Sebelius Resigns as HHS Secretary, Obama Nominates OMB Director

President Barack Obama announced the resignation of HHS Secretary Kathleen Sebelius in a press conference on April 11, 2014, ending her nearly two-term tenure with the Obama administration. President Obama then nominated Sylvia Mathews Burwell, the Director of the Office of Management and Budget (OMB) as her replacement. Sebelius’ resignation comes one day after it was reported that the Health Insurance Exchanges under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) had garnered more than 7.5 million signups, exceeding HHS’s original goals. The HHS Secretary oversees the 11 operating divisions and eight agencies in the U.S. Public Health Services and three human service agencies.

President Gives Thanks

According to Obama, Sebelius told him in early March that she planned to step down from her post following the March 31, 2014 end of what she predicted to be a successful open enrollment period. After “five years of extraordinary service” and 7.5 million new insured Americans, Obama said Sebelius had “earned that right.” Sebelius, Obama said, would “go down in history” for serving as the Secretary of HHS when it was “finally declared that quality, affordable health care is not a privilege but a right for every single citizen of the United States of America.” In her tenure, Sebelius led achievements—“often without fanfare, often without acknowledgement”—that Obama said were critical to the health of Americans.

Critical Responses to Website Failures

Despite the recent good news, the rocky start of HealthCare.gov—as well as the resulting backlash from those across the aisle, who called for the Secretary’s resignation—tainted the reputation of Sebelius and of the Obama administration as a whole. The initial failure of the website spurred mockery from Saturday Night Live and headlines like The Daily Beast’s Kathleen Sebelius’s Daily Show Disaster. In her Daily Show interview, host Jon Stewart challenged Sebelius, saying, “I’m going to try and download every movie ever made, and you’re going to try and sign up for Obamacare—and we’ll see which happens first.”

Flaws in Management

In October 2013, Sebelius, the former governor of Kansas and former insurance commissioner to the state, told the House Energy and Commerce Committee that she was responsible for the “debacle” of the flawed roll-out of the federal health insurance website. She also told the Committee that the two weeks allotted for end-to-end testing of the website was inadequate for the task, but that none of the contractors hired by the government to create the website suggested delaying the launch past October 1. Health Law Daily reported on the Committee meeting in Sebelius accepts responsibility, rejects suggestion to extend enrollment period, October 30, 2013.

Health Reform WK-EDGE reported that, in December 2013, Sebelius wrote on her blog, “The launch of HealthCare.gov was flawed and simply unacceptable.” She announced that she would be undertaking “a series of initial steps in the process of better understanding the structural and managerial policies that led to the flawed launch of HealthCare.gov.” These steps would focus on the government’s work with contractors in building the website, which according to Sebelius was critical in that “CMS alone spent $5.3 billion in 2013 on contracting engagements.” Sebelius wrote, “We must take steps to ensure that our contractors are well managed, and that they fulfill their commitments and provide good services and products for our tax dollars.”

Sylvia Mathews Burwell

Obama nominated Sylvia Mathews Burwell as Sebelius’ replacement, saying, “I could choose no manager as experienced, as competent as my current Director of the Office of Management and Budget.” Obama stated of Sebelius, “I will miss her advice. I will miss her friendship. I will miss her wit.” However, he said, Burwell “holds the same traits in abundance.”

According to her White House biography, Burwell has served as the President of the Walmart Foundation and as the President of the Global Development Program at the Bill & Melinda Gates Foundation, for which she also served as the Chief Operating Officer. During the Clinton Administration, she held the positions of Deputy Director of the OMB, Deputy Chief of Staff to the President, Chief of Staff of the Secretary of the Treasury, and Staff Director of the National Economic Council.

At the press conference, Sebelius welcomed Burwell as her replacement, expressing the strong beliefs of HHS in its “important mission” and referencing a quote that is engraved in the walls of the Hubert H. Humphrey Building, which will soon house Burwell’s office: “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”

Burwell’s Senate Confirmation

Before Burwell officially takes over the position of HHS Secretary, she must be confirmed by the Senate. Under Article II, Section 2 of the U.S. Constitution, the president shall appoint officers of the United States “by and with the Advice and Consent of the Senate.” When a nomination is made, the question before the Senate is “Will the Senate advise and consent to this nomination?” According to a report by the Congressional Research Service (CRS), “Only a majority of Senators present and voting, a quorum being present, is required to approve a nomination.”

Tens of thousands of nominations are made during each Congress, so the Senate is not able to consider all of them in detail. “A regularized process facilitates quick action on thousands of government positions,” according to the CRS. Hundreds of nominations may be approved en bloc by the Senate at one time. However, the confirmation process also allows for the Senate to closely scrutinize candidates when necessary, especially nominees for high-level positions such as Supreme Court appointees. According to the CRS, “Among the executive branch positions, nominees for policymaking positions are more likely to be examined closely, and are slightly less likely to be confirmed, than nominees for non-policy positions.”

At the press conference, Obama stated he did not think Burwell’s confirmation would be a problem, as she was confirmed unanimously one year ago for her post as the director of the OMB.