In her final speech on the Affordable Care Act as Department of Health and Human Services secretary, Sylvia Mathews Burwell challenged Republicans to come up with a viable alternative to the healthcare law—and warned them that it’s not as easy as they may think.
In her years as the head of HHS, Burwell has learned that “if something sounds too good to be true, it usually is,” she said in remarks at the National Press Club.
One example of that, she said, is the idea that it’s possible to repeal the bulk of the ACA but still guarantee affordable coverage for those with preexisting conditions—as President-elect Donald Trump has suggested. The reality, she said, is that the individual mandate is the “only evidence-based way to ensure a balanced risk pool” when insurers are no longer able to deny coverage because of health status.
She also criticized the idea of offering less-comprehensive plans to cut costs. That forces regulators to decide which important benefits they will allow insurers to drop, she said, and whatever they choose, it “will put needed care out of reach of millions of Americans.”
Beyond the individual markets, moving Medicaid to a block grant funding system would not cut costs without reducing coverage as Republicans claim, she said. That’s because such a system doesn’t give states new tools to control costs, but instead just shifts the costs onto states—which can be especially problematic if they ever face crises like spikes in drug overdoses, natural disasters or health emergencies like Zika.
What’s more, she argued that states already have considerable flexibility to mold their Medicaid programs, pointing to promising waiver programs in states like Arkansas and Indiana, the latter of which Burwell worked on with Vice President-elect Mike Pence when he was the state’s governor. Today, HHS will approve Washington state’s waiver application, Burwell added.
The healthcare reform law has made other, less heralded strides than just covering more people, she added, noting the progress HHS has made in moving healthcare payments toward a value-based system and improvements on key quality measures such as reducing hospital readmissions.
So as they work toward creating a replacement plan, Burwell said, Republicans must also ask themselves if it covers as many people as the ACA, maintains the quality of coverage and keeps bending the cost curve in the right direction.
“If it fails in any of these,” she said, “it is then a step backward.”
The Senate is expected to vote this week on a budget measure that would repeal major provisions of the law. House Speaker Paul Ryan has said the GOP will work out an ACA replacement plan this year, and Pence said recently that Republicans will ensure there is “orderly transition to something better” than the ACA.
But Burwell predicted that if Republicans go through with their plan to repeal the law first, many insurers will either raise prices or drop out of the marketplaces in 2018, and states and hospitals will be in budget limbo. And if Congress never enacts a comprehensive replacement, the consequences would be “stark,” she said, citing one recent analysis that predicts that 30 million people could lose coverage, or 10 million more than the ACA helped gain coverage.
"We’d fall behind where we actually started," she said.