Sebelius, 65, came to Washington by way of state government. In the red state of Kansas, she was elected as insurance commissioner and as governor. It's a background that has proven particularly useful as Sebelius oversees the implementation of the Affordable Care Act. The federal-state partnerships inherent in the law—and made more explicit by last year's Supreme Court ruling—have meant that Sebelius has often been deployed as the administration's ambassador in negotiations with her "former colleagues," as she calls them, in state capitals.
HHS is a huge agency, and Sebelius's purview extends far beyond the health reform law—into management of Medicare and Medicaid, drug approval, global health, and food safety, among many other areas. But the emphasis, in this term as in the last, is on Obamacare.
It's a tough environment. Despite extensive outreach to governors and gestures of policy flexibility, a minority of states opted to run their own insurance marketplaces next year, and only about half will be expanding their Medicaid programs to poor adults. Funding shortfalls have left the department scrambling for resources to run programs and get out the word about new insurance options, and Republican critics in Congress have criticized the department's handling of regulatory policy and its management of resources.
But Sebelius sees the job as crucial and enlivening as health reform rolls out. Despite the burdens and scrutiny of her post, she stayed on for the second term to see implementation of the law to the finish line. "While it's difficult and challenging, I can't imagine being anyplace else right now, and I can't imagine a portfolio that would be more satisfying," she says.
Sebelius is the daughter of John Gilligan, a former member of Congress and governor of Ohio. She grew up in Cincinnati and holds an M.P.A. from the University of Kansas and a bachelor's degree from Trinity Washington University. She often returns home to Kansas on the weekends to visit her husband, a federal magistrate judge; they have two adult children and one grandchild. When she's in town, she lives on Capitol Hill—close to the office and the airport, she says—and runs most mornings before work. "And if no one is chasing me, it feels pretty good."