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US Government: A Case Presentation


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Title: US Government: A Case Presentation

US Government A Case Presentation
  • Dana M. Block, OMS-IV
  • SOMA National Director of Political Affairs

  • Purpose to provide osteopathic medical students
    with a basic understanding of the structure and
    function of the US Government and the processes
    involved in a bill becoming a law
  • This presentation is Part I of III in the Student
    Osteopathic Medical Association (SOMA) Political
    Action Training Course (PATC), completion of
    which is recommended for all D.O. Day on the Hill
  • Completion of the SOMA PATC is one requirement
    for induction into Omega Beta Iota (O??), the
    national osteopathic political action honor
    society (exceptions will be made for 2007 O??
    inductees, as this is the first SOMA PATC to be

Presentation Overview
  • Case presentation of sample issue
  • Topic Review
  • Structure and functions of US government
  • How a bill becomes a law
  • Save the Date D.O. Day on the Hill (4/26/07)

Case Presentation
  • Disclaimer the case used in this presentation
    represents a current issue and is a creative
    adaptation of such it therefore should not be
    taken too literally nor is this an official
    production of the American Osteopathic
    Association (AOA).
  • CC We need improved funding for osteopathic
    graduate medical education (OGME).
  • HPI The AOA is a 110-year-old membership
    organization that supports, unifies, and
    represents osteopathic physicians within the USA,
    and is currently in need of improved funding for
    OGME. Although this need has been apparent for
    several years, it only recently became so severe
    that it required immediate attention. The need
    for funding is a deep, constant, 10/10 and
    worsens as graduating osteopathic medical student
    numbers increase. It improves slightly if
    Medicare provides additional funding and if
    approval for new OGME programs is attained. ROS
    is () for collaboration with other osteopathic
    organizations, employment of a team of political
    advocacy experts, and the promotion of
    osteopathic postdoctoral training institutes
    (OPTIs). All other ROS are (-).

Pertinent History
  • PMHx the Balanced Budget Act of 1997
    established a full-time equivalent resident cap
    on funded residency positions. Additionally,
    OGME programs are limited by Medicare laws and
    the restricted utilization of ambulatory sites in
    teaching hospital-affiliated OGME programs
  • PSHx OGME programs have been restructured in
    the past to assure compliance with current
  • Soc Hx
  • Medications none
  • NKDA

Pertinent Physical Exam Findings(a.k.a.
Pertinent Statistics)
  • Osteopathic physicians in self-identified
    specialties, as of June 2006
  • Family Medicine 46.4
  • Internal Medicine 8.3
  • Pediatrics 4.2
  • OB/GYN 3.9
  • OMT 1.2
  • Non-primary care 36.0
  • Visits to osteopathic physicians account for
    roughly 20 of annual patient visits to
    general/family practitioners, according to the
    National Ambulatory Medical Care Survey
  • Vital signs, as of June 2006
  • Total of osteopathic medical students 13,406

  • Estimated of graduating osteopathic medical
    students (13,406/4) 3352
  • Total of AOA-approved OGME internship programs
  • Total of AOA-approved OGME internship
    positions 2777

Pertinent Laboratory Data/Imaging
  • D.O. internships are offered in only 36 of the 50
    states Alaska, Arkansas, California, Colorado,
    Connecticut, Delaware, Florida, Georgia, Iowa,
    Illinois, Indiana, Kansas, Kentucky, Louisiana,
    Massachusetts, Maine, Michigan, Missouri, North
    Carolina, North Dakota, New Hampshire, New
    Jersey, New Mexico, New York, Nevada, Ohio,
    Oklahoma, Pennsylvania, South Carolina,
    Tennessee, Texas, Virginia, Washington, West
    Virginia, Wisconsin, and Wyoming

Assessment and Plan
  • Assessment we are in need of additional funding
    to improve upon existing, and to create
    additional, OGME programs
  • Plan author a bill to promote funding for the
    addition and improvement of OGME programs, and
    lobby to help the bill become a law!!!

