In it, but not of it. TPM DC

Sen. Bob Corker (R-TN) seemed to be leaning toward a strategy to repeal and replace Obamacare simultaneously Tuesday, something that is being pushed by House conservatives in the Freedom Caucus.

"Why would we put off for three years doing what we know we have to do?" Corker told reporters on Capitol Hill Tuesday.

While Corker said he still wanted to hear from Vice President-elect Mike Pence, who was scheduled to meet with senators shortly after Corker spoke to reporters, he openly wondered whether waiting three years to replace Obamacare could create political problems down the line.

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As the GOP confronts the complexity of repealing Obamacare, Senate Republicans hailing from states that expanded their Medicaid programs under the Affordable Care Act are feeling an extra layer of pressure.

Altogether, there will likely be 20 Republican senators from Medicaid expansion states next term. Many come from so-called “Trump country,” the industrial and rust belt states like Pennsylvania and Ohio that were critical to Trump’s win. Working class whites in general have been among the top beneficiaries of Medicaid expansion.

"I'm from a state that has an expanded Medicaid population that I am very concerned about," said Sen. Shelley Moore Capito (R-WV) this week. "I don't want to throw them off into the cold, and I don't think that's a strategy that I want to see. It's too many people. That's over 200,000 people in my state. So we need a transition. I think we'll repeal and then we'll work during the transition period for the replacement vehicle."

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Perhaps seeking to quell a flood of reporting on potential conflicts of interest in a Donald Trump administration, the President-elect announced Wednesday that he would soon separate “in total” from the business conglomerate that bears his name.

Yet in the series of tweets publicizing this upcoming move, Trump said only that he would remove himself from the Trump Organization’s “business operations,” leaving open the possibility that he would retain a financial stake in the company while in the White House. His advisors suggested that he still plans to hand management of the company over to his three adult children in what he refers to as “blind” trust that ethics experts argue defies the definition.

Those experts say there are certain steps Trump can take now to dispel the cloud of impropriety already looming over his administration, though, like ditching his Washington, D.C. hotel lease and removing his children from his presidential transition team.

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Since Donald Trump stunned Washington and won the White House earlier this month, Republicans in Congress have been frantically dusting off their legislative wish lists and prepping for the new era in which their party is in the driver's seat.

For House Speaker Paul Ryan (R-WI), overhauling and privatizing Medicare – the popular, single-payer health insurance plan for senior citizens – is a top priority. What exactly the House's plan would look like remains unclear, as Republicans have just begun ruminating about overhauling Medicare. But there is a treasure trove of past Medicare ideas and blueprints from Ryan that give us insight into what his plan might look like.

Ryan has been pushing his privatization plan – or what he calls "premium support" – for years. It's been part of his annual budget blueprints, and it has evolved over time. The basic idea is that Ryan would give the elderly a set amount of money to buy health insurance rather than Medicare's fee-for-service system where the government pays doctors and hospitals based on the services they provide.

How much money the elderly would receive to buy insurance, the quality of the plans available, how the government would regulate them and the rate at which the benefits would increase have varied over the years and sometimes have been unclear.

As Medicare is currently configured, American workers and employers contribute equally to the public insurance program via the Medicare payroll tax. When people turn 65, they become eligible for Medicare's guaranteed coverage, pay premiums and receive a robust package of benefits.

Looming as the biggest unknown is whether Medicare – in its current form as a single-payer, guaranteed-coverage, fee-for-service system – will remain intact.

Will Medicare be eliminated explicitly, as it has in past Ryan plans? Will it be changed so substantially that the long-term effect will be to weaken it so that phasing out it out is inevitable? Or will Ryan seek to change Medicare in fundamental ways while still preserving its most important protections?

How committed President-elect Trump and Rep. Tom Price (R-GA), his nominee as secretary of Health and Human Services, are to Medicare privatization is another wild card in the mix.

"It is quite clear at this point that Ryan and Price would say they are retaining traditional Medicare as an option, but the question is under what terms. Is it provided under terms that would allow traditional Medicare to continue and flourish? Or is it conversely under terms that would cause it to wither and perish?" said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities.

Over the years, Ryan's plans have evolved, in part because of pressure from his own members. Ryan told the New Yorker in 2012 that he recognized his plan needed to be accepted by more than just a few conservatives in the House. He needed to develop a plan that met the vision for the broader Republican conference.

He told the New Yorker in 2012, shortly before he became the Republican Party's vice presidential nominee, that his early plan "was just me, unplugged.”

"When you’re writing a budget you’re representing an entire conference, and so you have to get consensus," Ryan said.

But the underlying principle for Ryan's plans comes from the conservative idea that private businesses are more efficient at managing health care than the government would be. That, some experts argue just isn't true. Medicare, by and large, is a fairly efficient program. Seniors manage to get a lot of health care they are happy with for a decent price.

"Medicare is more efficient than private insurance for two main reasons. One it is able to pay providers less and second it also because of its size, it has lower administrative costs as well," Van de Water said.

Health care experts who have spent years analyzing Ryan's plans note that there are still a lot of questions to be answered. Here's what we do know:

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Republican senators are signaling that they shouldn't be tackling Medicare privatization anytime soon, at least not as part of repealing and replacing Obamacare.

The to do list for the Senate is already long. Senators are going to have Trump's cabinet to confirm, and they have to find a way to make good on Obamacare repeal and replace plan that many predict will take years. Add to it some motivation to tackle tax cuts and President-elect Trump's priority to pass a major infrastructure bill and suddenly overhauling traditional Medicare looks like a bridge too far, according to GOP senators who spoke with TPM.

Sen. Lamar Alexander (R-TN), chair of the Senate Health, Education, Labor and Pensions Committee, was blunt about the outlook for a major Medicare overhaul.

"I think we should leave Medicare for another day," he said. "Medicare has solvency problems. We need to address those, but trying to do that at the same time we deal with Obamacare falls in the category of biting off more than we can chew."

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The gravity of how difficult it will be to fully repeal and replace Obamacare is settling in on Capitol Hill.

Republican senators who spent years railing against the president's signature health care law are now trying to find consensus on how they want to make good on their years-long campaign promise to dismantle it – and the growing consensus is that it is going to take time to find a replacement.

"Its gonna take us awhile to make that transition from the repeal to actually replacing it with more affordable health coverage, which provides people better access," Sen. John Cornyn (R-TX), the Senate majority whip, told reporters Tuesday. "There is a lot to do so it's not going to happen overnight."

Republicans' inability to coalesce around a replacement plan in the six years after Obamacare was passed means they have no easy alternative to queue up with a repeal, which they have vowed to make the top of their agenda next year. Their current inability to settle on a clear repeal and replace plan also reflects the trade-offs that have been dogging the GOP in last half-decade. Within the Republican caucus are deep, philosophical rifts over basic questions about health care policy and the government's role in providing access to coverage.

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