Departing HHS Chief Cautions Republicans Seeking Repeal of Obamacare

Republicans in six years have been unable to produce an alternative to Obamacare that can be “measured and scored,” Health and Human Services Secretary Sylvia Mathews Burwell said on Monday at the National Press Club.

If the Republican majority in Congress does produce one in the next two years, she said, people should ask, “Does it cover as many? Does it maintain quality? And does it keep bending the cost curve?” If it fails on any one of these measures, Burwell added, “it’s a step backward.”

Burwell spoke alongside three guests she introduced as beneficiaries of the Affordable Care Act (including guitarist for the rock group The Breeders), acknowledging the need for optics to stress that “through the noise of the rhetoric, these people are the reality.”

A week after the Senate began the first step of killing the 2010 law that has always been a political football, Burwell delivered a detailed defense of the reforms as measured in access, quality and affordability:

--20 million who gained health insurance;

--a projected reduction in macro-level health care spending of $2.6 trillion since the law passed;

--affordable care organizations saved $450 million in care costs in 2015; and,

--8.8 million signed up during the still-open enrollment period (setting a one-day record), with HHS having received 35,000 calls from customers seeking reassurance that signing up was still doable given the Republican plan for repeal.

“Health care improved in fits and starts,” Burwell said, commending the 31 states that have enacted some form of Medicaid expansion under the law (with North Carolina newly considering it). 

The Affordable Care Act has benefited all Americans, she stressed, including improved treatment for chronic conditions, use of doctors rather than emergency rooms and reduced medical debt. Those benefits enforced through ACA-approved state-based insurance plans include help with prescription drug expense, coverage of mental health, maternity care and contraception, and removal of lifetime limits on overall coverage.

If the Republicans proceed as they say they will, as early as this spring, Burwell warned, “insurance companies will raise prices or drop out, states and hospitals will be left in budget limbo” and the overall system “goes backward” and more than 30 million could lose insurance. “It would leave to the unraveling of the individual market,” she said. Rather than repealing without replacing the ACA, she added, “the American people deserve to know what the answers are before it’s taken away.”

On questioning, she criticized specific Republican proposals. Allowing insurers to sell across state lines? “That’s already happening, and would cover only 400,000” while encouraging a “race to the bottom” of quality of plans, she said. Health savings accounts? “A tax break,” she said. Allowing “a la carte plans” in which customers pick only the benefits they prefer “works only for the healthy and wealthy,” not someone who, for example, finds they need mental health treatment, she said.  Medicaid block grants—Medicaid being “the most effective insurance we have,” she said—in the past have resulted in states cutting the spending by a third or a half. “They would end coverage for 14 million to 20 million and simply let the states decide who to cut.”

The not-very popular individual mandate to buy insurance, Burwell said, is needed to create the risk pools that enable the popular provisions, such as no denials to patients with pre-existing conditions and the ability for young adults to stay on their parents’ plan until age 26.

“If you hear something that sounds too good to be true, it probably is. Silver bullets don’t exist,” Burwell said.

Though Republicans have shown little interest in working with Democrats on minor improvements to the law, Burwell cited potential in boosting marketplace competition, helping families who can’t afford high premiums, improving wellness and use of data, and negotiating lower-cost prescription drugs.

“The whole team at HHS is putting the tools to work,” Burwell said, praising her department’s 77,000 employees as “dedicated, helpful and in it for the right reasons across the department.”

Asked what advice she’d give Donald Trump’s nominee for HHS secretary, Rep. Tom Price, R-Ga., she said, “Put the customer at center of all you do.”