Topic Review US Government
  • The United States government is composed of three
    branches, as delineated in the Constitution
  • Executive (President)
  • Legislative (Congress)
  • Judicial (Supreme Court)
  • These branches were created to provide checks
    and balances
  • Each branch of government has the right to amend
    or void those acts of another branch of
    government that fall within its purview

Topic Review US Government
  • Executive Branch in detail
  • Purpose responsible for enforcing the laws of
    the US
  • Membership
  • President (US leader, Commander-in-Chief of the
    US military, and appoints Department leaders)
  • Vice-President (President of the Senate)
  • Executive Office of the President
  • Departments
  • Department heads advise the President on policy
    issues and help put policies into practice
  • Agriculture, Commerce, Defense, Education,
    Energy, Health and Human Services, Homeland
    Security, Housing and Urban Development,
    Interior, Justice, Labor, State, Transportation,
    Treasury, Veterans Affairs
  • Independent Establishments and Government
  • Provide special services and help execute
  • CIA, NASA, USPS, etc.

Topic Review US Government
  • Judicial Branch in detail
  • Purpose to decide arguments about the meaning
    of laws, how they are applied, and whether or not
    they violate the US Constitution
  • Membership
  • The Supreme Court is the highest court in the US
    and is the only court created by the
  • Several other federal courts have since been
    created by Congress as allowed by the
  • Additional courts included within the judicial
    branch of government are the US Court of
    Appeals, US district courts, the US sentencing
    commission, etc

Topic Review US Government
  • Legislative Branch in detail
  • Purpose create and establish US laws
  • Membership
  • Congress Senate House of Representatives
  • Senate equal representation provided for each
    state, regardless of states population (2
    Senators per state, period)
  • House of Representatives representation
    provided for each state based upon states
    population (each state may have several
    representatives, elected from given districts)
  • Agencies provide support services for Congress
  • Architect of the Capitol, Congressional Budget
    Office, General Accounting Office, Government
    Printing Office, Library of Congress
  • This is the branch of government we will work
    most closely with when we participate in advocacy
    campaigns, including writing legislation and

Topic Review How a Bill Becomes a Law
  • A bill always begins with an idea ours is to
    promote funding for the addition and improvement
    of osteopathic graduate medical education (OGME)
  • Lets pretend we already authored our bill and we
    now are wanting to make it into a law

Topic Review How a Bill Becomes a Law
  • Anyone may write a bill, but a bill may only be
    introduced to Congress by a Member of Congress
    when the House is in session
  • There are 4 types of legislation
  • Bills
  • Joint Resolutions
  • Concurrent Resolutions
  • Simple Resolutions
  • There are also different types of bills
  • Private affects a specific person or
  • Public affects the population at large

Topic Review How a Bill Becomes a Law
  • The process of introducing a bill depends on if
    it is being introduced in the House or in the
  • In the House of Representatives, a bill is
    introduced by placing it in the hopper, a
    receptacle near the Speakers podium it is then
    assigned a number by a bill clerk
  • House bills are abbreviated H.R.
  • The first reading of a bill in the House means
    its title is read on the House Floor it is then
    referred to committee for markup
  • In the Senate, a bill is introduced by placing it
    on the presiding officers desk or by formally
    introducing it on the Senate Floor
  • Senate bills are abbreviated S.
  • Once introduced in the Senate, a bill is also
    referred to committee for markup
  • Once a bill is formally introduced in either the
    House or the Senate, the Library of Congress
    receives an electronic copy
  • The Library of Congress then posts the bill and
    its status on a public website named THOMAS,
    http// updates on bills at each
    step of the process are also included on the
    THOMAS website

Topic Review How a Bill Becomes a Law
  • There are 19 House Standing Committees and 16
    Senate Committees, each with jurisdiction over a
    specific area of public policy
  • Committee Actions
  • Bill is placed on Committee Calendar
  • Bill is debated and altered (if deemed necessary)
    utilizing parliamentary procedures
  • Bill may be tabled if it is determined to be
    unwise or unnecessary
  • Bill may be referred to subcommittee for further
  • Subcommittee evaluation of a bill mirrors that of
    Committee evaluation, but subcommittees may
    include hearings to obtain views of experts,
    supporters, and opponents
  • Once a subcommittee approves a bill, it is sent
    back to the full committee for a vote
  • Bill is voted upon after it is debated and/or
  • Approved bill is reported back to the House or
    Senate Floor

