SAN FRANCISCO – In their waning days in office, President Barack Obama and his appointees had expected to deliver an ode to the Affordable Care Act, not its eulogy.

For one of those appointees, the grim new reality became apparent early on Election Night.

“Whatever final speech I had planned in my head in November would have to wait,” recollected Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, speaking Monday evening at the JPMorgan Healthcare Investor Conference.

“I started a new speech in my head early in the evening on Nov. 8,” Slavitt told attendees here at the major, annual biotech conference.

In his final major address as head of the chief agency implementing Obamacare, Slavitt praised the healthcare law’s coverage expansions and insurer regulations, predicted a brighter future for its insurance plans and sharply rebuked Republicans intent on repealing its biggest provisions.

Slavitt encouraged Americans to support any health reform that’s better than Obama’s law, echoing sentiments Obama himself expressed in a Vox interview last week. In that interview, Obama said he’d support repealing and replacing Obamacare if the GOP can come up with something better.

“If a plan can improve the Affordable Care Act, we should all embrace it,” Slavitt said Monday. “There should be no pride of authorship. It doesn’t matter whether a plan comes from a Democrat or a Republican.”

But to Slavitt, an improvement upon Obamacare must involve four things. It must cover as many people as Obamacare. The coverage must be on par with Obamacare plans. It must bend the healthcare cost surve. And it must be fiscally responsible.

“We should build on what we started, not start over,” Slavitt said. “That should be a clear message to the incoming administration.”

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The Trump administration will preside over the final week and a half of 2017 open enrollment in the law’s individual insurance marketplaces. The administration weathered heavy criticism about the marketplace over the past year as insurers hiked premiums and some dropped out entirely.

While the law has halved the U.S. uninsured rate and made care more affordable for millions who previously couldn’t pay for it, the marketplaces have also suffered from far fewer enrollees than originally projected and plans widely deemed unaffordable for those without federal subsidies.

Slavitt, known for his candid Twitter style, has been a strong defender of the law through the firestorm, insisting its advances far outweigh its drawbacks. To him and other administration officials, things are looking up for 2018, when they say insurers will have recovered from the initial shock of losing payments to spread out the risk of sick enrollees.

But as they make their exit, a dark cloud hangs over Obama’s signature domestic reform, as GOP leadership vow they’ll repeal much of it.

Slavitt called it “irresponsible” to repeal the law without simultaneously proposing a replacement. Such a maneuver would also seed multiple political challenges down the road, as Republicans almost certainly struggle to unite around a replacement and figure out how to pay for it, he said.

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“Getting support and finding brand new money is infinitely harder than improving existing legislation,” Slavitt said.

Asked his deepest fear about what might happen to the healthcare law, Slavitt later told reporters it’s that “they would check the box on a repeal vote without having any sense of how they’re going to replace it.”

“It’s not entirely obvious once you pass repeal [that] you’re going to be able to get a second vote,” Slavitt said.

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