Burwell’s final speech as HHS Secretary: ‘In healthcare, there is no free lunch’

In what was billed as HHS Secretary Sylvia Burwell’s farewell speech, she criticized several proposals to replace the Affordable Care Act, while challenging the Republican majorities to introduce a replacement plan if they plan to quick repeal the law.

Speaking at the National Press Club in Washington, Burwell repeated many of the same defenses she and her boss, President Barack Obama, have made regarding the ACA since Election Day: It’s driven uninsured rates to record lows, increased access to care and slowed the growth in healthcare spending. She also touted efforts on the transition to value-based care, citing $466 million in savings achieved by accountable care organizations.

She then went on to attack proposals which have been common among Republican-sponsored ACA alternatives. For example, she described plans to turn Medicaid into a state-administered block grant program or implementing per capita caps as an attempt to find an elusive “silver bullet” to cut healthcare costs. In reality, she said, the result would be millions of people losing health coverage.

“That’s because block grants and per-capita caps don’t give states new tools to control costs: They just shift costs to states, giving them the so-called ‘flexibility’ to decide whose coverage to cut,” she said.

She also touched on President-elect Donald Trump’s comments that the ban on denying coverage for preexisting conditions would remain in place. Without the unpopular individual mandate to have coverage, Burwell said, premiums would quickly rise to the point of being unaffordable.

Other Republican healthcare ideas were described with similar criticism after her prepared remarks. Burwell called the expansion of health savings accounts “a tax break” and the idea of selling insurance across state lines “a race to the bottom” in quality.

She has advocated for some ACA changes, like introducing a public insurance option in areas where too few insurers are participating in the law’s exchanges, but she said the claims that the law is collapsing or failing are exaggerated.

“Are there things that need to be improved? Are there places where more competition could help affordability? Yes. But the idea of disaster and collapse—those comments need to be examined,” she said.

What could collapse, she said, is the insurance market if Congress moves ahead with repealing the law without a replacement ready. The uncertainty would lead insurers to drop out of the market beginning later this year and leave providers in “budget limbo” as lawmakers debate new, large-scale healthcare reform legislation.

“Some rural or community hospitals will have to shrink or even shut down if they can’t count on funding through Medicaid,” she said. “If Congress never enacts a comprehensive replacement, the consequences for American health care would be stark.”