Topic Review How a Bill Becomes a Law
  • The bill is termed reported once it has passed
    through Committee the bill is accompanied by a
    report outlining all of its provisions, hence the
    term reported

Topic Review How a Bill Becomes a Law
  • A reported bill is then placed on a House
    calendar for consideration on the House floor

  • Debate ensues according to established
    parliamentary procedure (which may be special
    rules for the specific bill)
  • After the debate, the second reading of the bill
    occurs, allowing the opportunity for scrutiny and
    further amendment
  • Following further amendment (if performed), the
    bill is read a third time in preparation for a
    vote by the House

Topic Review How a Bill Becomes a Law
  • House voting
  • The bill is read by title only and put to a vote
  • Members of the House who are present vote to pass
    or not to pass the bill
  • The House has an electronic voting system
  • Members may vote to pass the bill (yea), not to
    pass the bill (nay), or abstain (present)
  • The bill passes with a majority vote of the
  • A bill is termed engrossed once it (and its
    amendments) has passed the House and has been
    certified by the Clerk
  • A bill that passes the House is then referred to
    the Senate to undergo a similar process again

Topic Review How a Bill Becomes a Law
  • Senate voting
  • The Senate may decide to vote on a House bill or
    to continue its own legislation
  • The bill may be sent to committee
  • The bill may be voted upon by Senators
  • If the bill undergoes revision within and passes
    the Senate with language other than what was
    introduced, the bill must be sent to a conference
    committee for review
  • The conference committee is comprised of members
    from both the House and the Senate
  • Differences must be reconciled before the bill
    may be sent to the President for signature
  • A bill must pass both the House and the Senate in
    order to become a law

Topic Review How a Bill Becomes a Law
  • A bill is termed enrolled when it is submitted
    to the President for signature
  • The President may
  • Take no action (if Congress is in session, the
    bill automatically becomes law in 10 days)
  • Pocket veto (if Congress is not in session and
    the bill is not signed in 10 days, it does NOT
    become a law)
  • Veto the bill
  • Sign the bill to make it a law
  • A bill becomes a law once it has passed both the
    House and the Senate and has been signed by the
    President, or if Congress overrides a Presidents

Topic Review How a Bill Becomes a Law
  • If a Presidential veto occurs
  • The bill returns to either the House or the
    Senate, wherever it originated
  • Objections to the veto are read and debated
  • If enough objections to the veto exist, a vote to
    override the veto may be obtained
  • If the vote on the veto override passes, the bill
    becomes a law
  • In order to pass, a 2/3 majority of BOTH the
    House and the Senate is required
  • If the House or Senate does not vote on a veto
    override, or if the vote on the veto override
    fails, the bill does not become a law

Topic Review How a Bill Becomes a Law
  • So, WHY did we time-travel back to fifth-grade
    social sciences to review all of this stuff?
  • Our brains are currently inundated with medical
  • We got free food for coming to the meeting
  • Its required for induction into the national
    osteopathic political action honor society, Omega
    Beta Iota (O??)
  • Its important to understand the basics and the
    processes behind the legislation we will be
    lobbying to support in DC during D.O. Day on the

Save the Date
D.O. Day on the Hill April 26, 2007 Regis
ter online now!
  • Part II of the SOMA Political Action Training
    Course will be coming to you in the beginning of
  • Topic The osteopathic medical student lobbyist
    how-to guide
  • Part III of the SOMA Political Action Training
    Course will be coming to you in late March or
    early April!
  • Topic Preliminary introduction and review of
    2007 AOA priority issues to be lobbied during
    D.O. Day on the Hill

  • Licciardone JC. A comparison of patient visits
    to osteopathic and allopathic general and family
    medicine physicians results from the national
    ambulatory medical care survey. Osteopathic
    Medicine and Primary Care, 12, January 12,
  • AOA 2006 Report, including data from AACOM,
    accessed online at https//
  • AOAs 110th Congress Legislative, Regulatory, and
    Advocacy Agenda, accessed online at
  • http//
  • http//
  • Google images search