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By Robin Respaut and Hilary Russ | SAN FRANCISCO/NEW YORK

SAN FRANCISCO/NEW YORK President Donald Trump's push to fulfill a campaign promise to replace Obamacare, his predecessor's signature healthcare plan, with the help of a Republican-controlled Congress, could add to U.S. states' financial strain.

That is because a key component of the 2010 law allowed states to expand Medicaid, the government health insurance program for low-income Americans, and collect extra dollars that came with expansion.

Thirty-one states and the District of Columbia chose to expand Medicaid enrollment through Obamacare, formally known as the Affordable Care Act.

(Graphic - here)

While Republicans have not agreed to specific plans, one idea gaining traction has been to convert the current system, in which states share the cost of Medicaid enrollees with the federal government, into fixed payments, or block grants, sent to the states.

Trump's nominee to run the U.S. Department of Health and Human Services, U.S. Representative Tom Price, has long advocated such a plan.

The Kaiser Family Foundation estimates a repeal of Obamacare and a cap on federal Medicaid spending, such as through a block grant or a per capita cap, could cut Medicaid funding by 41 percent over the next decade. That would likely handicap states' ability to respond to larger enrollments during recessions.

"It will have clear implications for state budgets," said Robin Rudowitz, the Washington-based associate director at Kaiser's Program on Medicaid and the Uninsured. "States could raise revenue and spend less in other areas, but these are not easy choices to make."

The foundation is a nonprofit focused on health issues.

Faced with inflexible federal funding, states might also decide to limit Medicaid eligibility or freeze new enrollment, reducing the number of people covered.

In a letter to congressional leaders on Tuesday, the National Governors Association pleaded with lawmakers not to "shift costs to states."

New Jersey, one of many states struggling with ballooning public pension costs and modest revenue growth, expanded Medicaid under Republican Governor Chris Christie.

That state could lose up to $3 billion in federal aid if the Affordable Care Act is repealed and have to spend $1 billion more from its budget, Democratic state lawmakers there said this week.

MONEY FLOWS FROM THE HEART

Medicaid sits at the heart of the federal-state fiscal relationship. Over $330 billion in federal Medicaid dollars flowed to states in fiscal year 2016, accounting for more than half of all federal grants sent to state and local governments and the largest individual program, according to Standard & Poor's.

In 2015, the federal government paid about 60 percent of total Medicaid costs while states paid 40 percent.

Medicaid enrollment also tends to spike during an economic downturn, just as state revenues are most strained, spurring the federal government to send more money to states.

Despite calls from Trump to Republican lawmakers on Thursday for swift action on replacing Obamacare and on other priorities, changes will likely still take time to work out.

House of Representatives Speaker Paul Ryan said the agenda would take more than 100 days and said the goal "is to get these laws done in 2017," without guaranteeing an Obamacare replacement would be enacted by the end of December.

With so many details still up in the air, public officials are hard-pressed to craft budgets that directly respond to their concerns.

New York City Mayor Bill de Blasio on Tuesday said his next budget would hold a record amount of money in reserve and seek at least $1 billion of savings citywide to compensate for "a huge amount of uncertainty" emanating from Washington.

In California, Medicaid enrollment jumped from nearly 8 million in 2012 to more than 14 million today, thanks in part to federal healthcare reforms.

In a letter earlier this month to U.S. House Majority Leader Kevin McCarthy, Democratic California Governor Jerry Brown pleaded that Congress consider reforms that do not burden state budgets.

"That would be a very cynical way to prop up the federal budget - and devastating to millions of Americans," Brown wrote to the Republican congressman from California.

However, Brown's proposed budget this month did not include a contingency for a potential repeal of Obamacare or the threat of changes to the federal tax code.

"Until there is a change in policy at the federal level, we will continue to budget under the current rules of the road," said California Finance Department spokesman H.D. Palmer.

