may become law. (Note: Committee assignments have not been finalized for the 111th Congress, so some of the information below will change.)

(Print a version of this chart for easy reference)

Steps To Win

Broadly speaking, the legislative process moves in identifiable steps. Though the specifics, timing, and sequencing will change (such as skipping a subcommittee or full committee), we know generally what is going to happen and what we will need to do at each step to make health care reform a reality. The key at this point is to prepare for possible legislative scenarios rather than be too focused on predicting what route the legislation will ultimately move through.

Below is a chart showing where we are in the process (highlighted in red), where we've been, and where we are going. Some of these steps may ultimately overlap or the House or Senate may move through the process first, with the other legislative body following. Click on each step for more detailed information on what may take place in each step and what we need to do to move quality, affordable health care for all forward.

Steps To Win
Initial proposals
Hearings / draft legislation
Committees pass legislation
Congress passes legislation
House & Senate bills reconciled & passed
President signs bill into law

Completed Steps

Click on each completed step to see where we've been and what we've accomplished towards our goal of winning quality, affordable health care for all.

Step 1: Initial Proposals

Step 2: Committees Hold Hearings/Draft Legislation

Step 3: Committees Pass Legislation

CURRENT STEP - Step 4: Congress Passes Legislation

Overview of the Process

The three committees in the House (Ways and Means, Education and Labor, and Energy and Commerce) have passed their health care bills, as have the two committees in the Senate (Kennedy's former HELP Committee and the Finance Committee). Now, the bills are merged in each house of Congress and brought to the floor for amendments and a vote on passage by the full membership. The House has already competed this process and passed their bill, and the Senate bill is moving to the floor for amendments and a vote.

In the House of Representatives, a limited set of amendments (or an amendment that serves as a complete substitute) were offered. In the Senate, it is more common for there to be a more open-ended process for consideration of amendments to legislation on the Senate floor. These amendments would be voted on by the full chamber as well.

Once all amendments have been considered, both chambers will vote on their final bills before the two version head into "conference," where the two houses of Congress will hash out the differences between their bills.

Where We Are Now

The House

The House of Representatives has passed their health care bill on Novermber 7th, 2009 with a vote of 220-215 (roll call, full bill). The bill has the choice of a public health insurance option, tax credits to make health care affordable, asks employers to pitch in their fair share, and covers 96% of Americans according to the CBO. This is the first time in our country's history that the House has passed a comprehensive health care bill. (You can find out how your Representative voted by clicking here.)

Two amendments were offered in the House, a Republican substitute amendment which failed to pass, 176-258 (roll call), and an amendment offered by Congressman Stupak (D-MI) which would prohibit any health care plan in the new Exchange from offering abortion coverage. The Stupak amendment passed, 240-194 (roll call).

The Senate

All committees in the Senate have also passed a health care bill, another historic first. The Senate Finance Committee was the last to pass their bill on October 13th by a vote of 14-9 (press release [pdf]). Majority Leader Harry Reid has merged the two committee bills into the Patient Protection and Affordable Care Act (full text), which he is bringing to the floor of the Senate.

The merged Senate bill has a public health insurance option with an opt-out for states, and has more generous tax credits than the Senate Finance bill to make health care affordable for families. (While it is affordable for middle class families, the bill still falls short in financing for everyone. Click here for an analysis of costs for families in the House and Senate bills [.xls].) It does not ask employers to pitch in their fair share, and while it is more fairly financed than the Finance bill, it could be fully funded by asking those of us who can most afford it to pay their fair share. The CBO estimates that it will cut the deficit by $127 billion over ten years and cover an addition 31 million people, leaving 94% of the population insured. (Read the CBO letter here [pdf].)

We will work on the floor of both houses of Congress to defend provisions we support, as well as improve or fix provisions where possible. And we will work to make sure the Senate moves forward and allows a debate and a fair, majority, up-or-down vote on the merged Senate bill.

We expect bills to be considered on the floor of the Senate in late November.

Where We Are Going

The merged Senate bill will move to the floor of the Senate for a vote. Debate in the Senate is more free-flowing than the House, and may be extended over two or more weeks. Although amendments need a simple majority (50 votes) to be accepted in the Senate, we expect that for most amendments, procedural hurdles will be raised that require 60 votes to bypass.

After all amendments have been considered, the final bill will be put to a vote. The Senate bill will face a cloture motion requiring 60 Senators to pass. That motion is procedural and Senators will be under pressure to proceed along party lines. After cloture, the Senate can pass a bill with a simple, fair majority of 50 votes.

After the Senate passes their bill, the Senate bill will join the House bill and leaders from each house of Congress will head into "conference" to hash out the differences between their bills. The agreed upon bill ("conference report") will then be brought to each chamber for a vote which could again be blocked in the Senate by a procedural motion that needs 60 votes to clear.

What You Can Do To Help

We are nearing the final stretch. Things will be moving quickly, so we will have to pull out all the stops and make sure Congress passes quality, affordable health care for all, with the choice of a public health insurance option.

We will need your energy to keep Members of Congress committed to our principles for reform, to vote for bills and amendments that meet these principles, and dissuade them from compromising on principles or voting for a bill that doesn't meet them. Phone calls, office visits, faxes, emails, and demonstrations around the country are proven tools to communicate to Members of Congress the importance we place on enacting a true guarantee of quality, affordable health care we can all count on.

Calling and writing letters to your congressional representatives are by far the most important things you can do. Members take calls and personal letters from constituents very seriously, much more seriously than faxes or emails. Please take a moment and call, even if your Members of Congress are already supporting our efforts.

Call your Members of Congress in support of reform - Ask your Members of Congress to support real health care reform, including the choice of a public health insurance option.
Call your Senators in support of a public option - Call your Senators in support of a strong public health insurance option, not "co-ops" or other proposals that won’t do all the things a strong public option can.
Spread the word about our campaign - When President Bill Clinton tried to pass health care reform back in 1993, he didn't have a grassroots army behind him to hold Congress' feet to the fire and fend off opponents. That critical mistake eventually doomed his efforts. This time will be different, but we need your help to recruit your friends and family. Please send a message to anyone you know who supports President Obama and his promises of health care reform and ask them to join our campaign.
Volunteer in your state - Health Care for America Now has grassroots offices in 42 states and grassroots supporters in all 50. Get involved in the effort in your state and in your community to help us pressure Congress and win quality, affordable health care for all in 2009.