Session 2: Introduction to Congress and the Legislative Process

April 14, 2023
9:40 am-

10:55 am

This panel provided a high-level overview of health care coverage programs in the United States, such as Medicare, Medicaid, the Affordable Care Act, and employer-based insurance, as well as recent changes to coverage such as bolstering subsidies.

This Session:

  • Level-set on important metrics to track insurance coverage such as the national uninsured rates the populations covered under these programs, and trends in consumer affordability.
  • Addressed questions of how money flows through federal health programs versus private
  • Described how patients pay for care and interact with different forms of coverage
  • Described how the major insurance programs operating in the U.S. interact with one another.

Speakers

Rodney Whitlock, Ph.D.

Vice President, McDermott+Consulting
Rodney is an accomplished health care advisor with more than two decades on the Hill where he specialized in rural health, the health care safety net and disability policy. With more than 25 years of experience, Rodney possesses and offers clients the kind of knowledge that is uniquely available to those who have drafted and advanced legislation. He strategically guides clients through dense Medicare and Medicaid issues that have significant business impact. While working in Congress, Rodney served as former US Representative Charlie Norwood’s (R-GA) health policy director where he managed the Patients’ Bill of Rights (S.1890), among other notable health policy matters. Rodney then went on to serve Senator Chuck Grassley (R-IA) in the Senate. He first joined the Senate Finance Committee Staff as a health policy advisor to Chairman Grassley, and ultimately joined the Senator’s personal office as health policy director. During his time in the Senate, Rodney served as the lead Republican staffer for Medicaid legislation from 2005 to 2010, and continued to serve Senator Grassley on all health-related issues through 2015. During his time in the Senate, Rodney helped staff Republicans in the Senate on such prominent and important legislation as the Deficit Reduction Act of 2005, Tax Relief and Health Care Act of 2006, CHIP Reauthorization Act of 2007 and 2009 and Affordable Care Act of 2010. For the last 20 years, Rodney has been an adjunct faculty member at the George Washington University Milken Institute School of Public Health’s Department of Health Policy and Management, and the Graduate School of Political Management’s Department of Legislative Affairs. Hundreds of students have taken Rodney’s courses and have gone on to pursue careers in Washington, DC.

Katie Meyer, MPP

Head of Government Affairs, Novocure

Kim Corbin, J.D.

Pioneer Public Affairs, Partner

Brandon Garrett, J.D

National Minority Quality Forum, Chief Operating Officer

Presentation: Introduction to Congress and the Legislative Process

Event Resources

Transcript

Bailey: 

Thank you. I am pleased to welcome our second session titled Introduction to Congress and the Legislative Process and backed by popular demand. Dr. Rodney Whitlock, vice president at McDermott+Consulting is going to be our moderator for this panel. With that, I will turn it over to you, Rodney. 

Rodney Whitlock: 

Thank you, Bailey. I appreciate that. The nice folks at Alliance who chose to invite me and then I got stuck doing two of these things. They wrote me a script for this opening here, but bless their little hearts, they thought I would stay on script. 15, 20 years ago, I did one of these where they asked me to be their after lunch speaker talking about the demographic challenges to the Medicare program. I opened by saying, “Well, we need to talk about sex.” 

I did that because it was then allowed you to go in the demographic challenges facing the Medicare program, which is not doing the last Pres presentation. It took them five years to forget that enough to invite me back? I figure I might as well do one worthy of not getting back, invited back for a while. What is this panel about? Well, it’s their fault. They told me what this panel is about. Let me give you a little sense of it. 

Barry White: 

I’ve heard people say that. 

Rodney Whitlock: 

It needs Barry White to really appreciate what they want here. 

Barry White: 

I don’t know about that. 

Rodney Whitlock: 

They asked us to do the adult version of I’m Just a Bill. Ladies and gentlemen, we’re going to present to you the adult version of I’m Just a Bill with the panelist. Kim, Brandon, and Katie. I’ll start with Kim, who is a partner at Pioneer Public Affairs, a 15-year Capital Hill veteran with expertise in healthcare, food security, economic issues, strategic and creative problem solver. 

