Louisville Lectures

Open Access Medical Education

550 S Jackson St Louisville, KY, 40202 United States

Committed to sharing Internal Medicine focused lectures as free open access medical education.

Legislative Advocacy: Meet the Congress

May 16, 2022  /  Victoria Roman

Dr. Elizabeth Lehto

What is Congress?

Congress is the legislative arm of the government. It is made up of two houses, the Senate (also known as Upper Congress) and the House of Representatives (also known as Lower Congress). States have congress members at both the state and federal level.

The primary role of congress is to make new laws or change existing laws, many of which impact health either directly or indirectly. As physicians, it can often be helpful to speak with congress to share our expertise and provide insights on laws that will impact our patients.

For some, even thinking about speaking with congress can feel intimidating, especially if the role of congress is a vague memory from high school government class. This post will focus on federal congress, reviewing powers unique to each branch, leadership roles, and key differences in deliberating bills.  

The Senate

The Senate is composed of 50 members. Each state as two senators who represent the whole state. Senators sere a six-year term, however, there are no term limits so a Senator can remain in office for as long as they win reelections. Elections are staggered so that one-third of the Senate seats are up for election every two years. To run for Senate, a person must be at least 30 years old, have been a citizen of the United State for at least 9 years, and be a resident of the state they represent.

The main job of the Senate is to vote on new laws along with the House. In addition, the Senate has a few unique powers:

  • Approve some appointments made by the President, including Cabinet members, Supreme Court justices, and high-ranking military commanders

  • Ratify treaties with foreign governments

  • Try cases of impeachment of federal officers

  • Select the Vice President if there is no majority in the Electoral College

There are a few leadership roles within the Senate

  • President of the Senate—the Vice President also serves as the President of the Senate; the vice president only votes on new laws in case of a tie in the Senate

  • President pro tempore—presides over the Senate when the Vice President doesn’t attend; this person is elected by the Senate and typically the most senior member of the Senate majority party (the political party with the most leaders)

  • Majority leader—head of the majority party; serves as spokesperson for their party’s position on issues and schedules the daily legislative program

    • Has the right to be called upon first if several senators are seeking recognition, which enables him or her to offer motions or amendments before any other senator

  • Minority leader—head of the minority party (the political party with the fewest members); serves as spokesperson for their party’s position on issues

When a bill is up for consideration, the Senate will debate on the pros and cons of the bill. For most bills, there is no restriction on how long debate can last. The Senate often recesses instead of adjourning at the end of the day; therefore, Senator legislative days can continue for several calendar days. Senators can try to delay voting on a bill by filibustering, essentially giving a long speech. During these speeches, Senators may speak to issues other than the bill under consideration and can introduce unrelated amendments, known as riders.

A filibuster can be stopped if 60 Senators vote to end it, which is referred to as cloture. At this point, further debate is limited to 30 hours. Once debate is over, a bill will pass if a simple majority vote in favor.

 
 

The House of Representatives

The House of Representatives consists of 435 members. Each state has a minimum of one representative in the House. The remining seats are divided amongst states based on their population, with larger states having more Representatives. The number of Representatives each state is entitled to is calculated every 10 years. Members of the House represent their congressional district.

Representatives serve a two-year term, and like the senate there are no term limits. Elections occur for the entire membership of the House every two years. To run for the House, a person must be at least 25-years old, have bene a United States citizen for at least 7 years, and live in the state they represent.

By being elected every two years and representing their district (as opposed to Senators who represent their entire state), the House was designed to be closer to the people than the Senate and more responsive to constituents.

The main job of the House is to vote on new laws along with the Senate. In addition, the House has a few unique powers:

  • All tax bills and spending bills must start in the House

  • Only the House can impeach certain high ranking federal officials such as the president or the supreme court justice

  • The House decides who will be president if no one wins a majority of votes from the Electoral College

There are a few leadership roles within the House

  • Speaker of the House—elected from the members of the majority party, sets the calendar (what bills are debated and when the debate occurs), moderates debates, and determines who sits on what committees; this person is second in line to become the president after the Vice President

  • Majority leader—head of the majority party; serves as spokesperson for their party’s position on issues

  • Minority leader—head of the minority party; serves as spokesperson for their party’s position on issues

The House has a much more structured debate process than the Senate. Debates are usually limited to one hour, and each member who wishes to speak only has a few minutes. There is no filibustering in the house. the number and kind of amendments are usually limited, and unrelated amendments cannot be introduced on the floor.

The House has a structured debate process for bills up for consideration. Debates are usually limited to one hour, and each member who whishes to speak only has a few minutes. There is no filibustering in the House. The number and kind of amendments are usually limited, and unrelated amendments cannot be introduced on the floor.

Making Your Voice Heard

When creating and passing laws, members of congress depend on subject matter experts in order to create effective legislation. As physicians, it is important to advocate for policies that improve the health of our patients. A pervious post discussed strategies for speaking with congress, next we will briefly mention how to find bills to discuss.

Bills can be introduced any time congress is in session, and because there are so many bills and resolutions it can be difficult to keep track of what is being voted on. Online tools can be helpful in tracking bills:

Professional organizations can also be useful for finding bills related to a given specialty:

Final Thoughts:

After this review of the role of congress, we hope that some of you are feeling more comfortable (and excited) about participating in legislative advocacy.

Legislative advocacy is often intimidating, stay tuned as we continue to explore the topic and demystify the role of the physician advocate.

Elizabeth Lehto, D.O.

University of Louisville | UL · Department of Pediatrics | Doctor of Pediatric Emergency Medicine

Dr. Elizabeth Lehto is a Pediatric Emergency Medicine Attending at Norton Womens and Children’s Hospital. Dr. Lehto attended Midwestern University Arizona College of Osteopathic Medicine and completed her residency and fellowship at the University of Louisville.

Additional Resources:

For more information about the Senate and the House:

Comment
categories / LL Blog Internal Medicine
tags / Advocacy/Equity