(Reporting by Robin Respaut in San Francisco and Hilary Russ in New York; editing by Daniel Bases and Jonathan Oatis)

WASHINGTON The U.S. Department of Homeland Security has temporarily halted trips by staff to interview refugees abroad as it prepares for a likely shakeup of refugee policy by President Donald Trump, two sources with knowledge of the decision said on Thursday.

President Donald Trump's executive order directing federal agencies to take away funding from self-proclaimed sanctuary cities had one big exemption for one of his favorite constituencies: the police, who would be protected from cuts.

WASHINGTON Defense Secretary James Mattis stressed the United States' commitment to NATO in a telephone call with Germany's defense minister on Thursday, the Pentagon said.

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Republican ideas for healthcare reforms could spell trouble for US states - Reuters

Nashville Mayor Megan Barry, a Democrat, donated $500 to the campaign fund of Nashville Republican and Tennessee House Speaker Beth Harwell.(Photo: File / The Tennessean)Buy Photo

In something of a surprise move, the campaign committee for Democrat and Nashville Mayor Megan Barry donated $500 to the campaign committee for Republican and Tennessee House Speaker Beth Harwell.

While the amount of money is relatively small, the fact one of the most prominent Democrats in Tennessee would donate to someone expected to seek the GOP nomination for governor in 2018 raised eyebrows among Nashville politicos.

"Friends of Megan Barry" donated $500 to Harwell's account on Jan. 9, the last day state lawmakers could accept donations before the start of the legislative session. Barry spokesman Sean Braisted said the mayor contributed to every state lawmaker in the Nashville delegation, comprised of 10 Democrats and two Republicans.

With Gov. Bill Haslam set to depart, the 2018 race is expected to attractan untold number of Republican candidates.

Former Nashville Mayor Karl Dean, Barry's predecessor,is among Democrats weighing a bid. He hasn't filed any paperwork to indicate a formal run, but he's expected to announce his decision in the first part of this year. Nashville businessman Bill Freeman, who ran unsuccessfully for Nashville mayor in 2015, and state House Minority Leader Craig Fitzhugh of Ripley are also considering gubernatorial runs.

Harwell, R-Nashville, reported receiving $50,000 in the first nine days of January, which she can eventually combinewith the more than $1 million she has stored away in other campaign accounts. While Harwell hasn't officially announced that she will run for governor, the fact she filed this specific campaign finance report this week is an indicator ofher interest. The Nashville Post first reported Harwell's filing.

Barry's contribution to Harwell comes as the mayor is in need of the state legislature's help to pass legislation that would allow Nashville and other local municipalities to holdpublic referendums to use sales tax revenue to fund public transit projects.

Barry is hoping to find ways to begin paying for a $6 billion regional transit system that the Regional Transit Authority adopted last year.Harwell has expressed support fora local funding option for transit as long as it is contingent on a referendum.

A spokeswoman for Harwell did not immediately respond to a requestfor comment.

Other gubernatorial candidates have also filed similar campaign finance documents, including state Sen. Mark Green. The Clarksville Republican received $5,000 from the political action committee of recently retired Lt. Gov. Ron Ramsey, helping him reach a donation total of nearly $193,000 during the first few days of January. A spokesman for Green said the senator has nearly $650,000 cash on hand for his gubernatorial bid.

Reached by phone, Ramsey said he made the contribution because he typically contributes to every one of his senate colleagues before an election. However, he said Green had already reached a political action committee contribution limit at that point, so Ramsey pledged to donate after the election.

"Im not endorsing Mark. Hes a friend of mine, but so is Mark Norris and Beth Harwell and Diane Black," Ramsey said, noting other Republicans expected to run for governor.

Ramsey said he didn't plan to endorse any GOP candidate, but said he's helping them all to ensure a Republican becomes the next governor.

Staff writer Joey Garrison contributed to this report.

Reach Dave Boucher at dboucher@tennessean.com or 615-259-8892 and on Twitter @Dave_Boucher1.