She has a deep knowledge of the House and Senate navigating the federal administration and getting things done in D.C. as a senior advisor to the House Rules committee chairman Jim McGovern and she spearheaded a year-long effort, anti-hunger initiative that culminated in the September conference on food, nutrition, hunger and healthcare. Important to note, her go-to karaoke is the Katrina and The Waves classic, Walking on Sunshine. 

Next, we have Brandon Garrett, who is Chief Operating Officer and Chief of Staff to the CEO at the National Minority Quality Forum. He served as Chief of staff to Congresswoman Robin Kelly where he led the staff and volunteers on strategy, policy, and communications. He served as executive editor of the Kelly Report in 2015 on health disparities in America and executive director of the Congressional Black Caucus Health Braintrust. 

He has over a decade of experience on Capitol Hill that includes economic development for post-Katrina, New Orleans and policy director for then Vice President Joe Biden. His first car was an Oldsmobile Aurora. Lastly, turning to Katie Meyer, she’s head of government affairs at Novocure, a global oncology company working to extend survival in some of the most aggressive forms of cancer. 

With more than a decade of legislative experience on Capitol Hill, Katie leads Novocure’s government engagement and public affairs efforts to expand patient access to the most innovative medical devices on the market. Prior to joining Novocure, Katie served as a senior leadership staffer to now speaker Kevin McCarthy, where she managed the Republican conference’s legislative strategy on healthcare, international trade and veterans policy. In high school she was president of the Unicycle Club. Ladies and gentlemen, it is turned over to you all. Kim, you go first. 

Kim Corbin: 

I’m going to go first. Sorry, hello? [inaudible 00:04:01] I don’t know, I’m happy to go first. Hello, my name is Kim. I’m going to talk about how to get things done in the Senate. You’ve had the morning, you’re starting to talk about healthcare policy, having a great policy idea is like step one, but actually moving that policy through the Congress is the hardest gauntlet you’ll walk in this town. Just quick overview of the committees. 

Apologies if this is, I’m going to try to go fast but there’s a lot more here. I’m going to start with the Finance Committee because that’s the committee that I was affiliated with when I was in Health LA in the Senate. That is the place where you’re doing mandatory spending. You have Medicare, Medicaid, and CHIP. When I first started working on healthcare, I couldn’t tell you which program was for seniors and which program was for low income families. 

That’s a problem, you know what? Someday you will figure this all out and you will know all of these things, so do not fear what you don’t know. Finance is a one-stop shop for health policy. You walk in with your policy idea, you get people like Rodney to say that they think that’s a great idea. You have your bipartisan colleague and then you go ahead and you get your policy done. It’s not that easy, but basically you’re doing your policy and your pay for is in the same place. 

One of the things to keep in mind though is that it isn’t that easy because to get through the hurdles of passing law, that’s going to impact millions of people and cost probably millions to billions of dollars. That overarching being good stewards of the federal tax dollar will stay with you and it goes even further, it’s being a good steward of the trust fund. You will face a lot of obstacles as you move through there, but when you go into finance and you’re trying to move policy in those three policy areas, it’s a one-stop shop. 

Another core really important committee in the senate is the HELP Committee. To me, I think of it as, you know you’re going to do public health there, you’re going to do insurance markets, you’re going to do drugs, no, to FDA, apologies. A really good example of where the HELP Committee does a fantastic job is to look through the last year the infant formula shortage. They were able to talk through various policy responses and work through that. In the committee they had FDA reauthorization bills that were going through their committee. 

Ultimately, it passed in an end of year bill, but they do really great work there. They also work very, very closely with the Appropriations’ Committee because as the HELP Committee is an authorizer, the Appropriations Committee is going to appropriate, that means that you’re a two stop shop. You can pass your policy but you’re not going to get any money. You have to go to another place to get that money to fund whatever really fantastic program you’ve just designed. 

