After the federally facilitated insurance exchange system — the cornerstone provision of the Affordable Care Act — launched last 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. Republican lawmakers called for President Barack Obama to remove her for weeks. But she stood her ground, and the president defended her. Now, after exchange enrollments have surpassed the Obama administration’s highest target, the president’s healthcare boss is resigning, White House officials announced Thursday.
During a Friday morning speech in the White House Rose Garden, President Obama named Sylvia Mathews Burwell — current director of the Office of Management and Budget — as his nomination to replace Sebelius. “After five years of extraordinary service to our country, and seven and a half million Americans who’ve signed up for health coverage through the exchanges, she’s earned that right [to step down],” Obama said. “She’s got bumps. I’ve got bumps, bruises,” he added. “But under Kathleen’s leadership, her team at HHS turned the corner, got [the federal healthcare website] fixed, got the job done, and the final score speaks for itself.”
The HHS secretary told lawmakers Thursday that more than 7.5 million Americans had enrolled in private insurance policies through the Affordable Care Act’s exchanges, beating an estimate of seven million made by the Congressional Budget Office before the marketplaces launched. To the Obama administration, reaching 7.5 million enrollments means success; a target surpassed.
In her resignation speech, Sebelius described her involvement in the implementation of health reform as “the most meaningful work I’ve ever been a part of,” and thanked the president for giving her the opportunity to participate. “Critics and supporters alike are benefiting from his law,” she stated.
Even House Majority Leader Eric Cantor commended the HHS secretary in an oblique manner, tweeting: “She had an impossible task: nobody can make Obamacare work.” His comment also held an obvious critique of the healthcare reform: no matter who was in charge, the legislation was so flawed that it would never be the achievement the president had expected. It is true — her five years as the secretary of the Department of Health and Human Services has been marred by the disastrous implementation of the Affordable Care Act. Her resignation begs a few questions. Had the rollout of the insurance marketplaces been under the guidance of a different administrator, would things have been different? Would someone else have been more attuned to the progress of the website’s creation, noted the fact that the site had not been adequately tested by independent third-parties, or not pushed for last minute changes that prioritized signing up over browsing healthcare policies?
Sebelius is leaving the Obama Administration well before the full impact of the healthcare reform is understood by experts or felt by a vast majority of Americans, and if Burwell’s nomination passes Congress, she will have the difficult job of overseeing the exchange program, which includes the distribution of federal subsidies and the enforcement of regulations designed to ensure the networks of doctors and hospitals for Obamacare health plans are accurate. Plus several provisions of the Affordable Care Act, namely the employer mandate and the tax on high cost health plans, have yet to be implemented. Not the least of her tasks will be improving morale in a department that has received strong criticism in recent months.
When Sebelius — fresh from two successful terms as the governor of Kansas — first entered the cabinet of President Barack Obama in early 2009, she was seen as a leader capable of bridging the divide between Republicans and Democrats. The president noted that he respected her advisory skills during his first run for the oval office. “Secretary Sebelius has soldiered through, but now really is a good time for somebody new who can say, ‘That was then. This is now,’” Gail Wilensky — an economist, a health policy expert, and a government official during the administrations of Presidents George H.W. Bush and George W. Bush — told Time magazine. “Now we are really getting ready for round two.”
The appointment of Burwell is clear indication that the White House is looking to a new management style to oversee the final stage of Obamacare implementation and clear away lingering public doubt of the viability of the reform. Burwell is known as an effective manager, with a strong background in economic policy; she served in both the Clinton administration and the Treasury Department. Plus, the budget office, which she has led since last April, has played a significant role in developing and implementing health care policy. “The president wants to make sure we have a proven manager and relentless implementer in the job over there, which is why he is going to nominate Sylvia,” White House Chief of Staff Denis McDonough told The New York Times. Republican Senator John McCain of Arizona even tweeted that “Sylvia Burwell is an excellent choice to be the next #HHS Secretary.”
When Obama made the April 1 announcement in the Rose Garden that enrollments had surpassed the original target, notably, Sebelius was not at his side.
Despite the extremely partisan nature of American politics, privately Democrats have argued that someone in the administration should be held accountable for the problems with the federally facilitated insurance exchanges, The Washington Post learned. That someone appears to be Sebelius. However, even though White House allies told the publication that the website problems created tensions between Sebelius and Obama’s staff, she was not officially asked to resign.
Sebelius has maintained that her resignation was her choice, and by no means pushed upon her by the administration because the botched rollout of the insurance exchanges, which — unlike the administration’s promised — were near as easy to use as Amazon. But in the final analysis, her role in the implementation of the Affordable Care Act reflects strongly on the administration’s management strengths and its ability to set up a complex reform; the history of Obamacare is intimately tied with Sebelius. Her departure could possibly put the Democrat party in a better light ahead of midterm elections; the public’s perception of the success of the reform is closely tied to the party’s fortunes come November. Even Obama himself noted during his Friday morning speech that Sebelius will go down in history for serving as the secretary of Health and Human Services of when the United States declared that quality, affordable health care was a right and not a privilege.
Other Republican lawmakers were not so generous as Cantor in making an assessment of Sebelius’s tenure. Representative Marsha Blackburn of Tennessee said the secretary’s resignation “has been a long time coming after a litany of failures and total mismanagement.” Blackburn’s comments mirror those made by her party when the website problems were dominating the national political discourse. “The Department of Health and Human Services, under the leadership of Secretary Kathleen Sebelius, was entrusted with the responsibility of ensuring an integrated debut of the federal government’s website, Healthcare.gov,” wrote a group of 32 House Republicans in an October 23 letter. “Unfortunately, as we have seen in numerous new reports, many Americans have found it impossible to sign up for the required health coverage or to simply learn about the new plans and associated costs.”
More From Wall St. Cheat Sheet: