CURATED BY Sarah Kliff
2014-04-10 23:49:42 -0400
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Kathleen Sebelius is the head of Health and Human Services. She is resigning from that position on Friday, after overseeing the botched rollout of healthcare.gov.
Sebelius joined the Obama administration in 2009 after serving as governor of Kansas. Previously, she was the top insurance regulator in Kansas, so she came to the job with a lot of health policy background.
Sebelius has run HHS since the start of the Obama administration and during the troubled rollout of healthcare.gov she faced multiple calls for resignation as the website meant to get millions of Americans' into new health insurance plans barely functioned for its first two months.
She weathered the initial firestorm long enough to see Obamacare turn a corner, and enrollment numbers tick upwards. She told the President she was resigning in early March, right when Obamacare sign-ups were starting to surge.
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Sylvia Mathews Burwell is Obama's Office of Management and Budget (OMB) director, and his pick to succeed Kathleen Sebelius as Secretary of Health and Human Services.
Burwell is a veteran of both the Obama and Clinton White Houses. She started out working for Clinton under his economic advisor Robert Rubin, first as staff director of the National Economic Council when Rubin led it from 1993-95 and then as Rubin's chief of staff as Secretary of the Treasury from 1995-1997. From 1997-98 she served as deputy chief of staff to Clinton for policy, and then was deputy director of the Office on Management and Budget from 1998 to 2001.
She worked in the philanthropic sector between leaving the Clinton White House and joining the Obama administration as budget director last year, first as a senior executive at the Bill and Melinda Gates Foundation from 2001 and 2011, and then as the leader of the Walmart Foundation from 2011 and 2013. The Walmart Foundation (which is distinct from the Walton Family Foundation which the heirs to the Walmart fortune endowed) focuses on domestic hunger, food sustainability, women's economic development in foreign countries, and the job market for low-income Americans.
Burwell has experience battling House Republicans, both from last year's government shutdown (which she was responsible for overseeing as OMB director) and from similar battles during her previous stint at the Clinton OMB. She also led the OMB through the Affordable Care Act's rollout last October, in which the agency handled certain aspects of implementing the law's health insurance exchanges.
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Calls for Sebelius's resignation were almost constant after Obamacare's catastrophic launch. But President Obama refused. As National Journal's Major Garrett reported, Obama believes that "scaring people with a ceremonial firing deepens fear, turns allies against one another, makes them risk-averse, and saps productivity." Moreover, there was too much to be done to fire one of the few people who knew how to finish the job. Sebelius would stay. The White House wouldn't panic in ways that made it harder to save the law.
The evidence has piled up in recent weeks that the strategy worked. Obamacare's first year, despite a truly horrific start, was a success. More than 7 million people look to have signed up for health insurance through the exchanges. Millions more have signed up through Medicaid. And millions beyond that have signed up for insurance through their employers.
Healthcare.gov isn't perfect, but it works. We don't yet know how many young people signed up in March, but it's clear that there are enough of them to keep premiums stable in 2015. It's clear that insurers are going to stick with the program in 2015, and compete hard to sign up next year's wave of young, healthy applicants.
That creates the context in which Sebelius can leave the administration.
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A lot less tough than it would have been five months ago or than it will be eight months from today.
The reason that it's much easier than it would have been back in 2013 is that Harry Reid and the Senate Democratic caucus changed the rules regarding filibusters in early 2014, making it possible for 50 Senators (with the Vice President casting a tie-breaking vote) to confirm a nominee. Previously it would have required 60 Senators, meaning several Republicans would have had to be persuaded to vote for Burwell.
The reason that it's much easier than it will be eight months from now is that Democrats stand a good chance of losing their Senate majority in the 2014 midterms.
But right now, all the White House needs to put Burwell in office is for Senate Democrats to vote for her. Republicans will likely try their best to make political hay out of the confirmation process, but they can't stop Democrats from confirming her.
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The Health and Human Services Secretary oversees a massive federal agency that provides insurance coverage to over 100 million Americans through various public sector programs.
This usually makes the HHS Secretary the public face of any health-related initiatives that the Obama administration is working on. For the past four years, that's meant a lot of promoting the Affordable Care Act. Sebelius, for example, has spent a lot of time on the road holding events about why Republican governors ought to expand their Medicaid programs.
The HHS Secretary also oversees the country's two largest insurance programs, Medicaid and Medicare. It's her office that often sets policies meant to improve patients' outcomes in those programs and reduce their costs.
There are dozens of other agencies that fall under the HHS Secretary's supervision, ranging from the Centers for Disease Control and Prevention (which tracks public health statistics and responds to crises) to the National Institutes of Health (the hub for federal health research). You can see all the divisions of HHS here. Their agendas and budgets are all under the authority of the HHS Secretary, although the day-to-day management is left to lower-level leaders.
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It's really hard to pick one, honestly. It's either this one from a Senate hearing in October:
Or this one from the last State of the Union:
Both are pretty awesome.
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Vox's guide to the different Obamacare enrollment figures floating around will help give you a sense of how healthcare.gov has improved as a usable product.
If you want to know more about Obamacare in general, check out our cardstack on the subject.
If you've got way too much time on your hands, test your Kathleen Sebelius knowledge with Politico's Kathleen Sebelius quiz.
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