The Senate is poised Thursday to confirm Sylvia Mathews Burwell, the White House’s budget director for the past year, as secretary of the Department of Health and Human Services.
A preliminary vote of 67 to 28 on Wednesday demonstrated that Burwell has ample support in the Senate to take over the huge federal department. A final Senate vote will end a quick confirmation process that has been devoid of the bitter partisanship surrounding the 2010 Affordable Care Act and the changes it is bringing to the U.S. health-care system.
In her new role, Burwell, 48, a veteran of the Clinton administration’s economic team, will oversee 11 far-flung agencies within the department, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration and the enormous public insurance programs, Medicare and Medicaid.
Her early focus, however, is almost certain to center on the work that absorbed her predecessor, Kathleen Sebelius, during much of her five-year tenure as HHS secretary: implementing the health-care law in a climate that remains politically polarized and could become more so, depending on the outcome of the congressional elections this fall.
The White House and federal health officials have celebrated the fact that the first six-month sign-up period in new insurance marketplaces overcame a troubled start to enroll 8 million people by early this spring — more than predicted.
Health-policy specialists point out, however, that much work remains to put the sprawling law into practice. For example, federal health officials need to merge into the federal insurance exchange three states — and possibly more — whose attempts to run their own insurance marketplaces have failed.
Officials also continue to wrestle with HealthCare.gov, the computer system for the federal health exchange. Some aspects are not yet working or built, including parts designed to handle enrollment records, enable the direct enrollment of people poor enough to qualify for Medicaid, and allow the online enrollment of small businesses that want health plans through the new marketplaces.
HHS also will need to decide how to handle a requirement under the law that many employers offer health benefits to their workers — a provision that the Obama administration has delayed twice.
At midday Wednesday, 14 Republicans joined all voting members of the Democratic caucus in a procedural vote that advanced Burwell’s confirmation to a final vote, likely Thursday afternoon.
President Obama nominated Burwell in April, the same day that Sebelius announced her resignation. Last fall, Sebelius became a public face of what the president called a “disastrous” launch of new insurance marketplaces, but she remained in place until after the enrollment period ended.
During confirmation hearings last month before two Senate committees, Republicans reiterated their objections to the Affordable Care Act. But the critics did not challenge Burwell’s competence or suitability to run HHS.
Several Senate Republicans clung to that distinction on the Senate floor on Wednesday in preparation for the final vote. Sen. Johnny Isakson (R-Ga.) said that he plans to support Burwell, adding that he finds her “articulate, forthright, straightforward and candid — something we really haven’t had from the secretary of HHS for the last year or so. . . . I like having somebody who has the intellect and the capability and the willingness to be communicating with the members of Congress, regardless of their party.”
But Isakson was quick to add: “No one should confuse that vote, however, for being a vote in support of the Affordable Care Act or what it’s doing to health care in the United States today.”
Before returning to Washington last year, Burwell spent more than a decade in the world of philanthropy — with the Bill and Melinda Gates Foundation and then as president of the Walmart Foundation.
During the Clinton administration, Burwell held several economic roles — as staff director of the White House National Economic Council, as Treasury chief of staff under then-secretary Robert Rubin, and then at the Office of Management and Budget, where she eventually became the deputy director.
After becoming budget director 14 months ago, Burwell was mired at first in fiscal conflicts with congressional Republicans and, by October, had to manage the 16-day partial shutdown of the government.
Despite her Washington experience, she is not well known in health policy circles, and, during her confirmation hearings, she gave little concrete sense of the direction in which she will take the complex department she will inherit.
Ed O’Keefe contributed to this report.
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