Advocacy & the DC Dance

Recently, I had the privilege to attend the ADA Webinar for state dental association executive directors and officers where Mr. Michael Graham, the ADA’s Advocacy Guru, spoke glowingly about the membership’s response in contacting their congressional representatives on the subject of including dental benefits in Medicare Part B. So far, to the benefit of dentists, the benefits were not included in the bill that passed the House and sent onto the Senate. Mr. Graham’s report got me to think if the NESO membership knows how a bill makes its way through the legislative process in today’s DC. And so this Advocacy in Action report is dedicated on how a bill makes its way through the twists and turns of our nation’s capital.

In another era, a bill needed to pass both chambers of Congress before the president signed the legislation into law. Bills are ideas that are proposed, considered by a committee, brought up for floor votes in both the House and the Senate, and finally end up on the president’s desk, waiting to be signed into law. But the process today is a little more tortuous than the linear path of yesteryear.

Today, if there’s any kind of controversial bill, it’s going to have a lot more traveling time than just going through committee and getting to the House floor. There has to be behind the scenes negotiations for weeks, if not months or years. It’s so much more work today and questions that need to be answered are for example “what’s the impact going to be politically”, “what is the reason for party leaders to put this bill on the floor”, and “how do you get the votes for it when it is on the floor?”

Even with the chairs in both the House and Senate both currently Democrats there are hoops a bill must pass through to get passed. The big hurdle that Democrats have been dealing with for years is the Senate filibuster, that 60-vote margin needed to get anything accomplished. You can’t only have the Democratic chairman writing and passing bills, and sending them to the president. You now have to have bipartisan cooperation, and that doesn’t exist in the vast majority of legislation.

The more accurate version of the passing of a bill right now might be about frameworks and proposals and more than concerning the actual legislation itself. That’s what both parties have to agree to before you can even agree to write a bill. There is a lot of work going on behind the scenes. But they’re not the ones who are going to have the gavel at the end of the day, approving a bill out of the committee and sending it to the floor. The only way it can get to the floor is if the party leaders on each side can say, ‘we have the votes to pass this.’

 It is extremely rare for either governing party to be able to put together a package that can actually get signed into law. But reconciliation is the way to go now. Reconciliation is the only game in town if you want to have substantial changes to policy. The only other thing that motivates Congress to get things done is a deadline. And the only other way to try to get bills to the floor is to attach it to a ‘must-pass’ government shutdown impending kind of legislation.

Whenever a party doesn’t have full supermajority control of Congress, they’re going to be forced into this process every time they try to do special budget bills. And it comes with these really obscure rules where every senator can propose unlimited amendments. These votes are all political.  Think of the budget resolution as a checklist for how much money you can spend on certain categories. You don’t have to spend all of it and you also don’t have to say exactly what it’s going to be for. Basically, every committee gets a certain amount of money.

The American people think it’s a lot more of a direct process and that the representatives in charge of the House and the Senate have more leeway in how they decide to craft these bills. But in reality, there are so many invisible barriers. That’s why Congress ends up in circles with all kinds of extensions. You can acknowledge something is a problem, but actually coming up with even the first step toward the solution is never going to get the votes that you need and so it goes on and on until you get the votes for a bill that may do what it was originally intended to do.

I hope this helps you to understand how a bill is passed and the importance of being in close contact with your friendly congressional representatives. Even though dental benefits are not currently included in the Build Back Better bill that doesn’t mean it couldn’t make it back into the bill at a later date.