HHS Secretary Sylvia Burwell said she is troubled by some of the ideas being floated by Republicans to repeal and replace the Affordable Care Act could result in millions losing coverage.
Even though Republican lawmakers have released a few details on what they'll do to overhaul the nation's healthcare system, Burwell said none of them sound viable.
“We have not seen a plan that can be measured or scored to answer the three questions which are does it cover as many people, does it maintain the quality of coverage and does it keep bending the health care cost curve in the right direction?” Burwell said at a National Press Club luncheon Monday. The speech was billed as her last before she leaves her post as the nation's top healthcare policy official.
Burwell said if repeal happened without immediate replacement, damage to the country's individual insurance market would begin within months.
"If health insurance companies don't know what the market will look like going forward, many will either raise prices or drop out, " she said. "That means more Americans won't be able to afford coverage, and others won't be able to find it at all.”
Diana Furchtgott-Roth, a senior fellow at the conservative Manhattan Institute, said insurers would rebound by simply once again offering health plans that didn't cover all the essential health benefits, as they were able to do before the ACA required them to cover essential benefits such as preventative care.
State insurance commissions also would go back to determining the states' respective benefits.
Burwell said it was irresponsible that Republicans suggest consumers buy plans that cover only what they need.
“Which benefits should we allow insurance plans to drop? Mental health? Maternity coverage? Prescription drugs? The limits on out-of-pocket costs?” Burwell asked. “Plans without them were certainly cheaper, but…it's not clear they offered genuine coverage.”
Rea Hederman, executive vice president the the conservative Buckeye Institute, said while the mandated benefits sound "nice," they make insurance more expensive. "Allowing insurers to offer different plans will make insurance more affordable and attractive to consumers.”
President Barack Obama last week said he would support a repeal of the ACA if there was good replacement.
One of the most fleshed out ideas is to turn Medicaid into a capped program of fixed federal contributions to the states, either through flat block grants or per-capita contributions.
Republican lawmakers and health policy experts say that the approach would encourage states to provide better healthcare at a lower cost by giving them greater flexibility in setting eligibility and benefits. Congressional Republicans argue Medicaid's budget is ballooning and are looking to cut spending for the program by a third to a half over 10 years.
In 2015, Medicaid spending grew 9.7% to $545.1 billion, with states contributing about 40% of that sum.
Burwell, citing numerous studies, warned that would leave at least 14 to 20 million people without insurance.
“It's tempting to think that there would be a silver bullet that could cut costs without cutting coverage,” Burwell said. “But in healthcare, there is no free lunch.”
The proposals would just shift costs to states, she said and that would give them "flexibility" to decide whose coverage to cut.
Conservatives who support the idea, slammed her response. “The Secretary is wrong,” said Brian Blase, senior research fellow at the conservative Mercatus Center at George Mason University in Virginia.
“Block grants or per capita caps would reorient states away from maximizing spending to get as much Washington money as possible towards getting the best value of taxpayer dollars for program enrollees.”