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cannot be repealed (e.g. requirement that insurers cover young adults through age 26) because they do not meet the requirement of being directly budget -related. And to "replace" Obamacare, the same rule applies —only provisions that are directly budget related can be put in a reconciliation bill. So, for example, the GOP could create a new tax credit, a new insurance subsidy, a new pool of funds for states to use with the uninsured, or a revised funding allocation for Medicaid. But it may be a tough argument with the Senate Parliamentarian that revising insurance regulation, redefining required benefits, and making major reforms to the rules of the Medicaid program can fit in this bill. Replacement Plan President Trump recently vowed that his healthcare replacement would provide "insurance for everybody," but Republicans have not yet reached consensus about a replacement healthcare plan. We expect the new plan to eliminate Medicaid expansion, but how states will receive federal Medicaid funding is unclear. Options include block grants or per -capita grants, where states receive a fixed sum for each participant. Thus, it is possible that overall federal Medicaid funding will decrease. Several reform bills have been introduced in the last few weeks. Most notably, the Cassidy -Collins plan, the Patient Freedom Act of 2017, which would give states three options: keep the current ACA system, reject any federal assistance, or transition to a new program that will automatically enroll eligible individuals in a high -deductible plan linked to a health savings account. Their plan calls for initially keeping the ACA taxes and transitioning to the new system by 2020. Timeline The original Republican plan was to quickly move legislation that would repeal as much of Obamacare as possible, probably with a one or two year delay in the effective date of those repeal provisions, and leave the question of developing and adopting a replacement approach to later legislation. House Republicans hoped to complete the reconciliation process and have a repeal bill on the President's desk by February 20th. The Republicans did not want to replace one 2,700 page bill with another one. They also did not want to get into a messy internal debate about how to replace Obamacare. However, that approach is becoming less and less appealing politically. As a result, there is now an increasing number of statements from senior elected GOP officials and the President articulating different approaches such as "step -wise" repeal and replace, "nearly simultaneous" repeal and replace, or doing it all at once. The direction of movement is toward having more replacement features included in the repeal bill that is considered in the next few months under the protection of reconciliation. Impacts of Repeal According to a 2010 Congressional Budget Office report, overhauling the ACA could cause 32 million people could lose coverage and double premiums by 2026. Further, the cost of repealing the law will be at least $350 billion; and some estimates say $9 trillion in the long -teen. Eliminating the insurance premium tax credits and Medicaid expansion could result in $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, 19EPu17