All right, thank you for joining us. This is a continuation of our Advocacy 101 course. I'm presenting Section 2 today, The Difference Between Legislation and Regulation. So the first thing to understand about the difference in legislation and regulation is just the U.S. system as a whole. Our system of government is based on the concept of federalism, which is simply the power shared between federal and state governments, and then shared between local and state governments equally, just with different scopes and in different sets of responsibilities. So all of them function together at the same time, but they're covering different things. And typically local governments exist at the county and the municipal level, it could be called something different just based on where you're at. Legislation is the process of establishing law through some form of legislative body in its lawmaking process, and that can look a little bit differently based on the context of what you're talking about and the different scale that you're talking about. Sometimes you might hear that called policy, when you're referring to a system or a grouping of laws that may be focused on one particular thing that's important in our overall health care industry or our economy. And I would say we should think of it kind of like the policy manual that most of our organizations maintain. It's a group of documents or a group of explanations about how we're going to operate and behave as an organization. And in this particular context for advocacy, it's how we're going to behave and operate as citizens in the country. So the legislative process today is such that bills are produced by a legislative body, and there has to be a certain number of votes, again, depends on the context and the setting that you're in, but it has to be achieved for it to move forward. Federal and state typically is comprised of our bicameral houses, the House and the Senate collectively referred to as our Congress. And then typically at the county and the municipal level, those are going to be seen as city councils or county councils. And so a couple different levels of that legislative body and how it sits at the federal level, you have our Congress, at the state level, you typically have your state legislature. Most of the time at the state level, those are going to be bicameral houses as well, so House and Senate. And then again, typically when you get down to the county or the city, those are city and county councils that are making decisions. And so a couple of examples of that is that at the federal level, we're often seeing particularly in our context, Congress is working on funding bills for Medicare. And so that's always something that we see each year as the Medicare physician's fee schedule is worked on. And so those laws and those appropriations are made there to ensure that Medicare is funded for the following year. Then when you pull down to the state level, it may be something like certificate of need. It may be medical licensure. It could be medical malpractice. And so all those things tend to exist at the state level in each individual state. And so then when you come down to the county and the city level, you often see duplication in these different levels. One example might be property zoning or building code. But a lot of the times you do see in terms of something like public safety, there's often county public safety and city public safety departments that are there. So you can have some overlap at that level. So regulation really comes after legislation. So once that law or once that legislation is signed into law, an administrative agency is going to work to develop regulations for carrying out the intent of that law. And so that's kind of the second half of that policy manual. It's the policies and the procedures component that we all have and know in our organizations today. And so the regulatory process as a whole is set that our agencies are expected to act within the scope of their specific legislative statutory authority. So you often see problems and questions come up whenever agencies get into a situation where there's a questionable issue about whether or not they're exceeding what they should be doing based on what the legislative process has put in place for them. But most agencies go through a public process when they issue regulations, especially today where you've almost always got live feeds of what's happening in Congress. There's typically live video feeds of what's happening in our state legislatures, and you can almost always expect to see a live feed or at least an opportunity for the public to attend in most city and county council settings. So agencies do go through a public process, and it's intended for there to be an opportunity for stakeholders that are a part of this to be able to speak into that process of administrative rulemaking. And for most of us, we're going to see healthcare-focused legislative and regulatory action and impact really happen at the state and federal level. You really won't see a whole lot of that at the county and city level until you get into really, really exceedingly large cities and county areas. So a couple examples of the regulatory policies and the bodies that are out there at the federal agency level. We all know and love Center for Medicare and Medicaid Services, CMS. In our state agencies, it might be the Department of Health and Human Services, it might be the Department of Environmental Control. And then in the county and city departments, you might see emergency management, public works, public safety, building and zoning, waste management. So some of those common things that we all know from where we live locally today. So why does all this matter? Legislators and legislators, both individually and as bodies, are supposed to look to us as constituents for input on legislation as it's moving through the process. And so you'll often find if you approach a legislative body or an individual legislature or an individual legislator, one of our own representatives who covers one of the districts that you live or work in, you'll find that there are some things that they know really, really well. But you'll often, more often than not, find that there's also a lot of things that they may not know really well. And so there's a lot of one-sidedness and limited understanding as to what the downstream effect of what's happening in the legislative process is going to look like and what kind of impact that it's going to make. And so for all of us, we face a large opportunity, if you will, to be able to speak into that process. And so in the absence of that, it's important for us to know that lobbying is a really, really powerful force in our legislative system today. And it's a mechanism that you use to ensure that constituent positions, opinions, desires, issues are all well understood as the legislative process is carried out. And so if we choose not to speak into the process, it's not that there will be a void of information. There are plenty of forces and voices that are out there speaking into the legislative process. Some of them agree with us and some of them don't. And so it's really important for all of us to take our part in speaking into the system so that we can help ensure that the system as a whole moves forward in a direction that's positive for all of us. So AOE's advocacy influence, it has an impact on the legislation that gets passed and the regulations that are ultimately required of us out in the practice as citizens and as individuals in our communities that we live in. And so it's up to us to ensure that our legislature understands the full scope of those details and the positions that they take and what that's going to mean for all of us. And your voice and your experience as a leader in your community, and especially also that of your physicians in your community, is really important in making sure that they understand the downstream effect and the opportunities that are in front of us to get it right. And so I would urge you, join us in AOE's advocacy efforts. Getting involved means that you can change the environment that your practice exists in. It means that you can change the environment that all of us exist in from a greater health care perspective. Tons of different opportunities and options that are out there between websites, letters, emails. Our advocacy committee does a great job of making sure that opportunities to send letters to your legislative representatives are made available to us. But in short, nothing can really replace the opportunity to make your voice heard. And so building relationships with all of your legislators and making sure that they know who you are and they know who you take care of in the communities that they represent is really important. But this is a huge opportunity for all of us to be able to lock arms together and be able to try to move this forward into a positive direction. So that's a really, really quick overview of the difference between legislation and regulatory regulations and regulatory processes. There are my references if you're really interested in going and digging through anything that I showed you here today. And I would end by just saying thank you for joining us for a really quick run through of this and stay tuned for the next installment. Thank you.

legislation

regulation

U.S. government system

citizen advocacy

lobbying