Burwell, previously director of the White House budget office, recently took Kathleen Sebelius's place as head of HHS. She is popular on Capitol Hill and has a reputation as a skilled manager. She'll need those skills as she guides the Affordable Care Act into its second year while keeping the rest of the department humming. Burwell has already taken steps to reorganize HHS, adding new positions with direct oversight of the insurance exchanges.
With direct responsibility for Medicare, Medicaid, and most of Obamacare, Tavenner is on the hook for some of the most controversial decisions in health care, from cuts in providers' Medicare payments to rebuilding the ACA's enrollment system. Tavenner, like Burwell, came into the job with strong bipartisan support and largely avoided any blame for HealthCare.gov's rocky rollout. But CMS has come under fire from Republicans over proposed cuts to Medicare Advantage, and the agency is still sorting through a backlog of incomplete Medicaid enrollments.
Lambrew, who has a background in academia, is President Obama's top health policy adviser and has provided a steady hand on the issue since the early days of the administration. She is deeply involved in the nitty-gritty of ACA implementation and will have Obama's ear in the next big front in the health care debate: cost control.
As the health insurance industry's top representative in Washington, Ignagni has had an intense half-decade, having guided AHIP through the debate over the Affordable Care Act. During the botched debut of HealthCare.gov, insurers ended up doing most of the work the website was supposed to do, thus winning credibility as the protectors of Obamacare. Ignagni's next challenge: what's shaping up to be an all-out war between her industry and pharmaceutical companies over the high cost of prescription drugs.
Richards is undoubtedly one of the most powerful women in Democratic politics, and her status keeps growing amid flare-ups ranging from Todd Akin to the Supreme Court's ruling limiting Obamacare's contraception mandate. She leads Planned Parenthood's day-to-day operations as well as its political arm, putting her squarely at the intersection of health care policy and politics.
This article appears in the July 26, 2014 edition of National Journal Magazine as 25 Women Who Shape National Policy.