Policy is made though the legislative process, the executive branch agencies and actions, and the judicial system. As someone interested in health policy change, you may be interested in understanding these three processes as each offers opportunities for you to advance your agenda.

The Legislative Branch

  • Federal Level: At the federal level, there is a standard process for how a bill becomes a law. It is not a quick process, and one estimate notes that out of the 5,000 bills introduced each year, only about 150 become laws. The are no regulations dictating who can come up with the idea for a bill, but only a member of Congress can introduce the bill itself. This flowchart outlines the steps from the time a bill is introduced by Congress until it is signed into law – and the potential pitfalls that can derail it along the way.
  • State Level: The progression is similar at the state level. Here is a flowchart of the steps from idea to law in North Carolina. Other states have comparable processes. 
  • Local Level: Sometimes state and national policy changes start out at the local level. What begins as a change in a community may eventually gather enough energy to affect other cities, states, or the nation. Using the ENACT Local Policy Database, you can search for local policies by keyword or location. 

Executive Branch 
Policy is not always made in the legislature. Congress or a state legislature may enact a law, but it is up to a federal or state agency to develop the regulations to enforce that law. Lobbying groups are also active in influencing policy. This process guide from the Federal Register explains these regulatory steps in detail. 

  • Federal Government: There is a helpful portal to U.S. federal government departments and agencies. Each listing includes contact information, parent agency and related agencies.
  • Lobbyists: Another online database allows you to look up lobbying information by a number of parameters, including issue. The page for Health Issues provides summaries, details on specific issues within health and specific lobbyists. 

Judicial Branch
Two ways you can become involved in judicial change, without being a lawyer or judge, are by being an expert witness or joining class actions suits.

  • Becoming an Expert Witness: You may be more likely to become an expert witness if you are not only an expert, but also a thought leader on a particular issue. Thomson Reuters offers a service to connect expert witnesses with cases and law firms. Go to trexpertwitness to learn more. In addition, expert pages offers an online directory of expert witnesses that suggests ways to be a successful expert witness.  
  • Joining a Class Action Law Suit: There are several ways to find out about class action lawsuits. Two helpful resources are consumer-action.org, and classaction.org. You may also find information by searching online and typing in the name of the issue, product or service you are interested in and the words “class action” For example, try “health care class action” and review the results.


Additional Resources

Overview of the Congressional legislative process

Review of the state legislative process

Guide to the Rule Making Process 

A personal account of one person’s becoming an expert witness