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Democrat Mayor Megan Barry donates to Republican Beth Harwell's campaign - The Tennessean

The Hill

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Trump to GOP Gathering: Where's My CIA Director? - New York Times

Donald Trump and Paul Ryan. Photo: J. Scott Applewhite - Pool/Getty Images

There are hints in the air that the long-predicted ideological schism within the Republican Party between populists and traditional conservatives is breaking open. Donald Trumps unusually populist inaugural address, almost devoid of traditional conservative themes, seemed to break new ideological ground. Unlike most Republicans who try to ape the rhetorical tropes associated with Ronald Reagan, Trump instead tried to recall the stylings of Andrew Jackson. It was an unvarnished declaration of the basic principles of his populist and kind of nationalist movement, chief strategist Steve Bannon told the Washington Post. I dont think weve had a speech like that since Andrew Jackson came to the White House, Bannon said. But you could see it was very Jacksonian. Meanwhile, Trump has hired Julia Hahn, a 25-year-old Breitbart staffer who has savaged Paul Ryan for his past support for immigration reform, alarming allies of the House Speaker.

It is certainly true that ideological tensions exist between Trump and the party he has conquered. Trump is surely not a traditional conservative, for the simple reason that conservatism is a set of relatively coherent policy beliefs, and Trump does not have very many coherent policy beliefs. But the beliefs he does have, at least as far as we can tell from his administration and his agenda, overlap heavily with traditional conservatism. That is because the conservative tradition and the populist Jacksonian tradition turn out to be mostly the same thing.

The points of difference between Trump and Ryan are smaller than they might appear. Ryan has supported comprehensive immigration reform in the past, and continues to support free trade, while Trump opposes both. Neither disagreement is especially difficult to finesse. The only major new trade agreement on the docket, the Trans-Pacific Partnership, was already moribund before the election. Comprehensive immigration reform died three years ago, and Trump has already backed off his promises to quickly deport Dreamers and is focusing instead on border-security measures that enjoy long-standing Republican support.

Meanwhile, the Congressional party is working hand-in-glove with its presidential wing. Every Trump cabinet nominee, even those who are brutally unqualified (like Ben Carson) or laden with serious ethical problems (like Tom Price), seems likely to sail through a Senate that can only afford to lose two Republican votes. And Congress has allowed Trump to conceal his tax returns and maintain his business empire, two violations of norms that would permit massive self-enrichment by the president and his family. Republicans have instead directed the oversight machinery of Congress against Trumps critics and former opponents.

Trump and his party are cooperating on a wide range of traditional Republican policies: regressive tax cuts, weakening of labor laws, environmental protections, and regulations on the finance industry, and an assault on the Affordable Care Act. Both Trump and the Congressional GOP have attacked Obamacare for providing too little coverage, and have refrained from writing detailed alternatives because their ideas would provide even less coverage. To the extent that Trump is giving his Congressional wing trouble on health care, it is because he spouts off without understanding the issue.

The differences between Trump and his Congressional allies are no wider than those that divided Barack Obama and his party in 2009, or George W. Bush and his party eight years before that, or Bill Clinton and his eight years prior. Tim Phillips, president of the Koch-backed Americans for Prosperity, the epitome of the libertarian, pro-business, Paul Ryanesque Republican money wing, has praised Trumps policies. There just isnt much daylight between us, he told Politico recently.

What, then, explains the widespread belief that Trump has veered so far from traditional Republican doctrine? One reason is emphasis. Trump simply ignores the traditionally Republican elements of his governing program in his public remarks. Trump devoted most of his inaugural speech to the few elements of his platform that diverge from the Paul Ryan agenda, skipping over the many elements that conform to it. And he compounded the impression, as he has during the campaign, by portraying himself as an enemy of the elite and the political class.

But there is another thing that is necessary to grasp about the political tradition Trump represents. Jacksonian populism is conservatism, at least in the modern American form.

