Health and Human Services [official website] Secretary Sylvia Mathews Burwell warned [C-SPAN video] on Monday that a move to repeal the Affordable Care Act [text, PDF] without simultaneously implementing a replacement plan would create a dangerous situation in American healthcare. Burwell, who was appointed by President Barack Obama, did not address the intention of Congress to replace the ACA before appealing it, including House Speak Paul Ryan’s Outline [text, PDF]. Burwell did note that many of the ideas she has heard are inadequate in her opinion. One of Burwell’s main concerns is that any such replacement plan cover the same amount of people currently on Obamacare. Many others who support the ACA have shared the same concerns of an inadequate replacement that does more harm than good. Those who oppose the ACA and support its repeal state that the law is already failing [US NEWS report] and point to insurers fleeing the marketplace, unexpected costs to consumers, and patients unable to access preferred doctors and hospitals.

The ACA [JURIST backgrounder] has generated legal controversy and a series of court challenges since its passage. In May House Republicans were supported in a challenge against the Affordable Care Act [JURIST report]. Last January the US Congress sent a bill [HR 3762] to repeal the ACA to Obama, which he vetoed [JURIST report]. The National Conference of State Legislatures [official website] reports that between 2010 and 2015, at least 21 states have enacted laws attempting to challenge or completely opt out of mandatory provisions of the ACA. Most recently the ACA was amended by the Protecting Affordable Coverage for Employees Act [text], which allows states to consider employers with 51 to 100 employees as large employers, removing certain restrictions on small employers from those employers in this category. In June the US Supreme Court ruled [JURIST report] in King v. Burwell [SCOTUSblog materials] that tax credits available to those who buy health insurance through state exchanges are also available to those who buy it through the federal exchange. In 2014 the Supreme Court ruled [JURIST report] in Burwell v. Hobby Lobby [SCOTUSblog backgrounder] that closely held corporations can deny contraceptive coverage to their employees for religious reasons.