That means that, again, really important to work closely with Appropriations. That’s the next committee I think of note, the Labor HHS subcommittee is going to be a place where I’m not going to lie, I’ve never worked for an appropriator. We could probably fill this room with all the things I don’t know about the appropriations’ process. It is incredibly complicated or maybe it’s just very mysterious and they keep it that way so that they can keep all the money. You’re going to do a couple of things there. 

The most clear part is plusing, adding money to or minusing, reducing money from accounts. These are for programs that already exist and that’s the most basic thing that you do. The other really interesting place in Appropriations’ is report language. You can sort of change the law for a year on appropriate through an Appropriations’ report language. Now, it’s not exactly that. It’s a little bit more mystical than changing the law because you’re not actually changing statute, but you can impact, I’m sorry, the way the agencies and departments have to implement or spend money. 

You can direct them to do things through report language, which is and actually doing studies and other things but that’s not studies, it’s actually directing the agencies to do things. Then, the most, sometimes controversial but also maybe the most fun place of the Appropriations’ process is called ash and trash. It is the place when you will hear about an end of year funding bill coming through in December and everyone’s talking about that Christmas tree, and it’s our last vehicle. 

It’s loaded up with member gifts and other things, it is usually through ash and trash that you’ll find those items. Basically, if you do a really good job and convince people like Katie to take pity on you and add your policy in, sometimes you can have your policy item, your bill or amendment appear in that ash and trash. I’m going to give an honorable mention before we move on to the Aging Committee. 

Aging is a weird place, Select Committee, but you can use select committees in strategic ways in the Senate because what you’re trying to do all the time is build support among members of your own party but also members in the other party to move your agenda forward. Through really thoughtful hearings and important questions that you ask, you can do a lot of good to bolster and push and pressure those committees of jurisdiction. Just want to give honorable mention there. 

The committees are one piece of the process and the biggest, it’s not the whole story. A lot of people would say, well my boss is on a committee of jurisdiction that you just mentioned, so how am I going to move this policy that my boss really cares a lot about? In the Senate you have a lot of tools at your disposal and a lot of times people forget that they know about the chairman’s mark and they know about the amendments and committee and amendments on the floor. 

You’ll have a conversation about Jermainess, which sometimes I think is more important for the house than the Senate, but it is still important, but because you’re one of a hundred senators, you have a lot of room to do things and simple things that a lot of times people are like, “A letter to the administration.” It’s like if you get a letter to the administration on a policy issue that you care about where you have a friend from the other party who’s joining on and you happen to be on or somebody happens to be on committees where you can get a chairman or ranking member to care, you can do a lot of good. 

Sometimes you don’t even need that letter, you can just make a phone call, you can make the phone call or if you have a very motivated senator, you can have them make a phone call and that’s really how you can push. I think sometimes what people do is they wait for a package to materialize and then they are like, “Great, here’s my amendment or here’s my bill idea.” It is rarely the case that the great idea you came up with 30 seconds before amendments are due that you will have a positive result on the other end. 

You have to start very early to make these things work out. The last two things I’ll mention just before we move on is you know have your typical cadence of the committees of jurisdiction and the Appropriations process. The Appropriations process is most every year it’s on certain schedules. There are certain months and dates when things are very important. In healthcare though then, you have at the committees, the chair and the ranking member will set the priorities for those committees and you’ll work on lots of policy items through there. 

In healthcare there are also always other things, deadlines, timelines that in a year like this one we’ll see a lot of those deadlines and timelines correspond with the end of the fiscal year or the end of the calendar year those are really important times in Congress. It means that probably the deadlines in healthcare that pop up this year. Think things related to the pandemic or things related to physician payment. 

Those things are going to, they could get tied up or rolled into end of year packages, but in years past we would often have a march or may blockbuster healthcare policy exercise and that’s always possible depending on the deadlines and timelines. Pay attention to those deadlines and timelines. The last thing I’ll mention in this very last minute is healthcare stakeholders. I think a lot of us, we sit here and we’re like, oh, I came up with this great policy idea and I worked it and I’m going to change the law. 

Sometimes that happens and certainly for Dr. Whitlock that happens quite a bit. For the rest of us, you do rely on stakeholders to help you to understand not only what is going on the ground because you can’t possibly know all the things that are going on on the ground, but also to know about what are some of the chief issues and things that are developing in health policy. They tend to be it’s hospitals, doctors, drug companies, insurers, and advocacy groups. 

