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Sebelius resigns at HHS, Burwell steps in

Who is Kathleen Sebelius?

Kathleen Sebelius was head of Health and Human Services. She resigned from that position in 2014, 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 had 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.

Who is Sylvia Mathews Burwell?

Sylvia Mathews Burwell is the current Health and Human Services Secretary, who replaced Sebelius in mid-2014. She previously served as President Obama's Office of Management and Budget director.

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.

What did Sebelius' resignation mean for Obamacare?

It largely meant that Obamacare was on firm footing.

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 believed 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 had piled up by mid-2014 that the strategy worked. Obamacare's first year, despite a truly horrific start, was a success. More than 7 million people signed up for health insurance through the exchanges. Millions more have signed up through Medicaid. And millions beyond that signed up for insurance through their employers. It's in that more stable situation — one that looks markedly different from Healthcare.gov — where Sebelius could leave the administration.

What does the HHS Secretary do?

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.

What's the best Sebelius eye-roll gif?

It's really hard to pick one, honestly. It's either this one from a Senate hearing in October: 818529478

Or this one from the last State of the Union: 835955410

Both are pretty awesome.

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