The federal government’s role in health policy has expanded significantly over the past 75 years, with Congress setting laws and the executive branch, primarily through the Department of Health and Human Services, implementing them. Of the $4.9 trillion the U.S. spent on health in 2023, the federal government was responsible for roughly a third of all health services, including coverage for well over 100 million Americans through Medicare, Medicaid, CHIP, and other programs.
Congressional Structure and Authority
Congress makes health law through more than two dozen committees across the House and Senate, though three major committees handle most health issues. In the House, the Ways and Means Committee oversees Medicare Part A and tax subsidies for the Affordable Care Act, while the Energy and Commerce Committee holds sole jurisdiction over Medicaid. The Senate Finance Committee oversees all of Medicare and Medicaid, alongside the Health, Education, Labor and Pensions Committee.
The Budget Process
Under the Congressional Budget and Impoundment Control Act of 1974, Congress controls federal health spending through a standardized annual process. The House and Senate Budget Committees each write spending blueprints, and when mandatory spending changes are needed, they issue reconciliation instructions to authorizing committees. The Congressional Budget Office, created by the 1974 act, produces cost estimates that often determine whether legislation passes.
Federal Programs and Challenges
The Centers for Medicare and Medicaid Services operates the largest programs, serving more than 170 million Americans and accounting for nearly a quarter of all federal spending in fiscal 2023 at an estimated $1.5 trillion. The National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration round out major health agencies. Despite federal influence, state and local governments retain key roles in licensing health professionals and operating public health activities.
Recent Changes
In 2025, Republicans passed a budget reconciliation bill projecting deep cuts to Medicaid and new barriers for ACA enrollment. Additionally, a 2024 Supreme Court decision overturning “Chevron deference” may make it easier for outsiders to challenge federal agency actions, though full implications remain unclear.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.kff.org/state-health-policy-data/health-policy-101-congress-and-the-executive-branch-and-health-policy/