The Landscape: Monthly Government Affairs Post

April 26, 2023 by K. Carter Batey

Welcome to The Landscape, a monthly post that seeks to separate the signal from the noise and give you valuable insight into the inner workings of government at the federal, state, and local level.

Children’s National is uniquely located at the intersection of multiple jurisdictions, and multiple governing bodies that affect issues ranging from national defense to parking enforcement. It is the job of Government Affairs to represent the interests of Children’s National before Congress (and the myriad agencies with jurisdiction over healthcare), in the Wilson Building, in Annapolis, in Richmond, and in the local authorities around the region.

What separates Children’s National from its peers is our dedication to advocacy, and our ability to weave together efforts at all levels of power to achieve the best outcome for our patients, and children across the nation.

What follows is a rundown of the top political news from around the region and seeks to help you gain insight into the landscape in which Government Affairs operates.


Max Weber once said that politics is the “strong and slow boring of hard boards”. Nowhere is this truer than at the federal level. While effective advocacy at the state and local level requires quick reactions, and an idea can germinate into law in the span of mere months, federal policymaking demands more patience.

Children’s National advocates at the federal level for issues ranging from Mental Health, sufficient financing of medical education, innovative workforce development supports, pediatric research and development, and the expansion of health insurance coverage. However, these issues often simmer on the backburner while Congress and the White House tangle over hot-button, “must-pass” policies that threaten to boil over.

Such is the case with the current debt ceiling debate.

Just as with a credit card, when the United States borrows money to finance its ongoing operations it must make periodic payments on the debt. To be clear: the debt ceiling does not authorize new spending, it merely allows the U.S. to pay debt already incurred. An entire newsletter could be dedicated to the merits of deficit spending in a dynamic global marketplace, but for today the salient point is that the debt ceiling is something that the government MUST address.

Republicans want to attach conditions to any debt ceiling increase (non-defense spending cuts for example…and pay attention here because Medicaid is a favorite target), whereas Democrats prefer a “clean” increase.

Stay tuned for updates, as nothing big is likely to get done in the halls of Congress until this issue is resolved.

District of Columbia

In mid-March, Mayor Bowser presented her FY 2024 Budget, totaling $19.7B pending Council approval.

This year the District is facing a $1.7B deficit. To address the deficit, they are taking $275M from the rainy-day fund and making $373 million in cuts to programs and hiring, and Children’s National remains heavily engaged in this process working to protect key services that affect the health of the District’s children.

DC Council must now strike a balance between making necessary cuts and finding new ways to pay for priorities such as baby bonds, free metro, funding for DC public schools, and emergency rental assistance program.

On May 16, the Council will take the first of two necessary votes on the FY 2024 Local Budget Act and FY 2024 Budget Support Act of 2023, so you’re going to hear lots more about the D.C. Budget process in future editions of The Landscape


2023 began a new chapter for Maryland politics. After two terms of divided control of state government, Democrats achieved a trifecta of power with the election of Wes Moore as the 63rd Governor—and the first African American to hold the office in state history.

Whereas before Democratic majorities had to work with a Governor of the opposite party (albeit a widely popular one), now they could rubber stamp much of Governor Moore’s agenda.

Among the Governor’s priorities were increasing the minimum wage, enhancements to the EITC and Child Tax Credit, creation of a “year of service” program for graduating high school seniors, as well as expansion of broadband to underserved areas of the state.

The Legislative Session that began with transition in January closed with moments of chaos in April, as lawmakers exchanged heated words over the Speaker’s adjournment of the House (preventing an attempted stalling tactic to effectively kill several bills).

At issue was a bill that would have removed the pretext for a traffic stop solely on the odor of cannabis. An appropriate bill because the legislature also approved a framework for the legalization of the substance.

In addition to tackling marijuana legalization, the 188 members of the legislature also addressed abortion, clean energy (namely offshore wind), and gun control.

In Maryland, as across the region and the nation writ large, one of the issues that continues to be top of mind is how to marry the end of the Public Health Emergency with the policies that proved successful during the bulk of the COVID-19 pandemic. Telehealth, expanded Medicaid eligibility, public assistance programs, and cross-state licensure will continue to be debated and perfected in the coming months and years.


Before the 2023 Session began, Government Affairs stated that several factors would prevent big things from happening in the legislature. The toughest, most politically complex fights would likely be put off until after the 2023 general elections in November, which will put every member of both chambers on the ballot (except not, more on that later). The election year, further complicated by new district lines per the decennial redistricting, as well as the short session (45 days) all combine to disincentivize legislators from taking hard votes.

The session did not disappoint. Most controversial issues were either quickly dispatched in committee, or never heard at all. In the Senate, Democrats eager to tie their Republican opponents to abortion restrictions in the post-Roe landscape, crowed about the “brick wall” the Democratic majority in the Senate represented. In the Republican controlled House, such bills never made it to the floor. Of the roughly 2,200 bills introduced in 2023, 867 passed and 499 of those were on unanimous votes. The issues that received the most attention were casino gambling and charitable gaming, utility rate regulation, and the budget.

The two biggest things to note as of this writing are first, there is no budget and second, it seems as though much of the Legislature has decided not to return.

Citing the danger of a recession in late CY23 or early CY24, negotiations on amendments to Virginia’s $150B operating budget have stalled, leaving unanswered numerous policy questions that are contingent on funding.

About the author

K. Carter Batey, BA

Manager of Government Affairs within the Child Health Advocacy Institute at Children's National Hospital