[Extremely Extreme Extremist]

You create it by Congress simply using their interstate commerce power to allow health insurers to sell across state lines. I would support a one-time block grant to the states for them to help those who lost their prior insurance before Obamacare, and letting them run Medicare and Medicaid (and merging it with their existing state health programs) but that's only on the condition that Obamacare is fully repealed.

Understand two things: (1) States are going to be complacent about the money and use it to pay off pension debt or transportation boondoggles. The block grants will simply get sucked into state bureaucracies. (2) The agitators on the Left will never be satisfied. If this passes, left-wing groups will file suit demanding that abortion and transgendered people get covered. Republicans will be tarred and feathered and lose Congress in 2018.

[Behind the Blue Wall]

The states have already been using the money that way, via back-filling. Right now, the states that keep Medicaid spending down are basically punished by receiving less from the federal government than those states that maximize Medicaid spending. Now, it will be the opposite, here’s your check, do what you want with it. Ultimately though, Obamacare will be repealed by the elimination of the individual and employer mandates.