Families USA produced the Public Policy Toolkit for Enrollment Assisters to give assisters and others the knowledge and tactics they need to be effective advocates.

How a Bill Becomes a Law

The legislative process can seem overwhelming, and the road that a policy idea must travel before it becomes a law can be long and winding. This step-by-step overview of the federal process will give you a basic understanding of how an idea becomes a law, and it will show you where there are opportunities to get involved. 

  1. Legislation can be drafted and introduced in Congress by any member of the House of Representatives or the Senate.

    Members of Congress frequently get ideas for legislation from their constituents and groups that represent specific causes. For example, constituents may contact their representative about their struggle with high out-of-pocket health care costs (like deductibles and cost-sharing).

    If representatives hear about how an issue affects their constituents, they are more likely to look into legislation that addresses that problem.

  2. Once a bill is introduced, it is referred to one or more committees (explained in more detail below).

    These committees evaluate and amend the bill and vote on whether or not to move it forward in the process. If a majority of committee members agree to move a bill forward (a process that is called “reporting the bill out of committee”), it is sent to the full House of Representatives or Senate for consideration.

    Committee consideration can also be an important time for constituents to weigh in. You may want to research which committees your representatives serve on and contact them about pending legislation.

  3. The bill then goes to the Senate floor or House floor for debate and a vote.

    This is a key time when the public—including assisters—can weigh in with their views. Members of Congress appreciate having constituents’ input when a bill is being debated and they are considering whether or not to support it.

  4. If a majority of the House or Senate agrees on the bill, it is referred to the other chamber, where it usually follows the same route through committee action and voting.  

  5. After a bill has been approved by both the House and Senate in identical form, it is sent to the President for his or her approval or rejection. 

    If the President signs the bill, it becomes law. If the President vetoes the bill, Congress can attempt to override the veto with a two-thirds majority vote.

Key Committees

How Does a Health Care Idea Become a Law?

This infographic is a helpful guide to the health care legislative process.

Members of the House of Representatives and the Senate serve on committees that perform a range of functions, including writing and considering legislation, as well as overseeing agencies, programs, and activities. 

Several key committees in the House and the Senate oversee programs related to health coverage. These committees are important because, in order to get legislation passed, it must be introduced and passed out of one of these committees before it is voted on by either the full Senate or the House. 

Key committees in the House of Representatives that have authority over health-related programs:

  • House Committee on Ways & Means
  • House Committee on Energy & Commerce 
  • House Committee on Education & the Workforce 

Key committees in the Senate that have authority over health-related programs:

  • Senate Finance Committee 
  • Senate Committee on Health, Education, Labor, & Pensions (often referred to as the “HELP” Committee) 

In addition, the House and Senate each have a Budget Committee and an Appropriations Committee, which oversee the federal budget and federal spending, respectively. These committees are also important, because the federal budget includes spending on health care programs.

For more information on the scope of what these committees cover and updates on current legislation, visit senate.gov/committees/committees_home.htm and house.gov/committees/.  


Find out what legislation Congress is currently considering by searching for bills in the Library of Congress database at Congress.gov.

New bills are introduced each day, so tracking legislation can be a useful tool for seeing what issues Congress is working on and how they progress through the legislative process.

Glossary of Legislative Terms

Members of Congress and their staffs frequently use technical vocabulary, so it’s important to know some of the commonly used legislative terms. Knowing these terms will help you better understand and communicate with them.

Appropriation: Money designated by Congress for a specific purpose. For example, Congress appropriates much of the budget for the Department of Health and Human Services each year.

Entitlement: An “entitlement program” is a federal program that provides benefits to any person who meets the eligibility criteria established by law. Medicare and Medicaid are examples of entitlement programs. Entitlements are a binding obligation on the part of the federal government, and eligible recipients have legal recourse if the government does not fulfill that obligation.

Fiscal year: A fiscal year is the accounting period for the federal government that begins on October 1 and ends on September 30. State fiscal years vary; the majority run from July 1 through June 30.

Hearing: A meeting of a committee or subcommittee to take testimony in order to gather information and opinions on proposed legislation, to conduct an investigation, or to review the operation or other aspects of a federal agency or program. Hearings are generally open to the public.

Mark-up: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation. 

Recess: A temporary interruption of Congress’s proceedings, or a longer break when members of Congress are back in their home districts. Examples of recess include the breaks Congress takes during holiday periods. Also, Congress usually takes a month-long break in August, which is a great time for constituents to meet with their elected officials in their districts. 

Sponsor and cosponsor: A sponsor is the Senator or Representative who introduces a piece of legislation. Senators or Representatives who formally list their names as supporters of another member’s bill are called cosponsors. Asking your member of Congress to cosponsor a bill is a great way to get him or her to show support for your issue.