President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.

It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.

. . .

It is not a question of whether or not Republicans and Democrats will come to a compromise over replacing Obamacare.

Since it will take 60 Senate votes, and the Republicans only have 52 seats, there is no way we can get to a solution to the Obamacare conundrum without a bipartisan compromise.

So, what might that look like?

We can’t underestimate the fundamental ideological differences between Democrats and Republicans on the entitlements–of which Obamacare is just one.

First, think of an old-fashioned pension plan as a defined benefit plan. The employer promised a set benefit based upon years of service and wages for the rest of the retiree’s life. If the stock market crashed, the employer guarantee would continue. In a defined benefit plan, the sponsor takes the risk of being able to pay the benefits.

. . .

Despite heated congressional hearings on whether Rep. Tom Price should head the U.S. Department of Health and Human Services, President Donald Trump’s promise to “repeal and replace” the Affordable Care Act is already in motion.

On Inauguration Day, Trump signed an executive order urging federal officials to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens” of the federal health law.” Meanwhile, several Republican plans for a replacement to the law are in the works, including proposals to block grant Medicaid and another that would allow states that embraced the law to maintain it.

The American public appears divided on the law, which has resulted in coverage of more than 20 million people. A Kaiser Family Foundation poll conducted in December found that Americans are evenly divided on the fate of the law — 49 percent of respondents said Congress should vote to repeal it, while 47 percent said they should not. Just one in five agreed with the Republican strategy of repealing the law before creating a replacement. (KHN is an editorially independent service of the foundation.)

. . .

A key GOP senator introduced an Obamacare replacement bill Tuesday, the second such plan put forth in the Senate this week as lawmakers scramble to put their stamp on the nation’s health care system.

Kentucky Sen. Rand Paul introduced the Obamacare Replacement Act, which he says would create more affordable insurance plans, eliminate the gap between private and employer-sponsored care, and allow consumers to save unlimited amounts of money in health savings accounts.

Paul sits on the Senate’s Health, Education, Labor and Pensions Committee, which is expected to play a key role in writing legislation to replace the Affordable Care Act.

. . .

Republican leaders laid out an aggressive legislative agenda that would have Congress repeal major portions of Obamacare, pass replacement measures and embark on a major tax code overhaul. At their annual policy retreat in Philadelphia, the GOP put repealing and replacing Obamacare as the first order of business, with the target date for action within the next three months. They laid out a three-pronged plan—one that would start with a “reconciliation” bill that could skirt a Senate filibuster but accomplish only some of the GOP’s health care goals. Meanwhile, the Trump administration would use its executive and regulatory powers to abolish parts of the law, while lawmakers continue work on more thorough replacement legislation that would need some Democratic support.

. . .

The House Energy and Commerce Committee could look to attach legislation intended to overhaul the 2010 health care law onto several other bills expected to advance this year, panel chairman Greg Walden said Tuesday.

Walden, speaking at an event hosted by the Republican Main Street Partnership, said repealing and replacing Obamacare would be the top health care priority for his panel in 2017. But a handful of other major programs under the committee’s purview are expected to be reauthorized by Congress before they expire at the end of the year.

Among the items on the panel’s 2017 agenda is the Children’s Health Insurance Program, or CHIP, a popular program that provides federal funding to states to help cover the cost of health care for children.

. . .

Rep. Tom Price (R-GA), President Donald Trump’s pick to lead the Department of Health & Human Services, on Tuesday gave the clearest clues yet about how the administration might repeal and replace Obamacare. In a confirmation hearing before the Senate Finance Committee, Price laid out broad goals such as affordability and a focus on patients. Price wouldn’t say whether a new measure would cover as many people as the Affordable Care Act or what kind of coverage would be available for individuals to buy. Price repeatedly said that he wants a health-care system in which “every single American has access to affordable health coverage that will provide the highest-quality health care that the world can provide.”

. . .

Transition relief allowing the creation of ObamaCare-exempt individual markets is only one step toward solving the country’s many health care problems. The broader debate over replacing ObamaCare and reforming the health care system will continue for some time. But these early moves by President Trump’s executive actions are crucial to providing ObamaCare’s hardest hit victims quick relief. States and insurance companies should move with the same urgency that the Trump administration has shown. It’s time to allow the choices that people want also to be the choices they have.

. . .

In the tradition of departing presidents, Barack Obama left a letter for incoming President Donald Trump.

The thrust of the message, which Trump relayed to congressional leaders during their White House meeting Monday evening, was a plea to salvage ObamaCare — or swap it for something at least as generous.

“I haven’t seen the letter,” Rep. Steny Hoyer (D-Md.), who attended the meeting, told reporters Tuesday. “But President Obama correctly … stated that, ‘Look, we believe the Affordable Care Act is a very important piece of legislation which has given Americans better health, better access, more reliability. And if you have a bill … that improves upon all this, well, you know, maybe I could support it.”

. . .

Even as the individual mandate is about to be killed off (Congress is poised to reduce its penalty to $0, thereby effectively repealing it), some center-right policy wonks and politicians are trying to give life to a new idea that might be even worse—”auto-enrollment.”

Here’s how it would work: If an American citizen were made eligible for a tax credit for health insurance, but chose not to use it, the government could then “auto-enroll” that citizen in a health insurance policy of the government’s choosing. It would use the “tax credit” to pay for it. This is a terrible idea on its face, but here are five specific reasons why it is so:

1. It is paternalistic.
2. It would be a free-for-all for cronyism.
3. It would be very expensive.
4. It would feature federal spending that’s masquerading as tax cuts.
5. It would raise premiums.

. . .