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Watching the goings on in Congress around the various healthcare proposals, one might think that the day after Congress passes a reform package we all will immediately have insurance coverage. A quick primer in legislative process might come in handy here.

Congress is charged with creating the rules. This is going on now. The various proposals will ultimately be distilled into two bills, one in the House and one in the Senate. Then the two bills will be referred on to a conference committee. The conference committee combines the two bills into one final bill, which needs to pass both houses of Congress.

If and when Congress passes one final bill, then the legislation moves over to the Executive Branch.  Either the President signs or vetoes the bill. If he signs it, then the Executive Branch is charged with implementing it. The Department of Health and Human Services along with other federal departments like the Veterans Administration and Medicaid are charged with taking the new law and turning it into rules guiding the process of making the law operational. This process often involves getting input from outside stakeholders and can take months if not years. In the meanwhile these very same agencies are speaking to their counterparts at the state level. In many cases bills passed at the Federal level, create rules and obligations for state governments. These rules are sometimes called mandates.

It is quite possible given the complexity of this Healthcare legislation, that the entire bill should it pass may not be fully implemented until after the 2012 election. Regardless, what is going on in Congress around drafting a healthcare bill is more like the end of the beginning in the process as opposed to the beginning of the end.

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