Capitol to Capitol | May 8, 2017

For Better or Worse, Congressional Republicans Now Own Health Care

Ever since the then-Democratic controlled House passed the Affordable Care Act (ACA) 219-212 in March 2010 with no Republican support, the Democrats, for better or worse, have owned the issue of health care. That changed last Thursday, when the Republican controlled House passed an amended version of their repeal and replacement legislation, the American Health Care Act (AHCA), 217-213, with 20 Republicans and all Democrats voting against it. It now heads to the Republican-led Senate, where the legislation is all but certain to undergo drastic revisions that Republicans hope will help earn the support of at least 50 Republican senators, which will be necessary for passage. Senate Republicans will also closely follow public opinion, as they are keenly aware of how public disapproval for how Democrats handled the passage of the ACA helped propel the Republicans into control of the House in 2010, an historic wave that flipped a net of 63 blue House seats to red. In other words, don’t expect the health care debate to end anytime soon.

In April, the Kaiser Family Foundation released a poll that found that 64 percent of Americans believe that Republicans are responsible for fixing the problems of the ACA, given their unified control in Washington. So, fair or unfair, the tables have turned, and Democrats will now look to use the issue of health care to their advantage, just as Republicans had the made the ACA a central campaign issue for the last four election cycles. “You [Republicans] have every provision of this bill tattooed on your forehead,” House Minority Leader Nancy Pelosi said on the House floor before last Thursday’s vote. “You will glow in the dark on this one.”

Expect Republicans to continue to point to the ACA for health insurance spikes and limited options in the individual health care exchanges, and there will be no shortage of headlines for them to point to. Insurers are now just beginning to announce their rate increases for 2018, which will continue through the spring and summer. Some of the announcements will be helpful for congressional Republicans and their messaging. For instance, a CareFirst plan in Maryland announced last week that it is seeking a 59 percent rate hike for individual plans bought on the state insurance exchange. Some insurers are expected to abandon the ACA exchanges altogether. Already, most of the state of Iowa and the Knoxville region of Tennessee could have no insurers offering coverage next year. Nevertheless, if the final Republican replacement plan does not reduce premiums, drive down deductibles, improve competition, and provide “insurance for everybody” as President Donald Trump has pledged, public backlash against the GOP could be harsh at the ballot box in 2018 and 2020.

On Saturday, White House chief of staff Reince Priebus spoke to a dozen members of a Senate working group, which includes Senate Majority Leader Mitch McConnell (R-Ky.). The group has begun to explore what changes are necessary to achieve enough votes for passage. “Everyone is committed to getting this thing done and getting it done as soon as possible. I don’t think everyone is going to be beating down this group of 12. I think we’re going to want to let them do their work,” Priebus said.

But don’t expect the Senate too move swiftly. Republicans are divided over central components of the bill. Those elements includie the phase-out of Medicaid expansion, allowing states to opt out of certain ACA requirements, and how to provide affordable insurance coverage for people with pre-existing conditions. The Senate is also unlikely to act until they receive the score from the Congressional Budget Office (CBO). In its score of the original AHCA in March, the CBO found that while the ACA replacement would reduce the deficit and eventually lead premiums to fall, it would also lead to 24 million people losing health insurance over a decade.

Finally, it’s important to remember that if Congress plans to use budget reconciliation for comprehensive tax reform, as it has for the health care legislation, it cannot begin that process until the health debate concludes. And, the longer it takes to resolve health care, the less likely that tax reform will occur this year. In sum, it is all but certain that health care and taxes will dominate the policy front in Washington for most of this year, but what will ultimately occur is anything but predictable.

NCSL Contact: Rachel Morgan

Shutdown Fight Kicked to September

Last Friday, Trump signed a $1.2 trillion spending bill to avert a government shutdown and keep the government funded through the remainder of FY17, which concludes on Sept. 30. The bill’s passage in the Senate was relatively drama-free, with the majorities of both parties voting in favor of the bill, which passed 79-18, with the only opposition votes coming from Republicans, who argued that the bill did not cut spending levels enough.


When most people think of “Watergate” they think of the political scandal involving the Nixon administration. But before the scandal, and even before the hotel, the term meant something differently entirely. In 1828, President John Quincy Adams broke ground on the Chesapeake and Ohio canal, which aimed to complete the vision of George Washington of connecting the Chesapeake Bay to the Midwest. The plan was to build a canal from Georgetown on the Potomac River to Pittsburgh on the Ohio River, and on to the heartland via the Mississippi. While the final canal, which operated from 1831 to 1924, ultimately only made it as far as Cumberland, Md., its 184.5 miles began where Rock Creek empties into the Potomac River, at Milepost 0. The last lock of the canal, known as the “water gate,” is where water coming downstream could empty into the Potomac. While the Washington canal system never quite worked as planned and was made obsolete with the proliferation of railroads, the Water Gate structure itself still remains, and can be seen next to the now-infamous hotel that adopted its name. 

Many Democrats are claiming a victory in the passage of the legislation, as it failed to fund several of Trump’s priorities, including money to build a wall along the southern border. Additionally, the bill funds subsidies for health care coverage provided through the Affordable Care Act, another priority of Capitol Hill Democrats. The bill does not include many of the spending cuts on domestic programs Trump wanted, and adds $2 billion for the National Institutes of Health, $295 million for Puerto Rico’s underfunded Medicaid budget, and $407 million for firefighting in Western states. The legislation also adds $12.5 billion in defense spending.

