The changing of the guard at the Health and Human Services Department has finished with little to no fireworks.
The Senate voted 78-17 Thursday afternoon to confirm Sylvia Mathews Burwell as the next HHS secretary. The final vote followed a procedural vote to end debate on her nomination Wednesday, which passed 67-28.
President Obama announced Burwell's nomination nearly two months ago, along with the resignation of outgoing Secretary Kathleen Sebelius.
As head of one of the biggest government agencies, and charged with implementing the still-controversial Affordable Care Act, the HHS secretary holds a highly politicized position. This became all the more true following the disastrous rollout of the federal enrollment website in October, which had Republicans calling for Sebelius's termination as early as last fall.
Yet Burwell's confirmation process has been surprisingly smooth. The former Office of Management and Budget director has had the support of several top Republican lawmakers from the beginning, including Sens. John McCain, Tom Coburn, Orrin Hatch, and Richard Burr. Fourteen Republicans joined Democrats to advance her nomination to a final vote Wednesday.
A few conservatives, such as Sens. Ted Cruz and Mike Lee, attempted to hold up her nomination and use the vote as a vehicle to criticize Obamacare. But the efforts did not gain steam among others in their party, and new Senate rules requiring only 51 votes for approval gave Burwell an easy path to confirmation.
"No one should misread my vote today as an acknowledgement that all is well in the world of Obamacare and HHS," Sen. Hatch said Thursday, ahead of the vote. "[But Burwell] has acknowledged, for her part, that problems exist, and is committed to fix those problems. Under this administration, that's probably the best we can hope for." The senator from Utah said he would do all he can to help the secretary in her new role.
Twenty-four Republicans voted to confirm her on Thursday, including Hatch, Lamar Alexander, John Barrasso, Richard Burr, Saxby Chambliss, Dan Coats, Tom Coburn, Susan Collins, Chuck Grassley, Rob Portman, and Pat Toomey.
Both sides have lauded Burwell's willingness to work across the aisle and her effective management style as evidence of her qualification for the position — a crucial skill that former administration officials have said Sebelius lacked.
However, the new HHS chief certainly has her work cut out for her. The easy part is over; Burwell will now have to deal with the continued challenges of implementing the health care law — including ongoing technical problems, policy changes, political opposition, and looming premium rate filings — along with other issues that may arise in the department. Lawmakers hope that her willingness to work across the aisle will ease some of these potential roadblocks.
Burwell will be sworn in Monday, according to an HHS aide.