On President Trump's 'day one,' GOP Congress eyes Medicaid block grants in Obamacare replacement

On what President Trump has deemed his first day in office, a GOP-led Congress moves to act on the 45th commander in chief's "day one" priority of repealing the Affordable Care Act -- commonly known as Obamacare.

Hours after taking his oath of office, Trump took his first step in dismantling Obamacare as he signed an executive order instructing federal agencies to grant relief to constituencies affected by the Affordable Care Act.

President Obama's signature health care law has been a point of contention between Republican and Democratic lawmakers since it was signed into law in 2010. Congressional leaders are now planning to use a budget vehicle to overhaul the nation-wide law, in hopes of replacing the Affordable Care Act with legislation that includes what conservative think tank The Heritage Foundation calls "free market principles."

Rachel Bovard, Director of policy services for The Heritage Foundation, says congressional leadership must prioritize repeal, at least at first, before they debate different stances on a sound replacement plan.

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"Republicans have a lot of ideas, they've been sitting there for eight years trying to figure out how to repeal Obamacare," said Bovard in an interview with AOL News. "They can't make the same mistake the Democrats did in 2009, which was to jam through a huge bill that no one knew what was in it.

In an interview with CNN, Sen. Rand Paul said there are "about 50 replacement bills" for Obamacare that have been out there for years.

President Trump recently claimed "insurance for everybody" relative to his idea of replacing Obamacare, but later walked back that statement saying, "Well, we want people taken care of ... There will be nobody dying on the streets in a Trump administration."

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In a Sunday interview with NBC News's Willie Geist, senior Trump adviser Kellyanne Conway announced that an Obamacare replacement will transition Medicaid to a block grant program -- meaning federal government would give money to states to implement and disperse Medicaid funding as they see fit.

"President Trump has said that people will not go without coverage. And he means that," Conway said to NBC News. "That is certainly part of the official plans that are being worked on."

The Medicaid program grew during Barack Obama's presidency -- when he gave states the option to expand eligibility for the program to millions of people living above the poverty line. Since that move, a reported thirty-one states the District of Columbia have expanded their coverage programs.

While many Republican lawmakers have been integral in crafting a game plan for the next wave of health care reform, Tennessee Congresswoman Marsha Blackburn has been exceptionally vocal in her advocacy around rebuilding insurance legislation, saying Obamacare is "a broken system."

"A lot of it will be done through reconciliation — and the rest will be more of a cleaning up and restoring people's access to health care — increasing their options," said Blackburn, commenting on the repeal process. "We are well served by having a speaker who is an orderly process person, and we will move through this in a diligent manner."

The reconciliation process -- the replacement vehicle Congress is hoping to use in repealing the ACA -- is one known to those familiar with the legislative history of the health care law.

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Reconciliation came out of the Congressional Budget Act of 1974, and it expedites Senate consideration of bills relative to the budget. Reconciliation requires 50 votes to pass, as opposed to most Senate processes which require 60, and constrains debate on these bills to 20 hours -- eliminating the chance of a lengthy Senate filibuster.

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"They have worked on this and wanted this for the past four decades," said Rep. Blackburn in responding to Democratic resistance to Obamacare repeal. "Make our hospitals and our providers whole. Let's make Medicare whole. Let's get a product where everyone can afford it."

As Bovard of The Heritage Foundation says the repeal process is not a "one and done" process, she believes the debate portion of replacement needs to be debated "transparently" so the American people know what their options.

"Obamacare dictated to the states a lot of policies that didn't work," said Bovard, quoting that 70 percent of counties across the U.s. having one or two options in the market because insurance companies are pulling out of Obamacare.

"Health care is a critical element of policy in america, it needs time for people to understand what's being debated," said Bovard. "

Bovard also says that Tom Price -- Trump's cabinet pick for the Department of Health and Human Services -- will likely play a strategic role in dealing with some of the federal regulations at HHS that have come out of Obamacare.

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