Health Care Reform

04.10.14

Will Kathleen Sebelius Win in the End? Legacy Tied to Obamacare’s Outcome

Yes, there was utter failure, but there was also one hell of a recovery. As time goes on, she'll get less blame for the former and more credit for the latter.

It was always going to be a tough job, Health and Human Services secretary under this president. Even so, I’d bet Kathleen Sebelius was plenty shocked at the whole business.

True, she was only a second-string nominee, after Tom Daschle had to bow out because of those tax problems. But Sebelius still should have had little to fear. After all, she’d been the Democratic governor of a ruby-red state, Kansas. In a state where Republicans outnumbered Democrats roughly two-to-one, she won reelection in 2006 with 57 percent of the vote. She got one of the state’s prominent Republicans to switch parties and run with her for lieutenant governor.

So yes, it must have shocked when only eight Republicans voted to confirm her, while 31 voted against. Four-to-one against?! What had she done that was so bad? The answer was: nothing. Oh, Republicans invoked her “ties” to a Wichita doctor who performed abortions. But really, it was what she was going to do. She was going to be a point person on health-care reform, and they needed to ding her.

Today, and in the near future, she will have to endure being associated with the massive fiasco that was the launch of healthcare.gov. And that’s deserved. It’s hard to imagine what she was doing last summer instead of spending every waking minute ensuring that the initiative for which this administration will remembered, the one thing that will color and even determine its historical legacy, was going to launch well. But it happened.

I don’t know how many times she got dragged up to the Hill and asked the same questions by all those Republican solons, striving to win the “let’s use this guy!” competition for the cable nets and NPR and the nightly newscasts, but it seemed like she was up there almost every day for a spell. On the surface, it all looked disastrous.

But I will say this. Behind the scenes, they did get to work. I could tell just from the way people talked, the things they said were happening there, that it really was getting better. They were (and I guess still are) sitting on this battery of IT stats about response times and how long a person had to wait to be logged in and so on and so forth, and those were being cut quickly. So Sebelius and the rescue team really did do their jobs once they were up against the wall.

“The president wants to make sure we have a proven manager and relentless implementer in the job over there,” which is both praise of Burwell and a little slap at Sebelius.

Think of it this way. Did you think, last fall, that they’d actually hit the 7 million? Did you think they’d even come close? In a year-end column I wrote with my 2014 predictions, I said they’d make 5.8 million. And I thought that would be respectable. The latest report is that they’re approaching 7.5 million. So yes, there was utter failure. But there was one hell of a nice recovery. As time goes on, I think Sebelius will start getting less blame for the former, and more credit for the latter.

But her fate will be forever tied to Obamacare. If it succeeds, she’ll share the credit as the secretary who helped bring it to life. If it fails, she’ll share the blame. It’s about that simple. And I think it’ll probably succeed.

Meanwhile, there’s the question of getting a new HHS secretary installed. Obama’s nominee is Sylvia Mathews Burwell, who heads the Office of Management and Budget. Chief of staff Denis McDonough told The New York Times that “the president wants to make sure we have a proven manager and relentless implementer in the job over there,” which is both praise of Burwell and a little slap at Sebelius.

But will the Republicans let her through? Actually, forget the Republicans: Six Democratic senators are seeking reelection in red states. Are they going to vote for a new Obamacare point person during an election season? It never ends. Except it is now for Sebelius, who’s surely paid her dues.