Category: United States healthcare system

How Congress Regulates the U.S. Healthcare System

Here we look at how Congress oversees the federal healthcare system through two dozen committees in the House and Senate. Key committees include the House Ways and Means and Energy and Commerce, alongside the Senate Finance and Health, Education, Labor and Pensions Committees. They manage Medicare, Medicaid, and health policy funding.

How Congress oversees the federal health care-industrial complex is almost as byzantine as the U.S. health system itself.

Julie Kovner, KFF

This is the third in a series about the Federal government’s role in healthcare in the United States. Some of the content comes from an article at KFF by Julie Kovner, Congress, the Executive Branch, and Health Policy.

This post outlines how Congress-the House of Representatives and the Senate-oversee and fund healthcare.

More than two dozen committees in the House and Senate have jurisdiction and responsibility for various health agencies and policies (see Tables 1 and 2 below).  

The seal of the United States Congress
PRINTABLE AVAILABLE AT VISITTHECAPITOL.GOV

Three major committees in each deal with most health issues.   

The House of Representatives

(See Table 2 below)

The  Ways and Means Committee, which sets

  • tax policy,
  • oversees Part A of Medicare (because it is funded by the Social Security payroll tax) and
  • shares jurisdiction over other parts of the Medicare program with the Energy and Commerce Committee.
  • oversees tax subsidies and credits for the Affordable Care Act and
  • tax policy for most employer-provided insurance.  

The Energy and Commerce Committee has

  • sole jurisdiction over the Medicaid program in the House and
  • shares jurisdiction over Medicare Parts B, C, and D with Ways and Means.
  • oversees the U.S. Public Health Service, including the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention.   

The amounts allocated for many of those programs are determined by the House Appropriations Committee through the annual Labor-Health and Human Services-Education and Related Agencies spending bill.   

The Senate

(See Table 1 below)

In the Senate, responsibility for health programs is divided somewhat differently.

The Senate Finance Committee, which, like House Ways and Means, is in charge of tax policy, oversees all of Medicare and Medicaid and most of the ACA. (Affordable Care Act).  

The Senate counterpart to the House Energy and Commerce Committee is the Senate Health, Education, Labor and Pensions Committee, which has jurisdiction over the Public Health Service (but not Medicare or Medicaid).   

The Senate Appropriations Committee, like the one in the House, sets actual spending for discretionary programs as part of its annual Labor-HHS-Education spending bill.  

Rovner, J., Congress, the Executive Branch, and Health Policy. In Altman, Drew (Editor), Health Policy 101, (KFF, January 2025) https://www.kff.org/health-policy-101-congress-and-the-executive-branch-and-health-policy/ (date accessed). 2/8/2025

Executive vs Legislative Branches

We’ve looked at the multiple agencies in the Executive branch of government that are concerned with healthcare. Similarly, multiple committees of Congress oversee these agencies and the policies that govern them.

In a later post, I’ll outline the process for developing policies and a budget to pay for them.

About the Capitol

The cover photo for this post is the U.S. Capitol, the home of the Senate and House of Representatives. I took this photo while touring Washington, DC in August 2022.

“On January 6, 2021, a crowd stormed the 16-acre United States Capitol Building complex in Washington, D.C., hoping to overturn the results of the 2020 presidential election. Rioters scaled the walls and smashed the windows of the U.S. Capitol as Congress voted to certify the state-by-state results, halting the count until January 7.

The final figures for the material repair of the U.S. icon, including mental health counseling for traumatized staffers, members of Congress, and Capitol employees, came in at $30 million.

 Antique period-appropriate mahogany kept by the U.S. Forest Service for 100 year was required to repair the damaged window and door frames, while another $25,000 was needed to restore six damaged sculptures and two paintings from the House’s collection.

The damages would have been much worse, notes Smithsonian Magazine, had quick-thinking staffers not worked to reverse the HVAC system and blow out the tear gas and fire extinguisher residue filling the halls of the building, while others worked to hide the House’s ceremonial silver mace from 1841 and silver inkstand from 1819.

According to (Architect of the Capitol) Blanton, the AOC had received a $300 million appropriation from Congress solely for new windows and a camera system on top of the $30 million for repairs.

Although the reinforced windows are still being designed, Blanton did point out that a number of security upgrades have already been implemented. Both interior and exterior doors have been reinforced, damaged windows have been repaired, and security kiosks and lighting around the Capitol have been upgraded, all outside of the $300 million.”

(This is quoted and edited for length from an article at The Architect’s Newspaper, January 6, 2022)

Exploring the HEART of Health

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Understanding the U.S. Government’s Role in Health Policy

In this post I explain how the U.S. federal government significantly influences health policy, controlling one-third of healthcare spending. Executive orders by recent presidents affect healthcare, prompting questions among professionals. Congress and the Executive Branch, particularly the Department of Health and Human Services, oversee critical health programs. State governments also play essential roles in healthcare regulation.

This information was current as of the date of publication and will be updated as changes occur.

Since taking office, President Trump has signed more executive orders than any other president in history in such a short time. Only President Biden and President Truman issued more than 40 executive orders in their first 100 days in office.

If you are wondering what effect these orders have on health care, you are not alone. Professionals in all facets of healthcare are wondering too. And at this point, none of them know for sure.