The advocacy groups are everything from the patient advocacy groups to foundations that are pushing for really important changes in health policy. The only thing I’ll say is you can learn a tremendous amount. These folks really do, they are experts in what they’re talking about, but it’s really important to always remember and center around what makes the most sense for your state or region, what makes the most sense for your boss. 

Really, be critical of that information that’s coming through the front door. It’s the most important thing you can do. With that, I have one second left. I’ll stop right there. 

Brandon Garrett: 

Very good, I definitely appreciate that and that was a bit of an education for me because while I’ve worked with the administration and the house, I’ve never had any senate experience. Then, the Senate has always considered the smaller but more thoughtful body. There’s more time to get thing in the house. I look at it sometimes an episode of Veep, wherever you have like 500 people because once you include the delegates and whatnot you have about instead of 435, there’s like the 21 delegates so you do the math. 

You’re going to 451 people and they’re all vying for attention in the top part of this building. This person had my idea, you’re dealing with a lot of that, you’re dealing with the politics. I think that’s a great way to think of healthcare because I think healthcare is the most difficult issue to work on in Congress for a variety of reasons. I think the biggest is sometimes your boss might have a priority or you might have a priority because it’s a big deal in your district. 

You could be talking about no joke cancer versus HIV, how do you make that determination? How do you make that the important priority? How do you just decipher that? Then, you’re just looking at it, well we have more cases of cancer in our district than we have HIV or diabetes. How do you actually tell an advocacy group that’s coming in about that your boss can’t be the lead on this because they’re already the lead on there, can’t believe on X because they’re the lead on Y. 

That’s why I just want to put that out there that healthcare is the most difficult and I think that is the reason, so we’ll start there. I’m going to do a bit of an overview of the committees and I think we have three. Historically, when you think of healthcare, at least on the house side, we’re talking about three different committees. There’s probably another five that are also important because as she said on the Senate side you have about 100 people. 

It’s thoughtful, one senator could stop everything on the house side only someone in leadership can actually stop it. On the Senate side, there’s a whole bunch of rules that you can just filibuster whatever and make sure something doesn’t happen or does happen on the house side unless the leader says it’s not going to happen or they’re going to happen that they have that power and that jurisdiction. Let’s just think about it, let’s just go through it. 

First one, Energy and Commerce most important committee Chairman Dingell at the time, he was the chairman in the early 2000s and he had been on and actually in the ’90s too, but he had been on the committee for something like 45 years or something. He would always say Energy and Commerce and he’ll show, he’ll point to new staffers and he pointed a picture to the globe and he said, “That’s our jurisdiction.” That’s it. 

Everything that he wants or anything that he wants that’s what he’s going to be in. Specifically in Energy and Commerce, you have everything from hospitals. You have like she talked about pharma, you have the drug companies, HHS sort of reports. They’re the oversight body over there. I think that’s the first one to know if you’re really going to get in healthcare, you better start with the energy and commerce committee and just figure out all the areas that they have jurisdiction. 

Think it’s the house side, again think creatively, how can we get something in energy and commerce? How can we buy to get my boss on that committee or friends on that committee, that type of thing because that’s how things get done. I would say the number two area is ways it means because Ways and Means has jurisdiction over what? Medicare, and what do you think you hear about that more than anything. Obviously, that’s CHIP and all of that too, but it’s also where everything is financed. 

We pay for everything, it means we decide if we’re going to have a resin revenue razor and that’s where we’re going to tax something to pay for something else. Are we going to cut spending and we’re going to do it through not having a tax, et cetera. Then finally, the last of the big three as far as education is goes is ed and workforce. It’s because of that second part workforce, the health healthcare workforce is under that, we always know clinicians in general, the physicians, the physicians, nurses, social workers, everybody that has an impact on the healthcare space. 

