President Obama’s selection of Kansas Gov. Kathleen Sebelius as his health secretary means she will lead the administration’s efforts to launch “the largest expansion of taxpayer-subsidized health insurance in more than four decades,” as The New York Times put it.
And the president picked Nancy-Ann DeParle, a veteran of two decades of health policy battles, to direct the new White House Office for Health Reform.
With these leaders in place, health reform now is expected to move to the front of the policy agenda in Washington.
The HHS and White House jobs were split after Obama’s first choice to head both offices, former Sen. Tom Daschle, was forced to withdraw his nomination over tax and conflict of interest problems.
Governor Sebelius would be the third governor in a row (following Bush appointees Tommy Thompson of Wisconsin and Michael Leavitt of Utah) to head the agency.
Governors bring important experience to HHS as virtually all of them face the growing costs of Medicaid and are trying to reduce the number of people without health insurance in their states. Governor Sebelius did not distinguish herself on either front in Kansas.
While Kansas’s uninsured rate of 12.7% is below the national average, it grew seven times faster during her tenure than in the nation as a whole, even as state health spending continued to increase.
Leaders at both ends of Pennsylvania Avenue had said they want bipartisan support for a major health reform effort, but Governor Sebelius’s track record on that front is not promising either.
This Democratic governor tried twice to get her Republican state legislature to increase cigarette taxes to pay for an expansion of Medicaid and failed both times. Obama has proposed major tax increases to pay for his $634 billion health reform effort, so she will be on familiar terrain.
A Roman Catholic, Governor Sebelius has been severely criticized for vetoing anti-abortion measures passed by the state legislature, and the archbishop of Kansas City has asked her not to take communion. She vetoed a bill, for example, that would have required doctors who perform late-term abortions to report a reason for the procedure.
Governor Sebelius will have to hit the ground running to start spending the $150 billion in new health funds authorized in the stimulus law, including $87 billion for Medicaid, $24.7 billion to subsidize COBRA health insurance, $19.2 billion for health information technology, $10 billion for the National Institutes of Health, and $1.1 billion on comparative effectiveness research.
And she will lead the administration’s effort to shape details of the $634 billion “down payment” on health reform in the budget proposal Obama sent to Congress last week.
Working with her will be DeParle, an attorney who has extensive experience on the front lines of health reform.
DeParle served in the White House during the early years of the Clinton Administration and was a key architect of its attempts at health overhaul. She then moved to Health and Human Services where she oversaw creation of the State Children’s Health Insurance Program.
And she was the health commissioner in Tennessee, which tried to lead the way to sweeping health reform only to later crash after costs soared out of control.
Her experience with state overhaul and the political battles of the White House in the early Clinton years, and at HHS give her a detailed insider’s knowledge of government health programs to help navigate the significant political shoals ahead.
— Grace-Marie Turner is president of the Galen Institute.