As the 115th Congress begins, I am honored to assume a new role as Interim Chair of the House Budget Committee.

It is an exciting opportunity, particularly as the first woman to fill the position, but more than any title before my name, I’m still most proud of the two letters that follow: “R.N.”

I graduated from nursing school in 1971 and still keep my license today. Those years on the front lines of patient care, primarily in emergency room settings, inform much of the work I do in Congress – especially when it comes to ObamaCare.

It’s no secret that Congressional Republicans aren’t keen on former President Obama’s health care law (of course, recent polling shows that a majority of Americans still aren’t either) but, for me, the debate has never been about politics. It’s personal.

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The provision was buried deep in a 1,000-page bill that Congress passed in December by large bipartisan majorities. Most lawmakers probably didn’t know it was there. Yet it is the start of an answer to the biggest question on Washington’s mind: What to do about ObamaCare?

The 21st Century Cures Act, which President Obama signed Dec. 13, focuses mainly on helping patients obtain breakthrough drugs and medical devices. But it also includes provisions that will give small employers—those with fewer than 50 workers—more flexibility in the insurance marketplace. As Republicans debate how to replace ObamaCare, giving that same flexibility to all employers would be a perfect place to start.

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President Trump told Fox News last week that when it comes to ObamaCare, “we’re going to have a plan that’s going to be great for people.”

What that plan will actually be, though, remains unclear.

Trump has said that he will put forward an ObamaCare replacement plan shortly after Rep. Tom Price (R-Ga.) is confirmed as secretary of Health and Human Services, an announcement that caught lawmakers off guard.

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The executive order President Trump signed on Friday does not have any immediate policy effect, but it does call attention to the wide range of administrative actions that a Trump administration could take to change the Affordable Care Act—all without legislation from Congress.

We’ve compiled a list of those actions. It’s not exhaustive; there is a lot more a Trump administration could do. Nor do we mean to suggest that these actions would be legal. Declining to enforce the individual mandate, in particular, would be problematic, although the Trump administration might seek cover from dubious enforcement decisions made by the Obama administration (like the “like it, keep it” fix and employer mandate delays).

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Two Republican senators on Monday introduced a plan under which states could choose to maintain the Obamacare exchanges or overhaul the program.

The proposal from Sens. Bill Cassidy (La.) and Susan Collins (Maine) would allow state capitols to decide whether to maintain the Affordable Care Act or to launch a new plan that would automatically enroll people not covered by an employer, Medicare or Medicaid in a plan.

Under their plan, known as the Patient Freedom Act, states could opt to continue receiving federal premium tax credits, cost-sharing subsidies and Medicaid dollars as they have under the ACA, or enact a new system under which states would receive funds through advanceable, refundable tax credits or per beneficiary grants. Patients would receive funding directly through a health savings account.

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About 27 percent of people under 65 are thought to have some sort of pre-existing condition that will most likely leave them without individual insurance if the law is repealed, according to a recent study. The guarantee of coverage has already become a rallying cry for people who want to keep the law.

The issue “is the third rail” for the Republicans, said Michael Turpin, a longtime health industry executive.

Before the law, a fairly typical life event — like a divorce or the loss of a job — and a relatively minor medical condition could upend a person’s health coverage options. Stories of sick people unable to get coverage when they needed it most were legion.

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During the 2016 campaign, Donald Trump promised to begin repealing and replacing the Affordable Care Act on Day One of his presidency. Within hours of his inauguration, he put a down payment on that promise, issuing an executive order instructing federal agencies to “take all actions consistent with law to minimize” the law’s economic burdens. The executive order could lighten the impact of Obamacare’s “essential health benefits” rule and could undermine the law by refusing to enforce its individual mandate. However, to fully repeal and replace the former President’s health law, Congress will need to pass new laws that can overcome a filibuster in the Senate.

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Healthcare advocacy groups say a bill in the Missouri Senate that seeks to transform Medicaid into a block grant program would cut necessary funding for healthcare services for Missouri’s most vulnerable citizens. But Republican supporters say it would give the state more flexibility and help it control runaway spending.

The same debate is playing out on a national stage. GOP lawmakers, including President Donald Trump, have embraced Medicaid block grants as a solution to growing costs. As Medicaid reform looks more and more like a potential reality, states are beginning to question if it’s wise to forgo some federal funding in exchange for more control.

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The Trump administration may stop enforcing the Obamacare requirement that most Americans carry health insurance even before Congress repeals the law, Kellyanne Conway, a top adviser to the new president, said in interviews broadcast on Sunday.

Such a move would take the teeth out of former President Barack Obama’s health-care law and could destabilize insurance markets, analysts say. It was not clear from Conway’s remarks whether President Donald Trump would try to use his executive authority to make the change, which would be much faster than writing new regulations or waiting on lawmakers.

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Lawmakers, insurers and the health-care industry rushed over the weekend to decipher the full meaning and consequences of President Donald Trump’s executive order urging agency heads to do whatever they can to unwind some provisions of the Affordable Care Act.

The order, issued late Friday, encouraged officials to use “all authority and discretion available to them” to waive or delay ACA provisions they deem onerous on individuals, states or insurers. It isn’t yet clear how many provisions officials may choose to apply that to or when, leaving the political and health care worlds in a state of some confusion.

At a minimum, the move signals Mr. Trump’s willingness to take aggressive public aim at the law often dubbed Obamacare, as Republicans in Congress wrestle with their own efforts to dismantle the law and come up with a new health-insurance system in its place.

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