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Senate Confirms Sylvia Burwell as New HHS Chief

By Robert Lowes

Medscape Medical News

June 6, 2014 -- The Senate confirmed Sylvia Mathews Burwell as the next secretary of the U.S. Department of Health and Human Services (HHS) on Thursday in a 78 to 17 vote. Her job of overseeing the Affordable Care Act likely won't be easy, though.

The vote was overwhelmingly in Burwell's favor, but she had received unanimous approval -- 96 to 0 -- when the Senate confirmed her in 2013 as the director of the White House Office of Management and Budget (OMB). On Thursday, a cadre of Republican senators used her nomination by President Barack Obama as another opportunity to blast the health law and anybody who supports it.

"I'll be voting against this nominee, because I think we need to focus on repealing and replacing this law, not trying to do the impossible by pretending we can make it work," said Senate Republican leader Mitch McConnell (R-KY). "Her embrace of this disastrous law is reason enough to oppose her confirmation."

Challenges Await

Obama nominated Burwell to replace Kathleen Sebelius, who oversaw the massive department and its nearly $1 trillion budget since 2009, but resigned in the wake of the botched roll-out of the Healthcare.gov web site. The site was intended to help millions of Americans get health care coverage beginning in 2014 through state insurance Marketplaces, but computer glitches galore deterred many of the applicants initially.

During Sebelius' final months, HHS got the web site in better working order, helping to boost enrollment to 8 million, exceeding the administration's expectations.

Praised by the president as a "proven manager who knows how to deliver results," Burwell inherits the task of keeping the Affordable Care Act on track and away from bad headlines. Any misstep is liable to become a campaign issue in the November elections, when Republicans hope to regain control of the Senate.

One immediate challenge for Burwell is cajoling health insurers in the state Marketplaces to settle for modest premium increases in 2015, so coverage remains affordable. Another pitfall to avoid is the possibility of mass cancellations of small-group health policies as they come up for renewal this fall. A number of states will not allow policy holders to renew plans that fail to meet Affordable Care Act standards.

How Will She Respond?

Burwell has gone through political storms before. She was President Bill Clinton's deputy chief of staff during the Monica Lewinsky scandal.

Her track record during the Clinton administration also includes stints as deputy director of the Office of Management and Budget (OMB), chief of staff to former Treasury Secretary Robert Rubin, and staff director of the National Economic Council. Before she became OMB director last year, a role that hurled her into Capitol Hill's budget wars, Burwell served as president of the Walmart Foundation and president of the Global Development Program of the Bill & Melinda Gates Foundation.

Before Burwell's confirmation vote, Sen. Ron Wyden (D-OR), chair of the powerful Senate Finance Committee, said that the country needs a "true agent of bipartisanship" at HHS, and Burwell fits the bill.

"She will respond to the big questions and the big challenges in a way that brings America together," Wyden said.

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