Though lawmakers evaded a shutdown this month, Congress and Trump already have begun looking ahead to Oct. 1, the first day of the 2018 Fiscal Year, which will be a major test for the administration and the Republican controlled Congress. Many GOP lawmakers are optimistic that they can pass all 12 of the spending bills, but with their ambitious efforts to repeal Obamacare, their desire to rewrite the tax code, and the need to find a deal to raise the debt ceiling, reaching agreement on the budget may prove to be extremely difficult.

Trump last week also gestured to an impending fight by tweeting that he may back a future government shutdown and/or would support a nuclear change to Senate procedure, that would mean the end of the 60-vote threshold necessary to thwart filibusters. And, if there wasn’t enough already on Congress’ plate, it will also have to tackle three important programs set to expire at the end of September: Reauthorization of the Federal Aviation Administration, reauthorization of the National Flood Insurance Program and extending funding for the Children’s Health Insurance Program. With only about 12 weeks of session left before all 12 appropriations bills are due, lawmakers will try to make every day in session count.

NCSL Contacts: Max Behlke, Jake Lestock


Congress Passes Legislation to Pre-empt State Facilitated Retirement Plans

On Feb. 27, NCSL sent a letter to the Senate urging a "no" vote on H.J.Res. 66, a Congressional Review Act resolution to overturn the Department of Labor's final rule on Savings Arrangements Established by States for Non-Governmental Employees.


President Harry Truman had a very good reason to celebrate his 61st birthday—the end of war in Europe. On May 8, 1945, both Great Britain and the United States celebrated Victory in Europe Day. May 8 marked the day when German troops throughout Europe finally laid down their arms: In Prague, Germans surrendered to their Soviet antagonists, after the latter had lost more than 8,000 soldiers, and the Germans considerably more; in Copenhagen and Oslo; at Karlshorst, near Berlin; in northern Latvia; on the Channel Island of Sark—the German surrender was realized in a final cease-fire. More surrender documents were signed in Berlin and in eastern Germany. 

The resolution, which passed the House 231-193 and narrowly passed the Senate 50-49, overturns a rule that had removed uncertainty in federal law regarding state-facilitated retirement plans. This uncertainty has discouraged states from establishing IRA programs for workers who do not have access to workplace savings arrangements.

NCSL wrote, "Eight states have enacted laws that will establish state-facilitated retirement plan and many other states are considering these plans for their state's private sector workers. Passage of H.J. Res. 66 will likely prevent states from establishing these innovative plans and will result in increased costs for federal and state budgets as tens of millions of Americans who depend solely on social security will increase dependency on other entitlement programs."

The resolution has been sent to Trump, who is ultimately expected to sign it into law.

NCSL Contacts: Max Behlke, Jake Lestock

Trump’s Executive Actions

Trump’s first months in office have been filled with a flurry of executive actions. The 45th president has signed about 90 executive actions, which includes executive orders, in his first 100 days. The three types of executive actions include:

  • Presidential memoranda aim to manage and govern the actions, practices, and policies of the various departments and agencies found under the executive branch. To date, Trump has issued 28 memoranda.
  • Proclamations are mostly ceremonial observances of federal holidays or awareness months. To date, Trump has issued 34 proclamations.
  • Executive orders are assigned numbers and published in the federal register, similar to laws, and typically direct members of the executive branch to follow a new policy or directive. To date, Trump has issued 34 orders.


When the Nebraska Legislature ratified the 18th Amendment, which prohibited the manufacture, sale, and transportation of alcoholic liquors, on Jan. 16, 1919, the requisite number of state legislatures (three-fourths) had voted to amend the U.S. Constitution. However, the 18th Amendment lacked an enforcement mechanism, so Congress passed the National Prohibition Act on Oct. 10, 1919, popularly known as the Volstead Act, to do so. President Woodrow Wilson vetoed the Volstead Act, largely on technical grounds, but Congress overrode his veto, thus bringing on the Prohibition Era.

Recent executive orders include:

  • Promoting Free Speech and Religious Liberty—Signed May 4, 2017 | Eases IRS enforcement of the Johnson amendment, which bans churches from engaging in political speech. It also gives relief to companies that disagree with the Affordable Care Act mandate on contraception in health care coverage.
  • Establishment of the American Technology Council—Signed May 1, 2017 | Launches the American Technology Council, headed by 19 different Trump administration officials and cabinet members tasked with modernizing the federal government’s digital services and technology.
  • Addressing Trade Agreement Violations and Abuses—Signed April 29, 2017 | Directs Secretary of Commerce Wilbur Ross to review all U.S. trade agreements, as well as relations with countries that run trade deficits with America.
  • Establishment of Office of Trade and Manufacturing Policy—Signed April 29, 2017 | Establishes the Office of Trade and Manufacturing Policy, which will advise Trump on policies to increase economic growth and decrease the trade deficit. Leading the new office is Trump appointee and National Trade Council Director Peter Navarro, who said he wants to renegotiate NAFTA.

NCSL Policy Deadline for Legislative Summit

NCSL's Washington staff advocate before the Congress, the White House and federal agencies for the benefit of state legislatures in accord with the policy directives and resolutions recommended by the Standing Committees and adopted at the NCSL Legislative Summit Business Meeting. Because of the policy decisions voted on by the Standing Committees, NCSL is nationally recognized as a formidable advocacy force in state-federal relations.

All new policy directives and resolutions, as well as amendments to existing directives and resolutions, must be submitted to the attention of the NCSL Washington Office Directors, Neal Osten and Molly Ramsdell ( by 5 p.m. on July 7, the 30th day before the NCSL Annual Business meeting.

More on the NCSL Policy Process.

NCSL Contacts: Neal OstenMolly Ramsdell

Read the May 1, 2017, 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
  • 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