Washington A health care system overhaul, weak finances in Medicare, lapses in food safety. Those challenges and more await Kathleen Sebelius as President Barack Obama’s health secretary.
Obama planned to introduce Sebelius today as his nominee to lead the Health and Human Services Department. Later this week he is to host lawmakers and representatives of major interest groups at a White House summit on health care reform.
Barring any unforeseen circumstances, Sebelius is expected to encounter relatively few problems as she seeks confirmation, although she is likely to draw some opposition from anti-abortion groups because of her pro-choice views. She has clashed with abortion opponents in the state, and they may try to carry the fight to Washington.
On Sunday, Sebelius won praise from several Republican governors and from the chairman of the Senate panel that will handle her nomination.
Finance Committee Chairman Max Baucus, D-Mont., said Sebelius would make a “strong partner” in revamping the health care system and that she “really gets what needs to be done.”
Republican Govs. Arnold Schwarzenegger of California, Sonny Perdue of Georgia and Jon Huntsman of Utah also applauded her nomination.
Sebelius, 60, is seen as a steady hand, an experienced public official who knows how to work across political lines. As a former state insurance commissioner, she is unfazed by the complexities of health care and insurance issues.
But she represents Obama’s backup plan.
Originally, the president had counted on former Senate Majority Leader Tom Daschle to shepherd his health overhaul agenda through Congress.
Daschle would have worn two hats: health secretary and head of a White House health reform office. He was on a first-name basis with most senators, where health care legislation faces its stiffest test. Yet he dropped out of consideration after his failure to pay taxes on all his earnings came to light.
Sebelius knows some of the key players, but she will have to establish a working relationship with others. Obama plans to name a different person for the White House health care job, raising the prospect of tensions between that office and the health secretary’s.
Kansas’ two senators, both Republicans, offered words of praise.
“Obviously we will have different viewpoints than the administration on many issues including health care reform, especially given the huge price tag,” said Sens. Pat Roberts and Sam Brownback. But despite “real concerns” about Obama’s direction, they said they looked forward to being able to pick up the phone and talk directly with Sebelius about health care issues.
Brownback and Roberts could be allies in defusing any opposition to her nomination.
The health insurance industry and consumer groups have responded favorably to Sebelius’ nomination.
Obama made his opening move on a health care overhaul last week with a speech to Congress and a budget that set aside $634 billion over 10 years as a down payment on coverage for all, a goal that could ultimately cost $1 trillion or more.
Obama outlined some general policies, such as putting the country on a path to cover all its citizens and preserving the employer role in providing health insurance. His budget also showed it will take tough choices on spending cuts and tax increases to pay for health care.
It will be up to Congress to turn those ideas into workable legislation. Baucus and Sen. Edward M. Kennedy of Massachusetts, who leads the Health, Education, Labor and Pensions Committee, say they want to present legislation by the summer.
Obama wants to expand coverage while slowing the rate of increase in costs. Administration officials say they are hoping that in the end that will lead to a more affordable system, without the coverage gaps that leave an estimated 48 million people uninsured.
But Republicans are concerned about the costs, and about giving government an even larger role in health care. White House chief of staff Rahm Emanuel signaled that the debate could get contentious.
Appearing on the CBS program “Face the Nation,” Emanuel challenged Republicans to propose alternatives to Obama’s health care plan, not just criticize it.
Health care “is a particular example where America’s economic competitiveness, its strength around the world is sapped because we have a health care system that doesn’t allow American workers and business to compete,” Emanuel said. “And the Republicans will have an opportunity not just to criticize, but to propose.”
Before health care legislation gets moving, Sebelius’ attention may well be diverted by problems at the department. The administration will have to move quickly to name an FDA commissioner, a decision delayed by the difficulty in filling the health secretary’s job.
A trustees’ report due in the spring is expected to highlight the worsening condition of Medicare’s finances, hammered by a drop in tax revenues because of the recession.
Wins and losses
As governor, Sebelius has tried twice to raise Kansas’s cigarette tax to expand medical coverage. Both times she was thwarted by Republican legislators, who objected to the tax increases and wanted a more market-based solution.
“She is a Democratic governor from a Republican state. She had to be pretty competent to survive that. But health care was a disappointing exercise,” said Edmund Haislmaier, a senior research fellow in health policy studies at the Heritage Foundation who has worked with legislative leaders who opposed Sebelius in Kansas. “This is kind of an outline of what you are going to see play out nationally. People on both sides want the same goal, but they go at it differently,” Haislmaier said.
Still, Sebelius has enjoyed some victories on the issue. She was successful in having Kansas join a multistate consortium that allowed Kansans to order prescription drugs from Canada, Britain and Ireland, often at a lower price than in the United States. She also has added tens of thousands of children from low-income households to state health programs. And as Kansas’ elected insurance commissioner, Sebelius achieved national recognition when she blocked the sale of Blue Cross and Blue Shield of Kansas, which she was convinced would raise premiums.
Politics has been a constant in Sebelius’s life. Her father, John Gilligan, a liberal Democrat, served as a congressman and as a governor of Ohio. Sebelius studied at Trinity College in Washington, where she met her husband, Gary Sebelius, whose father was a congressman from western Kansas.
The couple settled in Topeka, Kan., where Kathleen Sebelius worked as a special assistant to the state’s secretary of corrections and attended graduate school at Kansas University, before becoming executive director of the Kansas Trial Lawyers Association. She successfully ran for the state legislature in 1986 and was elected insurance commissioner eight years later.
Sebelius was elected governor in 2002 and was reelected in 2006, and along the way she earned a reputation as a capable manager and a moderate who works well with Republicans. She was mentioned as a possible Democratic vice presidential candidate in 2004 and 2008.
As HHS secretary, Sebelius would take charge of an agency with 65,000 employees responsible for public health, food safety, scientific research, and the administration of the Medicare and Medicaid programs, which serve 90 million Americans. The financial health of the entitlement programs is yet another worry confronting the administration, which has vowed to rein in the runaway costs of those programs, which make up the lion’s share of the department’s $700 billion budget.