New 'face,' old Obamacare issues

Burwell must keep program running smoothly, help restore dialogue with Republicans

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WASHINGTON -- Abruptly on the spot as the new face of "Obamacare," Sylvia Mathews Burwell faces steep challenges, both logistical and political.

Ms. Burwell, until now White House budget director, was named Friday by President Barack Obama to replace Health and Human Services Secretary Kathleen Sebelius, who oversaw the messy health care overhaul rollout. Now, the new secretary-designate must keep the complex program running smoothly and somehow help restore a cooperative dialogue with Republicans, who are hoping to use the law's problems to regain control of the Senate in November.

At an upbeat Rose Garden event, Mr. Obama showered praise on Ms. Sebelius, a hero for his party's liberal base, whose impending retirement had been a tightly guarded secret.

The president ignored calls for Ms. Sebelius to resign last fall, after the website for consumers to enroll in new coverage experienced weeks of crippling technical problems. Last month, as it started to appear that sign-ups would exceed expectations, Ms. Sebelius approached the White House about stepping aside, officials said.

"Under Kathleen's leadership, her team at HHS turned the corner, got it fixed, got the job done," Mr. Obama said. "And the final score speaks for itself."

About 7.5 million people have signed up for subsidized private health insurance through the new law, exceeding an original target of 7 million that was widely thought to be unattainable because of the website problems.

Mr. Obama quickly pivoted to Ms. Burwell, 48, a low-profile Washington veteran now serving as his budget chief. He stressed her role last year in helping to end a government shutdown and reach a two-year budget deal with a politically divided Congress. "Sylvia is a proven manager, and she knows how to deliver results," the president said.

Senate Finance Committee chairman Ron Wyden, D-Ore., who will hold confirmation hearings for Ms. Burwell, said there is an opportunity for her to move the health care debate beyond stalemate.

While a political truce is unlikely over Mr. Obama's health care insurance overhaul, Mr. Wyden ticked off a list of other issues where Republicans and Democrats might be able to find compromise. Among them: revamping the way Medicare pays doctors, providing coordinated care for patients with chronic illnesses and using data to encourage delivery of quality health care at lower cost.

Although health care spending has grown at historically low rates during Mr. Obama's tenure, a reviving economy could stoke cost problems anew for businesses, government programs and consumers.

Health and Human Services is a $1 trillion agency that plays a key role in American society and the economy. More than 100 million people get coverage through Medicare, Medicaid and now Mr. Obama's health law. The secretary also oversees the Food and Drug Administration, which regulates a broad range of consumer products, and the Centers for Disease Control and Prevention, the front line for public health.

But Mr. Burwell could have her hands full addressing issues with the health care law, predicted Brookings Institution health economist Mark McClellan. "Don't underestimate the remaining implementation challenges for the Affordable Care Act," said Mr. McClellan, who oversaw the rollout of the Medicare drug benefit for former President George W. Bush. "It's true that the first open enrollment season is over, but that was just the front end of the implementation process."

Ms. Burwell has three tests immediately ahead, said former HHS Secretary Mike Leavitt, who also served under Mr. Bush. "Get confirmed. Learn the department. Prioritize the challenges."

Ms. Burwell has a head start on the first two; how she'll do on the third test remains to be seen.

She was confirmed by the Senate, 96-0, for her current post last year, and Mr. Obama said with a smile, "I'm assuming not much has changed since that time."

As she announced her resignation Friday, Ms. Sebelius called her work on the health care overhaul the "cause of my life," adding, "We are at the front lines of a long-overdue national change."



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