There’s also other groups that are in that. The researchers, their education grants from college. Are there enough GME slots for the number of people that are graduating from medical school this year, how do we decipher all that? Those are your big three and those are the folks that you’re going to have to get to know to have an impact on healthcare space. There are at least five other committees that have a pretty good amount of power in the healthcare fit space. 

If you think about it just the calendar year, it all starts with the budget. We wait until March usually for the president’s budget to come out and you’ll see, “The president wants to plus up HHS by X amount of dollars.” It says this little goals in it, “We want to do this for cancer research or HIV research.” It’s really just that number, it’s not anything specific. It’s like these are are the presidents or the administration’s ideas and we want to plus up healthcare by $2 billion. 

It’s important to know the budget, the budget numbers, and so when you’re on these authorizing committees, you can always go back point back to whether president wanted to raise it by X amount of dollars essentially, we have this amount of money to work with and we can work with health HHS. Another one is specifically for this calendar year is agriculture. The big ag bill is coming out, it happens about every five years and a lot of things are within the AG bill that impact healthcare. 

Number one, I would say food and nutrition SNAP benefits, those types of things. There’s going to be a lot of healthcare items within the agriculture committee spending. That could be pretty much not just for this year but highlighted this year, on this congress because we have to get this ag bill done. Historically, it’s one of the few bills that passes with bipartisan support. Another big one that’s important not just this year but every year is surprisingly is armed services. 

People talk a lot about defense spending and it’s too big, it’s too small, whatever however you feel about it’s big, it’s there. It’s the one thing House Armed Services Committee is going to work on an NDAA every year. In NDAA there’s our own, there’s sort of our sneaky way in some ways to do earmarks and projects important is that a lot of folks don’t realize that a lot of your funding, your research funding on diseases is actually done through the Defense Department and not HHS. 

The cancer research funding is actually mostly funded through DoD. A lot of HIV funding, I can mention diabetes funding, all that stuff to do research on in those particular items from the partnership with the NIH is done because of a defense money was appropriated. That word appropriations goes to our next one. Appropriations can be, you have all the authorized, you could say, “We want to do X, Y, and Z, we want to give it billion dollars to this. We want to give $2 trillion.” 

When I first got here and I worked on budget, I was like, “What are they talking about?” They just throw these threw billions around it’s like quarters, you know what I mean? Nonetheless, they have this money that is authorized, but is it actually going to be appropriated? You’re going to get the bill through, you’re going to get it done and you’re going to get to LHH, Labor, Health and Human Services, likely Appropriations, Defense Appropriations, Vet Affairs Appropriations. 

You’re going to try to get that actual number that they said, “Please committee, honor with the authorizer said and give us that actual number.” Then, get to the sanitary with it and get it to the White House to sign, so that’s another one. My last, I’m sure there are more but I think my last one is Vet Affairs because Veterans Affairs, my friend just took a job at Vet Affairs as a physician, as a radiologist in San Antonio, Texas. 

Obviously, they have a lot of money and jurisdiction that’s in line with the overall defense spending. I think another thing is, I mentioned that Veep, that TV show and the only reason I mentioned it over and over again because I went from the house to the Veep’s office. I really saw the nest like that show in the house side just because there’s so many things that you have to do. The Veep has I don’t know, 10 policy advisors on this team and then we had DPC to work with. 

You have all these resources so you’re not as clamoring, it’s a lot of work but you’re not clamoring for information or researching. It’s much easier you call from, “Hey, I’m calling from the VP’s office.” They’re like, “What do you need? You call from the house office. We’ve got 30 calls from that same person on that issue.” You’re fighting for a lot there. The best way to think of doing legislation, you have to think of three to four things. 

One, as you mentioned, you got to think of instead of the state, you’re thinking of a community district. If I introduce, if I write this bill, how is it impacting my community? I’ve worked for Rodney Kelly, what is Southside Chicago going to think about this bill? What are the big players that got me here going to think about it? They have to think a little bit more because it’s every election, you know what I mean? 

