‘Conga Line of Problems’ Awaits Burwell at HHS

A former department secretary says Obama’s nominee would have to put out fires she can’t anticipate — on top of handling Obamacare.

President Barack Obama embraces outgoing Heath and Human Services Secretary Kathleen Sebelius as he turns to Sylvia Mathews Burwell, his current budget director, after naming her to replace Sebelius in the Rose Garden at the White House in Washington on April 11, 2014.
National Journal
May 8, 2014, 1 a.m.

There’s already a moun­tain of prob­lems wait­ing for Sylvia Math­ews Bur­well at HHS. And that moun­tain will prob­ably grow even big­ger by the time she’s con­firmed.

Bur­well’s con­firm­a­tion pro­cess be­gins Thursday with a hear­ing in the Sen­ate Health Com­mit­tee, fol­lowed some­time soon by a Fin­ance Com­mit­tee hear­ing. She’ll likely be con­firmed. Demo­crats have enough votes on their own, and she’s already draw­ing some bi­par­tis­an sup­port.

And if she is con­firmed, she’ll then have to ac­tu­ally take over a sprawl­ing, poorly man­aged de­part­ment re­spons­ible for the pres­id­ent’s top do­mest­ic pri­or­ity — not to men­tion the coun­try’s most ex­pens­ive en­ti­tle­ment pro­grams, its food and drug reg­u­la­tions, and its most im­port­ant med­ic­al re­search.

Obama­care im­ple­ment­a­tion would cer­tainly be Bur­well’s biggest re­spons­ib­il­ity, and there’s still a lot that needs to be done. The new sec­ret­ary would face an im­me­di­ate polit­ic­al chal­lenge as in­surers be­gin to file their premi­ums for plans sold through the health care law’s ex­changes, and she also would have to nav­ig­ate un­fin­ished policy and tech­no­lo­gic­al work.

HHS is already look­ing for new con­tract­ors to over­haul Health­Care.gov, the primary Obama­care en­roll­ment site, in time for the next sign-up peri­od. Those con­tract­ors will have to build new sys­tems, re­pair or re­place old ones, and have the whole thing tested and ready to open for busi­ness on Nov. 15, while also in­teg­rat­ing the sys­tems of states that are giv­ing up on their own ex­changes and turn­ing to the fed­er­al gov­ern­ment in­stead.

Bur­well has a strong repu­ta­tion as a man­ager, and people who have worked in or with HHS un­der out­go­ing Sec­ret­ary Kath­leen Se­beli­us say that’s what the de­part­ment needs most. The be­gin­ning of the next open-en­roll­ment peri­od will be a clear test of how much the de­part­ment has im­proved.

Mi­chael Leav­itt, a former HHS sec­ret­ary un­der Pres­id­ent George W. Bush, said the de­part­ment is in­or­din­ately hard to man­age, even without something as huge as Obama­care im­ple­ment­a­tion on the table.

“My ad­vice would be to re­mem­ber it’s not the only thing that hap­pens in that de­part­ment,” Leav­itt said. “Make sure you be­gin to un­der­stand the oth­er parts of the de­part­ment that are go­ing to re­quire at­ten­tion.”

Which parts those will be is hard to pre­dict.

HHS’s um­brella in­cludes Medi­care, Medi­caid, the Na­tion­al In­sti­tutes of Health, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, and the Food and Drug Ad­min­is­tra­tion, which it­self reg­u­lates roughly 25 cents of every dol­lar Amer­ic­ans spend. Leav­itt came in­to the job ex­pect­ing to fo­cus mainly on im­ple­ment­ing Medi­care’s drug be­ne­fit but ul­ti­mately found him­self put­ting out fires he nev­er an­ti­cip­ated.

“We had food safety for a time, we had pan­dem­ic in­flu­enza, we had the rol­lout of Part D. We had a conga line of prob­lems that are com­ing at HHS all the time,” he said.

A pan­dem­ic flu — H1N1 — also dom­in­ated Se­beli­us’s first days on the job, and Leav­itt said a bad strain show­ing up now in the Middle East could do the same thing to Bur­well.

The biggest sur­prise about be­ing HHS sec­ret­ary, Leav­itt said, is just how many sur­prises kept hap­pen­ing while he was there.

“It was the breadth of re­spons­ib­il­ity.”¦ The chal­lenge was in be­ing able to man­age across that many plat­forms,” he said.

Leav­itt’s polit­ic­al ex­per­i­ences at HHS also might be in­struct­ive for Bur­well: In the last two years of his term, con­trol of both the House and Sen­ate flipped to Demo­crats.

House Re­pub­lic­ans have already houn­ded HHS over its Obama­care im­ple­ment­a­tion, but if Re­pub­lic­ans win the Sen­ate this year, re­spond­ing to con­gres­sion­al in­quir­ies will take up even more of Bur­well’s band­width.

“Life changed sub­stan­tially.”¦ It would amaze you how much re­sources in the de­part­ment that activ­ity takes up,” Leav­itt said.

He had a team of people whose sole job was to gath­er in­form­a­tion Con­gress had re­ques­ted and man­age re­la­tion­ships as the de­part­ment found it­self caught between the White House and Cap­it­ol Hill.

Else­where, though, del­eg­at­ing re­spons­ib­il­ity is an­oth­er hard part of lead­ing such a large de­part­ment, Leav­itt said. He noted that, un­like oth­er de­part­ments, HHS doesn’t have any un­der­sec­ret­ar­ies. He said he had 27 people re­port­ing dir­ectly to him, com­pared with few­er than 10 for oth­er Cab­in­et of­fi­cials. And they all rep­res­ent dif­fer­ent parts of the health care sys­tem.

“That is the nature of lead­ing a de­part­ment like that — you have the po­ten­tial of pri­or­it­ies shift­ing,” Leav­itt said.

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