Capitol to Capitol | March 13, 2017

Health Care Freezes Washington?

Late tonight, snow will begin falling inside the Capital Beltway, and by the time Winter Storm Stella leaves the Washington region on Tuesday, significant snowfall will have paralyzed a city already frozen by health care.

Last week, two House committees advanced the American Health Care Act, legislation to repeal and replace the Affordable Care Act (ACA) through the process known as budget reconciliation. Republican leaders chose to repeal the health care law through budget reconciliation, which was created by the Congressional Budget and Impoundment Act of 1974, because reconciliation measures only require a simple majority vote in the Senate and are not subject to filibuster. Reconciliation is a two-step process in which reconciliation instructions are included in a budget resolution that direct appropriate committees to develop legislation that achieve desired budgetary outcomes, which are then compiled by each chamber's budget committees before being considered by the entire chamber.


DYK? 2017 marks the centennial of the swearing-in of the first woman to become a member of the U.S. Congress, Jeannette Rankin (R-Mont.). A pacifist and suffragist, Rankin was elected to Congress four years before the 19th Amendment gave women nationwide the right to vote. In 1914, her home state of Montana passed a law granting suffrage to women in that state, but these women could still not vote for president. In fact, 15 states allowed women to vote before the 19th Amendment's ratification in 1920. "I may be the first woman member of Congress," she observed upon her election in 1916. "But I won't be the last."

The budget resolution for health care reform, which passed by the Senate on Jan. 12 and by the House on Jan. 13, directed the Finance Committee and the Health, Education, Labor, and Pensions Committee in the Senate, and the Ways and Means Committee and the Energy and Commerce Committee in the House, to each submit to their respective budget committee's legislative recommendations to repeal and replace the ACA. Last week, the two House committees marked up their portions of the reconciliation measure, passed those recommendations on a party-line vote, and then referred those recommendations to the House Budget Committee, which will now combine the legislation into one measure and then send it to the House floor for consideration.

Although the House plan, which will serve as the vehicle for health care reform, has been criticized by liberals and conservatives, House leadership expects that the replacement law will be ultimately approved by the body. However, the Congressional Budget Office is expected to release its fiscal analysis of the legislation as early as today, which could be a blow to the bill if it estimates that the replacement will add significantly to the deficit or if it reveals a massive drop off in coverage.

However, even if the bill makes it to the Senate, it will almost certainly be dead on arrival, at least as it is currently drafted, given the criticism expressed by Republican Senators whose votes are crucial, given the Republicans' slim 52-member majority. In addition to Senators Rand Paul (R-Ky.), Tom Cotton (R-Ark.), Mike Lee (R-Utah), and Ted Cruz (R-Texas), who have vocally opposed the House legislation because they believe it does not go far enough in repealing the ACA, four of their Republican colleagues, Sens. Rob Portman (Ohio,) Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska), signaled last week that they will vote against any ACA replacement bill that eliminates the law's Medicaid expansion. While the law's future is anything but certain, Senate leadership is currently planning to pass the legislation before the chamber's two-week recess that begins on April 7.

Key Provisions of the American Health Care Act

  • Age-based tax credits ranging from $2,000 to $4,000, replacing the Affordable Care Act's income-based subsidies.
  • Limits credits for a single household to $14,000.
  • Phases out subsidies for individuals earning $75,000 and at $150,000 for families.
  • Continues the increased FMAP funding for the existing Medicaid expansion population until 2020. States would be allowed to continue to add to the expansion population beyond 2020, but the federal match would revert to the traditional FMAP for that population.
  • Medicaid Overhaul: Caps Medicaid payments to states based on each state's historical per enrollee cost and the number of enrollees in the state using a base year of FY 2016. Eliminates the penalty for individuals who don't obtain health coverage and replaces it with a requirement that individuals maintain continuous coverage or face a financial penalty (a 30 percent surcharge on premiums for a year) the next time they obtain insurance.
  • Eliminates the penalty for business that fail to offer coverage to employees.
  • Defunds Planned Parenthood for one year.
  • Eliminates many of Obamacare's taxes beginning in 2018, including those on prescription and over-the-counter drugs, tanning services and health savings accounts.
  • Includes $100 billion for state grants aimed at stabilizing the individual market over 10 years. States could use this money to create reinsurance programs or high-risk pools.
  • Authorizes HHS to allow, through rule, insurers to vary premiums based on age by up to a five to one ratio for plan years beginning in 2018. The current limit is three to one.
  • Increases federal payments to community health centers.

NCSL's Summary of the American Health Care Act

NCSL Contact: Rachel Morgan

Trump Administration's Budget Expected This Week


 The U.S. is $20 trillion in debt. If you stacked 20 trillion U.S. dollar bills one on top of the other, the height would reach to the moon and back over five times. 

The Trump administration is expected to release its complete budget plan this week. While the budget proposal will not become law, it will be an important signal to Congress of the administration's funding priorities.

