"speaker ryan said: 'obamacare is the law of the land.' kansas and other states with republican legislatures are working toward medicaid expansion. it's time to stop the bickering, help our neighbors and pass insure tennessee. there is no excuse for inaction."  in his second senate tie-breaking vote of the year, vice president mike pence cast the deciding vote in congress' first steps to defund planned parenthood by allowing states to continue restricting certain providers from the title x program. 