photo shared by United States Mission Geneva
Whether or not you like Kathleen Sebelius, it’s unlikely that you envied her position.
Sebelius, the U.S. health and human services secretary whose five-year tenure included the rollout of at least some major portions of the Affordable Care Act, has resigned, the White House announced on Friday. Sebelius began discussing her departure with President Obama in March, The New York Times reported, and she suggested that following the first open enrollment period for the government exchange would be a good time to pass the baton of leadership, if that’s what you want to call it. It’s hard to feel much sympathy for the departing Sebelius, who has served as Obama’s political hatchet woman on health care generally and Obamacare in particular.
This is the woman who denied morning-after birth control to teenage girls for political reasons while serving in an administration that has trumpeted its commitment to reproductive rights. This is the woman who strong-armed insurance companies into keeping mum about the fact that millions of policies would have to be cancelled for their failure to meet the Affordable Care Act’s requirements, even as her boss repeated his infamous pledge: “If you like your health care plan, you can keep it.” This is the woman who, had she stayed in the Cabinet, would have taken on the task of trying to jawbone insurers into underpricing their policies, or failing that, keeping prospective price increases secret until after the upcoming midterm elections.
So it’s hard to be sympathetic, and it’s easy to say good riddance.
But Sebelius’ departure is also the latest evidence that loyalty in the Obama administration is purely a one-way street. After allowing much of the blame to fall on Sebelius for the disastrous launch of the federal online marketplace last fall, Obama neglected to invite her to the recent White House press conference where he celebrated the surge in sign-ups at HealthCare.gov. This celebration occurred even as the administration continues to keep quiet about such details as the demographic makeup of those signing up and how many of those seeking new insurance were merely replacing policies that they lost due to other Affordable Care Act provisions.
The White House resolutely denied rumors that Sebelius’ departure was anything other than her own decision; Press Secretary Jay Carney rejected any suggestion she would be fired as recently as the week prior to the announcement of her departure. But the White House’s frustration with Sebelius and her department had become increasingly clear to outsiders. The president’s general tendency to avoid rebuking top officials means that Sebelius will leave with a handshake, but she will leave all the same now that the administration is trying to put distance between Democrats and the Affordable Care Act’s dysfunctional rollout as election season approaches.
After all, it is Sebelius’ name and not Obama’s that appears on several major legal challenges to the law. It is difficult to imagine that the president had much trouble accepting the Health Secretary’s proffered resignation when it reached his desk.
So while I’m not sorry to see Sebelius go, I can at least respect her as having been a loyal soldier fighting for a generally unworthy cause.
Incoming nominee Sylvia Mathews Burwell, the president’s choice for Sebelius’ replacement, will not have an enviable job, either. Much like the lady who follows the circus animals with a broom and a dustpan, she will be responsible for cleaning up much of the mess the Affordable Care Act has left in its wake, including the delayed implementation of the employer coverage mandate and the mystery over which uninsured Americans will be granted waivers from the law’s penalties (and on what basis).
She will also be the target of critics’ attacks on the law. Burwell has a long history of working across the aisle, and her confirmation to her current position as the director of the Office of Management and Budget was unanimously approved by the Senate. But the contentious nature of the Affordable Care Act may mean Republicans - and even Democrats worried about mid-term challenges - may be reluctant to seem as if they are supporting the law in any way. Republicans have already taken her nomination as an occasion to renew calls for the law to be repealed and replaced, and it seems likely they may make the process more about the law Burwell will be administering than her qualifications. Of course, someone has to be in charge of the HHS, and there’s a good chance that, had she really had a voice in designing Obamacare, the well-respected Burwell might have come up with a better product than the one the administration actually sold.
Unfortunately, Burwell will inherit the responsibility of trying to wrangle the unwieldy and ever-shifting law that made it onto the books. I wish her the best of luck. As her predecessor proved, unflagging loyalty is not enough to make a department - or a deeply imperfect law - run smoothly.