Preliminary budget documents, obtained by the Washington Post last week, reveal that the Trump administration is considering more than $6 billion in cuts at the Department of Housing and Urban Development. The cuts would be realized through reduced funding of public housing support and through eliminating most federally funded Community Development Block Grants (CDBG). While the lion share of $3 billion in CDBG funding is transmitted directly to cities and urban counties, $870 million of CDBG funds are sent to the states who then direct their allocation. While it is unclear if the cuts will be realized or even if they will be included in the president's final budget proposal, they do signal that Trump is following through with his goal of reducing domestic spending to pay for his proposed $54 billion increase in defense spending.

NCSL Contacts: Max Behlke, Jake Lestock

Defense Spending Bill Advances

Last Wednesday, the House overwhelming approved the $584 billion defense spending bill that will likely become the vehicle for the entirety of government appropriations for the remainder of the fiscal year by the time it is approved by the Senate. While the defense bill has strong bipartisan support, Senate Democrats have signaled that they may hold up passage of the measure in order to secure funding for domestic programs. While there is not yet an urgency to act on the bill, expect the budget fight to intensify in the coming weeks as the current federal spending bill expires on April 28.

NCSL Contacts: Max Behlke, Jake Lestock

Debt Limit Returns on Wednesday

Last Thursday, Treasury Secretary Steven Mnuchin began taking "extraordinary measures" to delay the U.S. government from defaulting on its obligations and called upon Congress to lift the debt ceiling before he exhausts his options. In a letter the day before to House Speaker Paul Ryan (R-Wis.), the secretary wrote that the Treasury began suspending the sale of certain state and local securities and will soon suspend payments to certain pension funds in order to delay defaulting on other payments. If Congress does not raise the government's borrowing authority by the time the Treasury runs out of options, the government will default on its spending obligations.

NCSL Contacts: Max Behlke, Jake Lestock

McConnell Pessimistic About Swift Passage of Tax Reform


 First lady was used first in 1849 when President Zachary Taylor called Dolley Madison first lady at her state funeral. It gained popularity in 1877 when used in reference to Lucy Ware Webb Hayes. Most first ladies, including Jackie Kennedy, are said to have hated the label. 

In an interview with POLITICO last Thursday, Senate Majority Leader Mitch McConnell (R-Ky.) said that the complexity of tax reform combined with the health care reform debate is making it increasingly likely that the tax reform debate will not be considered until after the August recess. When asked about a realistic timeline, the leader responded with, "I don't know - it's complicated." However, the Chairman of the House Ways and Means Committee, Kevin Brady (R-Texas), said last week that he had not talked to McConnell, but was moving ahead on a more optimistic timeline. He said that, "I can tell you from the Ways and Means perspective, we're staying right on track. We're moving forward with action this spring - be ready for further action [in the full House] this summer."

NCSL Contacts: Max Behlke, Jake Lestock

Congress Sends Education Legislation to the President

On Wednesday March 8, the Senate voted 59-40 to pass House Joint Resolution 58, a measure blocking NCSL-opposed regulations on teacher preparation programs, issued by the Obama administration. The teacher prep regulations would require states receiving funds under the Higher Education Act (HEA) to create a rating system for teacher prep programs based on several criteria. Only programs rated as "effective" (rather than "low performing" or "at risk of becoming low performing") would be eligible to participate in TEACH grants, a federal student financial aid program. NCSL had issued a letter in support of HJR 58 and its companion, SJR 26. On Thursday, the Senate also voted 50-49 to approve HJR 57, a measure that would block ESSA accountability regulations. The vote was cast along party lines, with lone Republican Rob Portman, R-Ohio, voting against. The measures now await signature by the President.

NCSL Contact: Lucia Bragg

Read the March 6, 2017, issue of Capitol-to-Capitol.

If you have comments or suggestions regarding Capitol-to-Capitol, please contact Max Behlke.

NCSL's Advocacy in Washington

NCSL's Washington staff advocate Congress, the White House, and federal agencies on behalf of state legislatures in accord with the policy directives and resolutions that are recommended by the NCSL Standing Committees and adopted by the full conference at the annual NCSL Legislative Summit Business Meeting. As a result of the advocacy that is guided by these policies positions, NCSL is recognized as a formidable lobbying force in state-federal relations.

NCSL Staff in Washington, D.C.

  • Neal Osten | 202-624-8660 | Molly Ramsdell | 202-624-3584 | Directors
  • Max Behlke | 202-624-3586 | Budgets and Revenue
  • Danielle Jarchow |202-624-8686 | Communications, Financial Services and Interstate Commerce
  • Lee Posey | 202-624-8196 | Education
  • Rachel Morgan | 202-624-3569 | Health and Human Services
  • Jon Jukuri  | 202-624-8663 | Labor, Economic Development and International Trade
  • Susan Frederick | 202-624-3566 | Law, Criminal Justice, and Public Safety
  • Ben Husch | 202-624-7779 | Natural Resources and Infrastructure