EMS Insider, Expert Advice, Legislative Update

Influencing Public Policy

“There ought to be a law…” How many times have you said that in your lifetime? Funny thing is, statements like that are more often than not how new laws come about. But how do you get from a good idea to actual changes in public policy, or stop bad public policy from being implemented? Here are the basics:


A lawmaker is introduced to an issue and decides that a law is needed to make something better in society. The lawmaker has a bill drafted that they believe will accomplish the goal. Once the bill is drafted, they seek support from other lawmakers and key constituent groups. If enough support is garnered, the bill goes to the full lawmaking body (city council, county commission, state legislature or Congress) for a vote. If there are enough yes votes, the bill passes and moves on to the chief elected official for final enactment. Inn larger lawmaking bodies, the bill will typically go through several committee hearings and, if the lawmaking body has a bi-cameral structure (House and Senate), the bill typically must be introduced and passed in both houses. Occasionally, if there are minor, but substantive differences between the House and Senate versions, the bill will go to a conference committee made up of representatives from both houses for a final reconciliation before being submitted to the chief elected official for enactment.


Sounds pretty simple, right? Then why is it that some laws take years to pass, and why do so many die on the vine? In a word, hurdles. To change public policy, you have to overcome numerous hurdles along the way. Hurdles are not necessarily bad. In fact, they are put up for a reason—to help make sure the best laws get enacted with significant opportunity for public input. Here are the most common hurdles and some strategies to clear them.

The sponsorship hurdle

There are really two main reasons a lawmaker may not sponsor your bill, or agree to co-sponsor an existing bill. One, they do not believe the initiative has enough merit to warrant their support, or two, they believe that supporting the initiative will jeopardize their relationship with someone else—typically a relationship they think is very important to maintain. Finding an elected official to sponsor or co-sponsor a legislative effort for you takes a relationship, with both the elected official and their key staff members. Fundamental political philosophy also plays a role. Republicans generally are probusiness, believe less government is better, believe in self-sufficiency and are fiscally and socially conservative. Democrats are generally pro-labor, believe in large roles for government and support entitlement programs for underprivileged citizens. These basic philosophies could impact your sponsorship options, especially depending on which political party holds the majority in the elected body.



Clearing the hurdle: Build a relationship with your elected officials now. Stop reading this article and call your city council member, county commissioner, state representative and congressperson now (OK, you can finish the article first). If you don’t know them, simply offer to come meet them, introduce yourself, tell them about yourself and learn about them. Find out what you can do to help them. Educate them about how the EMS system works where they live or work, and the great things you and your agency do. You have a great story to tell and they typically want to hear it. Do your homework before you go. Read their bio. What political party do they belong to? What business are they in? What is their background? Do they have kids? Where did they go to school? What constituency groups supported their election? You may find some connections you can share when you go meet them. Have them come do a ride along with one of your units (and make it a media event if possible).


Be a trusted partner. Have a strong reputation in the community. Do things in the community that forge alliances. Collaborate on projects to improve the community. Earn the media’s trust. Build alliances with other constituency groups. In EMS, find partnerships for bills from the state medical board, nursing associations, hospital associations and insurance companies, anyone you can. The more who are with you, the fewer who will be against you.


Be prepared with an answer when the elected official asks, “What does the (XYZ) association think about this bill?” That is most likely an indication that the official has a relationship with that constituency group and they want to know if this group is on board with the proposal. This means you should meet with that constituency group first to assure they are supportive of your proposal. This may mean you need to make several revisions to your proposed legislation to get them on board. Even with a relationship and support of key constituent groups, the elected official has to fully support the idea you are bringing forward in order to agree to sponsor or co-sponsor legislation you support. If not, you have an uphill climb.

The committee hurdle

In state and congressional processes, bills need to be approved by committees that have jurisdiction over the issues in your bill. For EMS, this generally means committees related to healthcare and finance. Each house of the legislature or congress have their own committee structure. The committee chair will generally not calendar a bill for a hearing unless there are numerous co-sponsors. Committee time is very limited and valuable, and the chair will typically not calendar bills that do not have a great likelihood of advancing. It’s amazing how many bills die in committee, or never even get scheduled for a hearing. If the bill gets a hearing, the committee members will listen to testimony from various witnesses and either approve it out of committee or not. This is when your alliances pay off, or lack of alliances will destroy you.