A place to start understanding what these changes mean is to understand the federal government’s role in healthcare. We all live under it, but may not understand how it works.

I am publishing a series of posts based on Congress and the Executive Branch and Health Policy by Julie Jovner at KFF, an independent source for health policy research, polling, and news, an endowed national nonprofit organization.

Ms. Jovner explains how the three branches of government work together, why the Department of Health and Human Services (and therefore its Secretary) is so important, and the budgeting and regulation processes.

This series is nonpartisan and objective. I made minimal edits to improve readability but retain meaning. I insert comments in parentheses to explain unfamiliar terms.

The photos are for illustration only and do not appear on the KFF article.

Congress and the Executive Branch and Health Policy

The federal government is not the only place health policy is made in the U.S., but it is by far the most influential. Of the $4.5 trillion the U.S. spent on health in 2022, the federal government was responsible for roughly a third of all health services.

The payment and coverage policies set for the Medicare program often serve as a model for the private sector. Many health programs at the state and local levels are also impacted by federal health policy, either through direct spending or rules and requirements.

Federal health policy is primarily guided by Congress, but carried out by the executive branch, predominantly by the Department of Health and Human Services, HHS. 

The Federal Role in Health Policy 

No one is “in charge” of the fragmented U.S. health system, but the federal government probably has the most influence, a role that has grown over the last 75 years. Today the federal government pays for care, provides it, regulates it, and sponsors biomedical research and medical training.   

The federal government pays for health coverage for well over 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the Veterans’ Health Administration, the Indian Health Service, and the Affordable Care Act (ACA).  It also pays to help provide insurance coverage for tens of millions who are active-duty and retired military and for civilian federal workers. 

Federal taxpayers also underwrite billions of dollars in health research, mainly through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).   

James H. Shannon Building (Building One), NIH campus, Bethesda, MD
James H. Shannon Building (Building One), NIH campus, Bethesda, MD

Federal public health policy is spearheaded by the Centers for Disease Control and Prevention. Its portfolio includes tracking not just infectious disease outbreaks in the U.S. and worldwide, but also conducting and sponsoring public health research and tracking national health statistics.  

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The Health Resources and Services Administration (HRSA) funds critical health programs for underserved Americans (including Community Health Centers) and runs workforce education programs to bring more health services to places without enough health care providers.  

Meanwhile, in addition to overseeing the nation’s largest health programs, the Centers for Medicare and Medicaid Services (CMS) also operates the federal insurance Marketplaces created by the ACA (Affordable Care Act, also called ObamaCare ) and enforces rules made by the law for private insurance policies.  

State and Local Government Roles

While the federal government exercises significant authority over medical care and its practice and distribution, state and local governments still have key roles to play.   

States oversee the licensing of health care professionals, distribution of health care resources, and regulation of health insurance plans that are not underwritten by employers themselves. State and local governments share responsibility for most public health activities and often operate safety-net facilities in areas with shortages of medical resources.  

The Three Branches of Government and How They Impact Health Policy 

All three branches of the federal government – Congress, the executive branch, and the judiciary – play important roles in health policy.  

3 BRANCHES OF U.S. GOVERNMENT-legislative, executive, judicial
3 BRANCHES OF U.S. GOVERNMENT, FROM usa.gov, public domain

Congress

Congress

  • makes laws that create new programs or modify existing ones. It also
  • conducts “oversight” of how the executive branch implements the laws Congress has passed.
  • sets the budget for “discretionary” and “mandatory” health programs and provides those dollar amounts. 

 Executive Branch

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations.

Federal workers in the health arena may

  • provide direct patient care,
  • regulate how others provide care,
  • set payment rates and policies,
  • conduct medical or health systems research,
  • regulate products sold by the private sector, and
  • manage the billions of dollars the federal government spends on the health-industrial complex.  

 The Judiciary

Historically, the judiciary has had the smallest role in health policy but has played a pivotal role in recent cases. It passes judgment on how or whether certain laws or policies can be carried out and settles disputes between the federal government, individuals, states, and private companies over how health care is regulated and delivered.  

Supreme Court Justice Ketanji Brown Jackson

Recent significant decisions from the Supreme Court have affected the legality and availability of abortion and other reproductive health services and the constitutionality of major portions of the ACA. 

Supreme Court Justice Amy Coney Barrett

The Executive Branch – The White House

 Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself has taken on a more prominent role in policy formation.

THE WHITE HOUSE, PHOTO BY DR ALETHA

The White House Office of Management and Budget not only coordinates the annual funding requests for the entire executive branch, but it also reviews and approves proposed regulations, Congressional testimony, and policy recommendations from the various departments.

The White House also has its own policy support agencies – including the National Security Council, the National Economic Council, the Domestic Policy Council, and the Council of Economic Advisors, that augment what the President receives from other portions of the executive branch. 

Rovner, J., Congress, the Executive Branch, and Health Policy. In Altman, Drew (Editor), Health Policy 101, (KFF, January 2025) https://www.kff.org/health-policy-101-congress-and-the-executive-branch-and-health-policy/ (February 4, 2025)

Coming next -HHS

In the next post, we will look closer at the role of the White House (the President) and the Department of HHS (the cabinet Secretary) as explained in the KFF article.

Exploring the HEART of Health

Thanks for your interest in learning more about our government and healthcare. It may not be the most exciting topic, but it is vitally important.

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Dr. Aletha