President Barack Obama's top health official on Monday gave her final public speech -- in which she warned Republicans and Donald Trump's looming administration that wiping the Affordable Care Act off the books will have severe consequences, for Americans and the U.S. insurance industry.
Health and Human Services Secretary Sylvia Mathews Burwell delivered the remarks at the National Press Club Monday, which are expected to be her last as department chief. She leaves office, along with Obama's administration, next week.
Republican lawmakers and Trump's team have pledged for weeks to undo Obama's signature health care law and replace it with something better. However, it remains unclear what that replacement program might look like, how it would work, or whether Trump has even begun crafting it yet.
If the latter is true, Burwell said Monday that chaos in the U.S. insurance market might be inevitable.
"Last week, Congress took a first step toward repealing the Affordable Care Act without any replacement at all," Burwell said.
"Here are three things that would happen ... first, the damage to the country's individual insurance market will begin this spring," she added, stating her belief that insurance companies would soon start dropping out of the exchange.
"Second, states and hospitals will be in budget limbo. ... Repeal and delay would create unacceptable uncertainty [for states].
"Third, if Congress never enacts a comprehensive replacement, the consequences for American health care are quite stark. We would not just go backward, we would fall behind where we actually started."
Republicans have been trying for years to start dismantling the ACA, through defunding, but with Trump's election they are now in position to make it happen. Their intent, they claim, is to implement a better program that would lower costs, lower premiums and make coverage even more available.
Asked Monday if he was concerned that it appears no clear successor to the ACA presently exists, Trump said, "Not even a little bit. That's going to all work out."
Count Burwell skeptical.
"As for silver bullets, they don't exist," she said. "If something sounds too good to be true, it usually is."
A key part of Obama's law, which mandates coverage for pre-existing conditions, could become impractical under the GOP's plan, according to Burwell, even though many Republicans have said they want to keep that provision in whatever package they roll out.
A guarantee for pre-existing conditions could end up on the chopping block if Trump opts instead for an a-la-carte style of coverage, as has been mentioned.
Burwell summarized her remarks by saying Republicans should evaluate any replacement plan with three questions -- does it lower costs, does it lower health spending, and does it expand access?
"So far, we have not seen a plan that can be measured or scored that can answer the three fundamental questions," she said.