How a Bill Becomes a Law

The bill-to-law process can be simple or complicated, based on a wide variety of variables.  It is important to know about the different stages when advocating for legislation, because each stage may require different levels of political, social, and media outreach.  How the bill advances is often dependent on a wide range of people whose interests may or may not be aligned to those backing the bill.  Below, is a brief overview of each major step, with the caveat that there are differences in language between states.  It is important to know your particular state’s process and rules when advocating for a bill to become a law. At each step, advocates can help.

Disclaimer:  This is very generalized, and each state may have some differences.  Most of the vocabulary is consistent across state levels, so being familiar with some of these terms is very helpful in organizing your campaign.

For help in your state, consider reaching out to seasoned lobbyists at other non-profits, in this case reach out to related organization like the American Heart Association and March of Dimes if possible. Many larger groups have full-time state lobbyists. Ask for a quick phone chat or lunch with the lobbyists to ask about particulars.

1. The Idea

This is the first step.  For those proposing the bill, it is important that they present “the idea” in a way that will show the legislator that “the idea” will have a collective good, and be important to the legislator’s constituents.  It is especially helpful if the “the idea” has a personal connection to the legislator as well. In the case of Pulse Ox legislation, it is critical to identify some key aspects of potential legislation: significant research supporting Pulse Ox for newborns; current status of legislation across states and at federal level; examples of important media attention; and the reason why you, as a constituent, would like to see “the idea” become a law.

2.  Writing a Bill

In most states, the legislator sends “the idea” to an Office of Legislative Services (OLS).  This is a group of legal and policy experts that research the idea, advise the legislators on the viability of “the idea”, and write the first draft of the bill.  Depending on the legislative calendar, OLS can spend between a week and a month writing a bill.  They will look closely at the other legislation that has been proposed or already exists.  They will also look at what the current state laws and/or regulations say about “the idea.”  When finished, they will send the bill to the legislator.

3.  Sponsors and Co-Sponsors

The primary Sponsor of a bill is usually the legislator who sent “the idea” to OLS.  There may be multiple Sponsors, and those legislators will work together to push the bill through.  Co-Sponsors are legislators that agree early in the process to support the bill.  By signing on as Co-Sponsors, they are sending the message that this is important to them.  There can be many Co-Sponsors to a bill, and many are often added up to the very last minute.  The more Co-Sponsors, the stronger the bill. Every state, except Nebraska, has a Senate and an Assembly/House of Representatives/Delegation.  Each bill has to go through both (except in Nebraska), and the bills each have different numbers, Sponsors, and Co-Sponsors.  This is an excellent time to encourage supporters to reach out to their local legislator requesting that they sign-on as a Co-Sponsor.

4.  Readings and Hearings

In order for a bill to be voted on, it has to be read at least twice, at two different legislative sessions.  The leader of that particular body (i.e., Assembly Speaker) has the privilege of scheduling these readings.

In order to be considered, a bill has to be read into record during a meeting of the legislative body.  It is then assigned to a committee to be considered.  These are two critical dates for the passage of a bill.  The earlier the bill is given a first reading, the earlier it can be sent to Committee with the possibility of being considered before the end of the legislative session.

At the Committee hearing, the Committee will hear from the public and accept testimony regarding the bill.  The Committee can recommend that the bill be sent back, held for further consideration, request additional data or studies, or move the bill forward.  This is generally the best time to identify experts and supporters with compelling personal stories to share.

5.  The Legislative Calendar

Once the bill has made it through the Committee, it is put on the legislative calendar for second and third readings.  The bill will be voted (usually) in the third reading, although the leader of that particular body may have some discretion to call a vote after the second reading.  If a bill is being “held up”, it is not being promptly scheduled for the committee hearing or the second or third readings.

6.  The Vote

After the final reading of a bill, the legislative body will vote on it.  Passage is dependent on a majority, as defined by the state law.  Depending on state process, it will then move to either the other legislative body, or to the office of the Governor. This is generally the most critical time for letter-writing campaignsand state-wide media campaigns encouraging the passage of the bill.

7.  The Bill Becomes a Law

This occurs either through the Governor’s signature, or a specific amount of time without being vetoed.  In Missouri, this time is 7 days, in New Jersey, this time is 45 days.  The timeline for the signature is often at the discretion of the Governor.  In New Jersey, after a significant amount of time had passed, we conducted a letter-writing campaign to encourage the Governor’s signature.

8.  From Words to Action

After the bill is passed, there is usually some amount of time that is devoted to working out how the bill will be implemented. This stage shouldn’t be overlooked. While implementation might largely be out of your hands, attempt to write groups working at this level to suggest resources, especially those that help with protocols and parent/clinician education.


For example,  the process might look something like this:

Advocates/Lobbyists contact lawmaker asking for bill introduction, through letter writing and scheduling meetings. This might take one letter or a couple of meetings and varies.

Bill authored by legislator

Provide your legislator resources to write an effective bill like examples of bills from other states and research about pulse ox.

First reading

Ask targeted people to write letters to the committee assigned the bill. This might include clinicians and people directly affected. Best not to put a general call out for letters to avoid compassion fatigue, however a few letters can help get the bill on the committee calendar.

Committee (Bill can be changed)

Testify in favor of the bill in front of committee

Second Reading

Third Reading

Goes to other side of general assembly

First Reading

Repeat steps above


Repeat above

Second Reading

Third Reading

Conference committees between chambers if needed

Governor (signs or sends back) Bill becomes law if the governor signs

Implementation dates are outlined in the bill. Work is done within the appropriate government agencies (the Department of Health)

Consider a strategic letter writing campaign at any of these steps if it seems likely the bill might get held up. However, avoid asking the public at large to write letters at each stage to avoid compassion fatigue.