You win and then you run immediately on November 5th or whatever. You’re like, “Great, I won. Let me start campaigning again. I have to think of all those issues that are important.” Two, I think is important is the business community, the folks that employ these people, what are they going to say about it? I know sugar may be considered bad, but I represent all of Hershey’s. What am I going to do about that? I know sugar’s bad, but we have a lot of beet sugar growers in our district.” 

I know that sugar could be considered bad and we’d have nothing in it, but what if they did that to soybeans? How do I handle that? You got to think what that community thinks. Another thing on the house side it, there’s power in numbers and caucuses and strengths. You’re looking for other caucuses to support you. On our side, what does the Republican study committee think of this? What did the new Dems think of this bill? Are they going to endorse it? 

An endorsement from a group like the Congressional Black Caucus for example? You may say, It’s not just me, it’s 59 other people. It’s not just me, it’s a 100 some people.” Those are the things that you need to think about when you’re working on house legislation. One second over, so I took her second. 

Katie Meyer: 

Great, thanks guys. I’m excited to talk about how to get things done with house leadership and how that’s set up. I know folks often say house leadership’s kind of a black box and no one knows how it works. I’m excited to demystify this. I was tempted to say wish I could but I had to swear a oath of secrecy in order to become a leadership staff or someone going to give you that line. 

Kim Corbin: 

You could believe that. 

Katie Meyer: 

No, that’s not the case. I think folks generally are aware of the structure, but I’m going to go over this just to be a little hopefully helpful. There’s obviously House and Senate, Republicans and Democrats and each of those have a leader, a whip, and some kind of policy leader. Then, in the house majority, there’s the speaker so there’s a general structure for both. I think generally speaking in the house you have the speaker doing the overall policy and agenda setting. 

Then, the leader is in charge of kind of committee management and specifically what bills are coming to the floor on a day-to-day basis, week to week. Then, the whip is in charge of making sure that there are votes to pass those things. For the majority side, the minority is similar. Generally speaking, that’s a similar structure in the House and the Senate. Knowing that there are, each of these leadership jobs have a concrete set of responsibilities is important to understanding how the leader structure works. 

The leadership’s job is to manage the competing priorities of the members of their caucus and of the committees that are comprised of those members. That’s the hardest thing to do. When Brandon talks about the house, and it’s like Veep, it’s true, you have so many big personalities, but just really so many people that it’s hard to even keep track of who all of these folks are, let alone what they care about and what they want to see happening in the congress. 

Members of Congress came here to Washington to get things done and they’re usually pretty frustrated because they aren’t able to. The scarcest resource for a member of leadership is floor time and everyone wants to see their things getting scheduled for the floor and passed. There are only so many minutes that the House and Senate are in session each week and those minutes tick away very, very quickly. 

In the Senate, because of the way the rules are structured, I’m not an expert on senate rules, but it often takes a week or two in order to have votes on one large bill, one package of legislation. There’s a real limit on the number of things that can happen through regular order. The same is true in the house although the house leadership has a lot more control over the way the rules packages are scheduled, which means you can just make it up and speed things through if there’s enough support in order to do that. 

Each week the leadership is looking for what do we want to schedule on the floor this week?Generally speaking, there’s an overarching plan for we want to accomplish these 10 things. There’s a contract for America or whatever your policy agenda is for the Congress and you want to say, by the end of the Congress we’ve accomplished X, Y, and Z. Usually, there’s maybe one healthcare thing on that list possibly or maybe nothing. 

How does anything else ever get done if we have maybe one healthcare vehicle moving per one healthcare agenda item. There are of course a lot of things that do have to get done. A lot of them get accomplished either on suspension calendar or via unanimous consent suspension calendar in the house or via unanimous consent in the Senate. The easiest way to get anything accomplished in either body is to have a lot of bipartisan support and very little objection to what you’re trying to get done. 

The easiest way to demonstrate that to leadership that you have little few objections is to move through the regular order process through committee, which these folks have talked about how to do that. Obviously, having a lot of support externally and a lot of co-sponsors on your legislation leadership looks to that to say, “We do understand that a lot of people care about this, so it’s worth doing and spending time on because our members are going to be happy to see it move.” 

