HHS Secretary Sebelius Resigns; Obama Nominates Burwell to Post
HHS Secretary Kathleen Sebelius is resigning, after a tumultuous five-year tenure leading the department that oversaw the rocky rollout of the Affordable Care Act's health insurance exchanges, Bloomberg reports (Wayne et al., Bloomberg, 4/11).
White House officials said Sebelius was not forced out and made the decision to resign on her own. According to the officials, Sebelius approached President Obama in March to initiate discussions about her future as HHS' chief.
According to White House Chief of Staff Denis McDonough, Sebelius told Obama that surging enrollment numbers at the end of the ACA's initial open enrollment period provided an opportunity for change, and that an individual who was not the target of so much political criticism might serve him better, the New York Times reports.
McDonough said, "What was clear is that [Sebelius] thought that it was time to transition the leadership to somebody else." He added, "She's made clear in other comments publicly that she recognizes that she takes a lot of the incoming [ACA criticisms]," and that "[s]he does hope -- all of us hope -- that we can get beyond the partisan sniping."
However, the Times notes that "frustration ... over her performance" was growing among members of the Obama administration, as White House aides were concerned that the problems with HealthCare.gov could "result in lasting damage to the president's legacy" (Shear , New York Times, 4/10). Despite that, the relationship between Sebelius and Obama remained "warm," according to the Washington Post (Eilperin/Goldstein, Washington Post, 4/10).
After serving as the governor of Kansas from 2003 to 2009, Sebelius took over as HHS secretary three months into Obama's presidency. She also spent about a decade as Kansas' insurance commissioner, a position that helped prepare her for her upcoming role in the launch of the ACA, Bloomberg reports (Bloomberg, 4/11).
Sebelius' 1,808 days as HHS secretary is about 500 days longer than average for HHS secretaries, according to the Post. Federal health officials on Thursday said Sebelius' official departure date is not yet set, but it is expected she will stay until her successor is confirmed (Washington Post, 4/10).
Although she oversaw the troubled launch of the ACA's exchanges, Obama administration officials noted that Sebelius also had a number of successes, including helping push through mental health parity and leading the department during a time when health care costs growth was at historic lows (Shear , New York Times, 4/10).
Surprise at Resignation
Sebelius' resignation came as a surprise in the health policy arena. According to the Post, even the Obama administration's closest health care allies had "no clue" it was coming, while senior Democratic lawmakers also were "caught off guard" (Washington Post, 4/10).
Obama Nominates Burwell
On Friday, Obama nominated current Office of Management and Budget Director Sylvia Mathews Burwell to replace Sebelius, the New York Times reports.
Burwell -- a Harvard-educated Rhodes Scholar -- served in multiple roles during the Clinton administration and spent much of the 2000s working at the Bill & Melinda Gates Foundation, according to the Times. Before she became head of OMB, Burwell served as president of the Walmart Foundation.
In an interview with the Times on Thursday, White House Chief of Staff Denis McDonough said Obama selected Burwell because he wanted "a proven manager and relentless implementer" to lead HHS. McDonough and other federal officials who have worked with Burwell say she has strong crisis management and organizational skills and she is able to easily navigate the "lumbering bureaucracy of government," according to the Times.
Gene Sperling -- former director of the White House National Economic Council and a mentor to Burwell -- said, "You want to talk about the person who walks around with a checklist, and never lets a ball drop -- that's Sylvia" (Shear , New York Times, 4/10).
Senate Confirmation of HHS Role Expected, But Path Could Be Bumpy
Burwell will be required to go through the traditional Senate confirmation process, but some observers say it could be more contentious than the confirmation process last year for the OMB role, according to Politico (Haberkorn, Politico, 4/11). Nearly one year ago, the Senate voted unanimously -- 96-0 -- to confirm her as OMB chief.
However this time, some Republicans likely will use the confirmation hearings as a platform to highlight her work as OMB chief and "bash" the ACA ahead of the November midterm election, the Times reports. In the past year, Burwell was a key figure in the standoff that culminated in last fall's federal government shutdown and has dealt with the formation of health policies as budget chief (Shear , New York Times, 4/10).
ACA Implementation Tasks
According to Politico, Burwell also is expected to face immediate pressure from some GOP lawmakers who want the ACA to be repealed before she continues the work to implement it. In addition, Democrats might press her to make further improvements to the law and health care stakeholders will call on her to improve ties between HHS and the industry.
If confirmed, Burwell will face other political obstacles, including:
- Promoting the law and its health insurance exchanges to a skeptical public to ahead of the next open enrollment period, which is scheduled to begin Nov. 15;
- Ensuring that insurers remain in the exchanges for a second year, primarily by strengthening ties to the industry that were strained in recent months by HHS' decisions to extend the first open enrollment period deadlines and previously canceled health plans; and
- Strengthening relationships with governors, particularly those who have rejected or are on the fence about expanding Medicaid under the ACA (Politico, 4/11).
Observers also say Burwell likely will face more direct obstacles relating to the implementation of the law as it currently stands, according to Time. The primary challenge will be facilitating the ACA's second open enrollment period, particularly as a growing number of people start using the service to purchase and enroll for coverage.
Burwell also will have to lead several other efforts to implement the ACA in the coming years. For example, she will have to lead or oversee preparations for:
- The employer mandate, which was originally scheduled to take effect this year but has been delayed until 2015;
- Exchanges for small businesses, which were also scheduled to open in this year but are still being developed; and
- The so-called "Cadillac tax," a fee that will be imposed on certain high-cost health care plans in 2018 (Pickert, Time, 4/10).