While nearly two centuries have passed since Andrew Jacksons time, he pioneered almost every recognizable feature of contemporary Republican politics. Jackson built a following by denouncing elites. But he did not mean economic elites, exactly. He meant Easterners, urbanites, and experts, including the ones who argued a national bank was necessary to avoid a financial crisis. (They were right and Jackson was wrong. Jacksons destruction of the bank caused a serious recession.) Jackson did not oppose bankers, per se he drew support of regional banks that felt threatened by the national bank. Jackson had no program of taxing or regulating the rich. His economic populism was directed entirely against the state. The rich and powerful too often bend the acts of government to their selfish purposes, he wrote.

Many people understand that Jacksons reputation has come under harsh scrutiny and revision in recent decades, in part because he owned slaves. Of course, many (though not all) political elites owned slaves before the Civil War. It is not just that Jackson owned slaves but that he followed policies to protect and defend slavery, as opposed to the conflicted positions of other slave-owning politicians who wished to see the practice end eventually. Jacksons conquest of Native American lands the cruelty of which provoked strong domestic opposition was carried out for the purpose of expanding slave territory, in order to prevent the slave states from being outnumbered and eventually outvoted (the fear among slave states that led, via the Missouri Compromise, to the Civil War). Jackson banned the mailing of abolitionist literature into the South. As the cast of Americas racial hierarchy has changed over its history, the meaning of the right-wing and left-wing positions on the racial question has evolved. In Jacksons time, his position of expanding land available for slavery and blocking avenues for organizing opposition to it clearly represented the right-wing position.

Jacksons resemblance to Trump runs even deeper than Trump or Steve Bannon may realize. Jackson, like Trump, throbbed with resentment at his enemies, a feeling that was channeled into extraordinary personal entitlement. (As Steve Inskeep discovers in Jacksonland, Jackson used his office to enrich himself by speculating in lands whose value he knew would increase as a result of his conquests.) Jackson opposed South Carolinian secession for the same reason he dismissed a hostile Supreme Court ruling not out of any larger principle, but out of a domineering instinct that made him lash out instinctively at any threat to his authority. That style endeared him to the part of the country that forms the base of the GOP today. Jackson fused the white working class in the South and Appalachia with the interests of the planter elite, expressing their shared interests not through activist government but through militaristic plunder.

An aura of progressivism has clung to Jackson for decades, largely due to an accident of history. During the 19th century, the Democratic Party was the conservative, Southern, rabidly white-supremacist, strict constructionist party, while the Whigs, and then the Republicans, favored more activist government and more egalitarian social structure. During the 20th century, those roles reversed. But the Democratic Party retained its Southern and Appalachian base for decades during the transition, and it convinced itself of a narrative (using wildly selective history) that wove Jacksons reactionary presidency into the 20th-century version.

Meanwhile, as the Republican Party has grown more uniformly conservative, it has naturally grown more Jacksonian in its style. The cultural populism, anti-intellectualism, paranoia, and crude nationalism of such figures as Joe McCarthy, George Wallace, and Sarah Palin presaged the buffoonish ravings of the current president. Far from being at odds with the agenda of a party allied with entrenched wealth, that populist style is the best way to lend that agenda mass appeal. We should stop seeing Trumpism as a challenge to the GOP and instead understand it as the partys natural historical evolution.

Trump Aides Keep Leaking Embarrassing Stories About How He Cant Handle Embarrassment

It may involve different ways of defining what the word reimburse means.

The White House has demanded that its appointees review any studies produced by the EPA before the public gets a look at the data.

In tone and substance, President Trumps actions are faithful to the tradition of the belligerent old culture warrior and super-patriot.

It could be a test of the willingness of both Congress and the courts to restrain the new president.

Sources say the president feels personally betrayed by CNN chief Jeff Zucker.

The meeting was scheduled for January 31.

