Can Kathleen Sebelius’s Successor Do a Better Job With Obamacare?

kathleen sebelius

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After the federally facilitated insurance exchange system — the cornerstone provision of the Affordable Care Act — launched in October to numerous software errors and design flaws that significantly hampered the enrollment process, Department of Health and Human Services Secretary Kathleen Sebelius, the person responsible for the functioning of Healthcare.gov, drew much of the blame.

Republicans called for her resignation for weeks,  but she stood her ground and the president defended her. However, six months after the exchange enrollment period concluded and signups surpassed the Obama administration’s highest target, Obama’s healthcare boss announced her resignation. In her place, the president nominated Sylvia Mathews Burwell, the current director of the Office of Management and Budget, one of the most powerful positions in most administrations. She was also the deputy director of the budget office during the Clinton administration.

Burwell faced little opposition from lawmakers in a series of hearings held before the Senate Health, Education, Labor, and Pensions Committee on May 8 and before the Senate Finance Committee on Wednesday. There was no tough debate between Republicans and Democrats over whether Burwell would be able to effectively manage what has proven to be a troubled healthcare reform. Rather, the hearings suggest that Burwell’s confirmation will face little opposition from lawmakers who would like to see significant changes made to federal health policy and regulations.

In fact, her prepared statement for both hearings mentioned the Affordable Care Act just one time. “The Department’s work to ensure accessible, affordable, quality healthcare through the implementation of the Affordable Care Act (ACA) is making a positive difference in the lives of our families and our communities, while strengthening the economy,” she said. Neither did her statement contain any references to the myriad problems that plagued the rollout of the individual insurance exchanges.

In the questioning that followed Burwell’s delivery of her prepared speech to the Finance Committee this week, senators turned their focus to the healthcare reform law, and their questions were more pointed than those from their colleagues in the Health, Education, Labor, and Pensions committee. Still, lawmakers did not receive the answer to a question Republicans have been asking for months: Who are Obamacare’s 7 million enrollees?

Burwell’s inability to offer lawmakers details did not derail the debate. Rather, her answers, delivered with confidence, appeared to reassure lawmakers. If one particular sentiment can summarize the comments made by lawmakers during Wednesday’s questioning, it’s that both Republicans and Democrats believe Burwell is capable of overseeing an important and far-reaching agency such as the Department of Health and Human Services. Guiding the ongoing implementation of the Affordable Care Act is at the top of her agenda.

“Regardless of my objections to the Affordable Care Act, the Department of Health and Human Services needs competent leadership,” Republican Sen. John McCain said during the Finance Committee hearing. “I believe Ms. Burwell has the qualifications to run Health and Human Services.” Through the several endorsements Burwell received, it was clear in the May 8 hearing that Republican senators see a great difference between her management style and that of her predecessor, Sebelius, whose relationship with GOP lawmakers can best be described as strained.

Like McCain, during the Wednesday hearing, conservative Republican Sen. Tom Coburn of Oklahoma called Burwell competent, noting that “so often we have people placed in Washington who aren’t competent for the task at hand.” It was his comments that set the general tone of the hearing. “Even when she has her mind made up, she will listen to another point of view to gain information she might not have,” Coburn said. He also argued that because she is from a small town in West Virginia, “she comes to Washington with a lot of common sense.”

But while Wednesday’s hearing was not as a grueling a cross-examination as was expected, Republicans did air their grievances over how the Obama administration handled implementation, with South Dakota Sen. John Thune expressing his dissatisfaction at the “selective enforcement of the law.” Republican Sen. Charles E. Grassley of Iowa also noted that when unable to push measures through Congress, the Obama administration implemented the health law “by any means necessary,” ignoring explicit requirements and statutory deadlines.

Burwell told lawmakers that she would work with Congress to address a number of pressing issues, including finding a better method to adjust the payment formula for doctors who treat Medicare patients. The current system includes frequent pay cuts that Congress attempts to block with annual regularity. She did not specify how the changes to that formula would be covered, and they could cost as much as $180 billion over 10 years. However, she did say she would consider increasing premiums for Medicare beneficiaries with higher incomes if further savings could be gained from healthcare providers and revenues generated by other sources.

In what may be one of the GOP’s more modest Obamacare requests — given the party forced a shutdown of the federal government over the implementation of the healthcare law’s key provision in October — lawmakers asked that Burwell be responsive to their requests for pertinent information regarding the exchanges.

Finance Committee Chair and Oregon Sen. Ron Wyden, a Democrat, said he would seek an official committee vote next week, while Democratic Sen. Jay Rockefeller of  West Virginia expects that Majority Leader Harry Reid of Nevada would push for Burwell’s confirmation by the Senate before the Memorial Day holiday. As the hearing drew to a close, Wyden said that if she was confirmed, Burwell would serve as “a force for bringing people together, finding common ground and being bipartisan.”

The problem is that even though Burwell is known as an effective manager and has experience budgeting healthcare policy, she has never been fully immersed the healthcare business.

“The biggest issue facing America now is what to do about healthcare,” Republican Sen. Jeff Sessions of Alabama said. “And she lacks experience in that and you would think that in this point in history you would get somebody who served as a head of a state health department, a state Medicaid [agency], who ran an insurance company or a big medical company or just a big company that bought a lot of healthcare.” Of course, Sebelius — who previously served as the state insurance commissioner for Kansas — did have that expertise but was widely criticized member of Obama’s cabinet.

Sebelius will remain secretary of Health and Human Services until her successor is confirmed.

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