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U.S. President Barack Obama (2nd L) listens after announcing Director of the Office of Management and Budget Sylvia Mathews Burwell (2nd R) as his nominee to replace outgoing U.S. Secretary of Health and Human Services Kathleen Sebelius (R), during a ceremony in the Rose Garden of the White House in Washington, April 11, 2014. At left is U.S. Vice President Joseph Biden. REUTERS/Larry Downing (UNITED STATES - Tags: POLITICS HEALTH) - RTR3KWNN Larry Downing/Reuters