Trumps executive order would cut U.S. funding of international organizations by 40 percent, devastating U.N. peacekeeping and refugee aid efforts.

So long as Republicans have an advantage in House districts, they will be thinking about building that right into the system for electing presidents.

There are 50 total on the $137.5 billion plan for emergency and national security projects.

Whatever other chaos is in store for America, you can rest assured that Trump is doing fine, financially.

Its beginning to look like the presidents outrage over Hillary Clintons email habits may not have been entirely sincere.

Despite the uncertainty surrounding Trumps policies and their long-term impact, investors see nothing but green in his pro-corporate leanings.

I havent seen convincing evidence of it, explains David Gelernter.

Trump brought the GOP back to the White House by conning insecure voters. Now, he may keep the party in power by conning his insecure self.

Trumpism is not a challenge to the party of entrenched wealth, but its natural historical evolution.

An act his boss, President Trump, just promised to investigate as part of his ongoing election-fraud fantasy.

The president is looking anything but passive so far. But on big, important issues, theres no sense of a policy infrastructure.

Employees say theyre scrambling to save the data.

What we know about the executive orders that could ban refugees and immigrants from countries deemed a terror risk.

He tweeted just after The OReilly Factor discussed the topic.

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The Fight for the Soul of the Republican Party Has Been Canceled - New York Magazine

WASHINGTON Nevada Gov. Brian Sandoval (R) warned Congress on Wednesday about the consequences of repealing the Affordable Care Act without an adequate replacement for millions of people insured under the law.

Sandoval, who opted to expand Medicaid under Obamacare for Nevadas neediest residents, said he likes what hes heard so far about a replacement for the law. But the governor added there are a lot of lives at stake with its possible repeal and said he hoped congressional leaders would take them into consideration.

We have a state run insurance exchange. Its working well for us. There are a lot of lives at stake, with regard to decisions that are made here, Sandoval said at an event hosted by the National Governors Association near Capitol Hill.

I hope decisions arent made in a vacuum and that there is a reach out to the governors. Everything can be improved, he added of the law. The rhetoric Ive heard is nobodys going to lose their coverage, that prices arent going to increase. I say great, thats wonderful. But until we get into the specifics, Im not going to get into an adversarial relationship.

The governor noted he had conveyed his concerns to the entire Nevada delegation, including Republican Sen. Dean Heller, who supports repealing the law.

Sandoval is one of five GOP governors including Govs. Charlie Baker of Massachusetts, Rick Snyder of Michigan, John Kasich of Ohio and Asa Hutchinson of Arkansas who set a letter to Congress about the disastrous consequences of repealing a law without a replacement in place.

Earlier this month, Senate Republicans took the first big step in their years-long crusade against the law. They say they want to ensure those people currently insured through the law wouldnt be hurt by efforts to replace it.Rep. Tom Price (R-Ga.), who is President Donald Trumps nominee to lead the Department of Health and Human Services, for example, says it is absolutely imperative that people with insurance get to keep their coverage even if Republicans repeal Obamacare.

But current GOP proposals to replace the law such as block grants would result in far less federal spending on health care and thus far fewer insured people.

In Virginia, unfortunately, we have not expanded Medicaid.A repeal of the ACA, accompanied by a proposed block grant, could cost the state of Virginia in the next budget over $300 million, said Virginia Gov. Terry McAuliffe (D), the chair of the NGA, who spoke alongside Sandoval at the event.

McAuliffe said that House Speaker Paul Ryan (R-Wis.) disclosed few details about the GOP replacement for Obamacare in his meeting with governors earlier on Wednesday.

Nobody today is telling us what theyre going to replace it with, he said. I dont think anybody knows, to be honest with you.

But he added the sense he got from the speaker about giving more power to states, is that Ryan would like to see them implement block grants.

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Republican Governor Warns 'Lives Are At Stake' If Obamacare Is Repealed Without Replacement - Huffington Post