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Rx for Survival — A Global Health Challenge

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Stage IVa: Congressional authorizing committees devise authorizing legislation and pass mandatory spending bills…

Congressional authorizing committees have two key responsibilities. The first is to develop authorizing legislation on which spending levels can be based; the second is to review all mandatory spending bills prior to sending them to the full Congress for a vote. As there is no single authorizing committee whose sole jurisdiction is health spending, these committees develop authorizing legislation for health programs as part of their broader responsibilities for all areas under their jurisdiction.

Spending for any proposed health program is classified as discretionary or mandatory at the time its authorizing laws are written. Entitlement programs such as Medicare, Medicaid, and Food Stamps, for example, are considered direct mandatory spending because their authorizing legislation defines a set of benefits and criteria for eligibility. From that point forward, the programs automatically receive annual funding sufficient to deliver those benefits to all eligible candidates without any further congressional action. The only exception is when the authorizing committees see a need to adjust the terms of a mandatory spending program in light of new spending priorities laid out in the congressional budget resolution. Whenever this becomes the case, the underlying authorizations must be rewritten.

In April or May, authorizing committees in both the House and Senate receive the mandatory (direct) spending portion of the budget resolution and transform it into a series of mandatory spending bills. During the same period, the authorizing committees also consider any new discretionary programs that the budget resolution lays out and write legislation that will establish a basis for operating those programs. This legislation is then forwarded to the appropriations committees in each house of Congress along with guidance to help them set appropriate funding levels for these programs.

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Federal Agencies with Mandates for Health

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Point of Influence For health-related spending, six authorizing committees are responsible for developing any new authorizing laws that may be needed, or for suggesting changes to existing laws. In the House, they are the Committee on Ways and Means, the Committee on Energy and Commerce, and the Committee on Veterans' Affairs. In the Senate, they are the Committee on Agriculture, Nutrition and Forestry; the Committee on Health, Education, Labor and Pensions; and the Committee on Veterans' Affairs. (Each committee also has jurisdiction over a number of non-health-related programs.)

After a review, all mandatory spending bills generated by the authorizing committees are passed on to the full House and Senate for a vote. Majority approval by both houses of Congress is required before any mandatory bill can be passed on to the president for approval or veto. If the Senate and House versions of a bill are at variance, then members of each body meet to work out any differences and develop a single version for approval and presentation to the president.

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