Clearing the hurdle: Get lots of cosponsors. Start educating the probable committee chairs having jurisdiction and staff of the chair early in the process. Know who the committee members are and seek their co-sponsorship of the bill. The more committee members co-sponsoring the bill, the better the chance of a hearing and a successful hearing outcome. Once it is calendared, meet with all the committee members and brief them fully on the bill. Know the background of each member before you meet with them. Bring support from other constituency groups. Attend the committee meeting! Bring people to testify, especially people from the members’ home districts. For example, if the bill addresses easing reciprocity for EMTs and paramedics from across state lines, bring a paramedic from the chairman’s home district who could not get reciprocity and, as such, is not able to work on the ambulance in service her own town (the one the chair represents).


Special note on local initiatives: Count noses! Meet with every council member individually and as often as necessary to vet any issues they may have with a proposed ordinance. Assure you have more than enough votes to pass the ordinance before it gets placed on an agenda for a vote. You want to be sure that even if one or two council members change their mind, you have a buffer to still pass the measure.

The conference committee hurdle

If the bill passes both houses but a conference committee is necessary to iron out some differences in the bills, the presiding officers from the house and senate will appoint representatives to the committee. They generally pick officials who were on the committees having jurisdiction that conducted the hearings on the bill in their respective house. It’s important that the members of the conference committee fully understand the reasons for the difference in the passed versions and how they might impact the intent of the legislation. Sometimes the reasons the two bills are different is they were amended going through one house or the other, usually as a result of lobbying on the part of constituent groups. If a clause was added or taken away from the original bill in one of the houses that detrimentally affects the intent of the bill, it’s possible that clause will remain a part of the bill through the conference committee process.


Clearing the hurdle: Be sure you fully and continually brief all the members of the committee having jurisdiction so if they are appointed to the conference committee, they know the important parts of the bill and the bill’s legislative intent. Try to find a member or two who are willing to vote down any compromise language that kills the intent of the bill. A failure of the committee to reach consensus sends the bill back through the whole process again, but sometimes that may be the preferable option to the committee report containing language for approval that is contrary to the intent of the original bill.

Chief elected official hurdle

If the initiative makes it through all these described processes, it’s likely to be enacted by the chief elected official, more than likely by a signature. In some states, such as Texas, the Governor has a period time allowed to actually veto the bill. If they do nothing, the bill automatically becomes law. There are some very controversial measures that the example is the law passed by the New Jersey legislature adding additional regulations for EMS that Governor Christie vetoed, twice.1 If this happens, you get to go through the whole process again.



Clearing the hurdle: Start early! If the measure looks like it will pass the legislature, follow the same process as with the other elected officials. Find the key staffer in the chief elected official’s office who you can brief on the merits of the measure and see of there might be any objections and try to address them. Frankly, if your bill makes it through all the other hurdles, it’s likely to get signed into law.

Opposing sponsored legislation

We’ve spent the bulk of this article on promulgating legislation, but more often than not, you may find yourself in the position to opposed currently sponsored legislation. When this happens, start at the source—the sponsor—whenever possible. Seek first to understand. What is the problem they are trying to solve? What is the wrong they are trying to right?


Knowing this information may allow you to educate the sponsor and others on the unintended negative consequences that could result of the law passes. Most of the other counsel still applies—have or build a relationship with the sponsor or co-sponsors, educate, attend and provide testimony at committee hearings, find alternate solutions, offer revised language for the bill. Maybe finding better solutions than a new law, or enforcing laws already on the books, or encouraging the regulatory body to create rules would solve the dilemma.

Be careful what you ask for

There is a reason legislation is one of the three things you don’t want to watch being made. Legislation is a very risky proposition and the landmines are numerous. Often, public policy can be changed by regulation instead of legislation—try the regulation route first. Laws generally state that the agency having jurisdiction (state EMS office, CMS, etc.) can promulgate rules to implement the law. Sometimes, you might want to work with your regulatory body to make changes in policy without having to go the legislative route. Let’s take backboards for example. There is a growing body of evidence that we put too many patients on backboards. Say your medical director wants to change protocol to allow you to not put so many people on backboard, but the state protocol says you have to put all patients with “XYZ” injury on a backboard. You do not need a law change for that, simply a change in the state rules. It’s usually much easier to work with a regulator agency within the current framework of legislation.


In some cases, the state EMS office may tell you that they cannot make the change you are suggesting without enabling legislation. If so, you’re off to the races!