- The Washington Times - Monday, January 9, 2017

President Obama’s top health official issued her final defense of Obamacare on Monday and accused Republicans of trying to enlist states to do the dirty work of gutting a major part of the health law under the banner of “state flexibility.”

Health and Human Services Secretary Sylvia Mathews Burwell said replacing the law’s expansion of Medicaid to cover millions of poor people with block grants, which gives states the ability to experiment with various approaches, will end up slashing benefits.

She also said without a full replacement in hand, attempts to repeal Obamacare could send the individual insurance market into a tailspin by the spring, since insurers won’t know what rules will be in place for 2018 and won’t know how to price their offerings.

She said any replacement must match Obamacare in the number of people covered and the hefty list of benefits, and said a replacement must also keep medical costs low — something with which Obamacare has struggled.

“If it fails on any of these, it is then a step backwards,” Mrs. Burwell said in a National Press Club speech.

She surrounded herself with Americans who rely on the Affordable Care Act for coverage, including Kelley Deal, a guitarist for The Breeders rock band who could have been denied coverage for a pre-existing medical condition, and women from New Jersey and Chicago who relied on the law to cover cancer treatments.

Their stories are part of a last-minute push by the administration to move outside the political echo chamber and put faces on the 2010 reforms under threat by congressional Republicans and President-elect Donald Trump.

“Through the noise and the rhetoric, they are actually the reality,” Mrs. Burwell said.

Yet Senate Republicans say everyday Americans are sharing their stories, and the reports aren’t good.

“They’ve told me about the cost of their premiums doubling, or even tripling, with deductibles so high they are practically paying for all of their own care,” Majority Leader Mitch McConnell, Kentucky Republican, wrote Monday in an op-ed for the Cincinnati Enquirer.

Mr. McConnell is moving rapidly to set up an Obamacare repeal by debating a budget resolution that would pave the way for a final vote later this year without having to overcome a Democratic filibuster.

Democrats are trying to make the process as politically painful as possible, offering budget amendments that would make it more difficult for the GOP majority to cut Social Security or Medicare — two popular programs among seniors who vote in large numbers.

Meanwhile, Sen. Rand Paul of Kentucky and a handful of other GOP lawmakers are leery of repealing Obamacare before the party coalesces around an alternative, or fear repeal would balloon deficits.

But in a lopsided 83-14 vote, senators defeated an amendment by Mr. Paul on Monday that would have required the proposed budget to balance.

Republican leaders say the budget resolution amounts to a shell needed to enact repeal legislation, before they write a new budget for actual spending.

Mrs. Burwell said Obamacare is making progress despite repeal chatter, with sign-ups on the law’s web-based exchanges this year outpacing the 2016 enrollment period, although the portals aren’t attracting as many new customers.

She argued Republicans will find it difficult to replace Mr. Obama’s “individual mandate” requiring Americans to purchase insurance with market-based reforms, such as tax-advantage savings accounts or allowing insurers to sell across state lines, and still cover as many people as existing law.

Obamacare extended Medicaid coverage to those making up to 138 percent of federal poverty level in the 31 states, plus D.C., that opted to expand the federal-state program for the poor. Federal taxpayers had to pick up the full cost of expansion in 2014-2016, though states are slated to pick up 10 percent of the cost in 2020 and beyond.

Republicans say Congress should rein spending on the federal-state program for the poor by offering block grants or placing a per-capita cap on federal spending, while allowing governors and state legislatures more control over how their program are administered.

Mrs. Burwell said that type of flexibility would just allow states “to decide whose coverage to cut.”

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