Then, there are must pass vehicles. We’ve talked about some of those, the appropriations vehicles in the healthcare space, there are quite a few of other things too that have to get done. User Fee reauthorizations there are tax policies that have to get extended where there’s a lot of healthcare policies usually that ride along those and a number of other things that are must do. Could go to the floor or could pass via on the suspension calendar or unanimous consent, or get tacked on to another must pass vehicle. 

Often Appropriations or continuing resolution, which then becomes a Christmas tree. Kim talked about ash and trash and that absolutely is where leadership gets involved. I would think about it like this generally, leadership wants usually to make as few decisions as necessary and are trying to push the decision making down to the people who are experts at the committee level at least that’s what I tried to do. 

Some people in leadership prefer to make more decisions, but usually you want to empower your committees who are the experts on the issue and say, “Please bring as few things to me, work it out on a bipartisan basis. You make the decisions and you represent your members. Make as many people happy there and decide.” Where there are issues that cannot be resolved, then those filter up first to the healthcare staffer in the leadership offices. 

Then, those folks will sit down on what we call a four corner corners basis and have a negotiation, “You want this, well, if that is in the bill, my members won’t vote for it. Well, what can I show as a win to my members so that I can get them to vote for it?” The leadership really has to have an understanding of where those lines are, what they think they can sell to their members in order to have that negotiation. 

Sometimes some of that gets agreed to at the healthcare level for Four Corners Health Care and sometimes there’s a big issue that you just can’t figure out. Then that gets elevated to, you have discussions with the policy directors and then they’re doing, “Well, I’m going to trade this healthcare issue for an ag issue.” Then, some of those issues don’t get resolved and it goes up and up to the chiefs of staff. Then, sometimes the members themselves will have conversations to address those last outstanding issues. 

That’s when it’s bipartisan and sometimes there are partisan packages then all holds barred. I think one other thing I want to talk about is how the leadership folks meet and talk to one another. Generally speaking, the committees will, there’s a healthcare meeting each week. On the house side you have a top staffer from each of the healthcare committees meeting together with the leadership healthcare staff, and they sit down and say, “What’s happening this week at your committee?” 

Make sure everyone has awareness, issues get worked out. That happens Republicans, Democrats, House and Senate, and then there are bicam meetings that happen. There’s a Republican bicam meeting and a Democrat I believe, I think. In the bicam meetings you’re saying, “What’s going on in the house this week? Do you think that’s going to come over? Do we need to schedule floor time for it?” Sort of procedural, but a ton of political issues come up here. 

There are those formal meetings. There’s also formal member meetings, the speaker and the senate leader of the same party will meet usually once a week and have a conversation. Now, a healthcare issue could come up there, but usually it’s whatever’s happening day to day. Time to time when one of those issues gets elevated, those things can come up in those bicam meetings as well. Now, I’ve only just began to scratch the service of these are the policy issues, but often the leadership is balancing political issues with the policy issues as well. 

You guys exist in this universe, so you do understand this, but there are things like, “Well, this member is in cycle and this has been their priority for years, but I don’t want to give them floor time for their bill because that’s going to be positive for them. I don’t want to give them the time to have the attention.” That sounds gross, but this is a part of the process because the leadership is also in charge of, and their tasked with their members want them to be in the majority, again, the next congress so that they can continue to control the floor, so they continue to control the agenda. 

Things like, “Well, in the house I have these vulnerable members, I want to make sure that they have a bill that gets voted on so they can take that back home and tout it and say, this is what I was able to achieve this congress.” That’s a huge motivating factor, so when you’re thinking about who do I want to work with? Who do I want to be my partners on legislation, keep those things in mind it can cut both ways. 

If it’s a vulnerable member on the other side, that could be a positive or a negative and it’s hard to know how that’s going to shake out. Well, you guys talked a little bit about, in addition to the committees, there are caucuses and leadership does care about that as well. There’s the DOT caucus on the Republican side. You’ve talked about some of the Congressional Black Caucus. 

 In the house in particular because there are so many members, these organizing bodies really do drive policy and leadership looks at that. It’s important to keep those in mind and talk to those people when you’re developing your policy ideas.