My old Clinton Administration colleague Sylvia Mathews Burwell sailed through a confirmation hearing last week. What was expected to result in serious anti-ObamaCare fireworks and soundbite fodder for midterm campaigns ended with a whimper. Her second confirmation hearing was yesterday, and it’s a “Washington dog isn’t barking” story. It’s now looking like she’ll cruise through and we’ll have an unexpectedly rapid successor to the embattled Kathleen Sebelius.
Mathews is unquestionably qualified for the job, but there are both positives and negatives of her succeeding the former Governor and Insurance Commissioner of Kansas as Secretary of Health and Human Services at the most critical juncture since Medicare and Medicaid were launched in the 60′s.
Here’s what’s gained: bipartisan support. Sebelius had become the face of last fall’s ObamaCare meltdown and needed her own parking spot on the Hill for all the oversight hearings she had to endure. The GOP majority in the House had especially come to revile her, but Mathews is known on the Hill as a skilled technocrat with none of Sebelius’ baggage, quiet, non-ideological, and effective. It also helps that with the 7 million enrollee target easily met in the first ObamaCare open enrollment period and at a lower cost than expected, Republicans are turning away from their “repeal and replace” mantra of the last 4 years.
Mathews’ proven management skills are also critically important as ObamaCare sails into Year 2. The initative’s turnaround this winter was nothing short of incredible, but there’s still ample opportunity for health insurers to cause a crackup with the less-visible “back end” problems that persist. Details matter now more than ever. Remember Mark McClellan’s impact on Medicare Part D. A massive implementation of government-sponsored insurance needs an operator to see it through.
But here’s what’s lost: Burwell, locked in the bowels of the Office of Management and Budget for much of her career, enjoys none of the relationships with governors, state Medicaid directors, insurance commissioners or insurance executives Sebelius does, especially those in hostile red states where coverage expansion is needed most. And that could hurt post-midterm chances of getting RedGovs to roll over on the Affordable Care Act’s Medicaid expansion and hostile insurance commissioners like Georgia’s to back off. She will need to build trust as the face of ObamaCare with politicians in the deep south and west. She will also need a “meet-and-greet” tour of insurance executives, and must demonstrate her ability to hear their concerns and implement fixes quickly in CMS in the runup to open enrollment Round Two.
This isn’t to say Burwell will completely avoid controversy and that the Health Secretary’s impossible job got much easier. She should continue to pull on her asbestos Spanx every time she sets foot outside her new office in this political environment. But it will give her some breathing room to hit the job hard, get some wins early, and build the trust that’s necessary to see ObamaCare through from partisan lightning-rod to established and popular entitlement program.
This blog was originally posted on blog.gormanhealthgroup.com.
John Gorman: Under John’s leadership, Gorman Health Group has become the leading professional services and solutions firm for government-sponsored health care, providing thought leadership and expert strategic, operational, and technology-based solutions. Read more.
