Kathleen Sebelius is in the hot seat amid rising angst over the administration’s implementation of ObamaCare.
The Health and Human Services (HHS) secretary is implementing the biggest change to the nation’s healthcare system in decades, and the stakes couldn’t be higher.
ObamaCare has always been controversial, routinely blasted by the GOP. But now, Sebelius is taking some friendly fire.
HillTube video: A tough few months to implement ObamaCare
A liberal lawmaker who requested anonymity said, “She's been terribly defensive, terribly slow to react.”
"There have been many conversations among progressives about this. We want a personality that acts to confront any glitches immediately — more of a nose-to-the-grindstone manager.
"If there is any more defensiveness as we're implementing, it will be a huge issue in 2014."
Many Democrats, however, came to Sebelius's defense. Others blamed the White House.
"If the president can't sell [the law] to the country, so be it," said a Democratic lawmaker. "She has done a workman-like job. She has moved it forward."
"She has solved problem after problem in a very tough environment," said another Democrat who emphasized Sebelius was "handpicked" for the job. "She has made sure the department implemented the healthcare law successfully even given the very limited funds provided by Congress."
Over the next several months, Sebelius and her team must finalize controversial regulations, educate the public and deal with a restive Congress watching her every move. By all accounts, it’s an enormous challenge — especially with the hurdles confronting the administration.
Red states continue to balk at the new law. Regulators are pleading for more implementation funds. Unions are in an uproar. And polls show the public remains largely ignorant of the law's benefits.
Furthermore, the Obama administration lost a key healthcare player when former White House deputy chief of staff Nancy-Ann DeParle departed earlier this year. DeParle, who served as a senior HHS official in the Clinton administration, is one of the few Washington insiders who know healthcare politics and policy inside and out.
Senate Finance Committee Chairman Max Baucus (D-Mont.), who helped write ObamaCare, recently told Sebelius he worries its implementation will be a “train wreck.”
Sebelius has adopted a measured approach with Congress, preferring not to engage in verbal combat with her opponents. She has expressed frustration with the never-ending politics surrounding ObamaCare, even after the Supreme Court ruling upholding the law and Obama’s reelection.
Earlier this month, Sebelius was put on the defensive when news broke that she solicited money for Enroll America, a non-profit that will educate consumers about healthcare reform, from powerful healthcare interests.
The effort has prompted investigations and earned her comparisons with Oliver North of the Iran-Contra affair. HHS says Sebelius only made two phone calls.
GOP lawmakers are seeking to portray Sebelius as another Obama administration player consumed by scandal. Republicans have reminded reporters that Sebelius violated the Hatch Act in 2012. That law prohibits political activity while serving as a federal employee.
At the time, Sebelius said Obama's reelection was “imperative.” She subsequently sought to rectify the error, but the incident made her a bugbear on the right.
Sebelius came to Washington from Kansas after serving as a state lawmaker, insurance commissioner, then governor from 2003 to 2009.
She was Obama's second choice for the HHS post, behind former Senate Majority Leader Tom Daschle (D-S.D.). Daschle withdrew amid a tax controversy.
Supporters tout Sebelius, 65, as uniquely qualified to implement complex reform legislation given her background. She is able to work across the aisle and understand the concerns of business, they say. Forbes Magazine lists her as the 25th most powerful woman in the world.
But she remains a divisive figure on Capitol Hill.
Conservative lawmakers dispute claims that she's able to bridge political divides. One cringing GOP senator pointed out that Sebelius once headed the Kansas Trial Lawyers Association.
But former GOP federal health officials expressed sympathy for Sebelius.
"Few would understand the complexity of the interworking parts of this," said Michael Leavitt, who served as HHS secretary under President George W. Bush.
He now runs Leavitt Partners, a firm helping to create some of the new healthcare exchanges.
"Some of them are technology related, some are organization and sociological and regulatory. If there is one thing that is underestimated, it's the complexity," Leavitt said.
The Affordable Care Act is seen as especially complex because of its far-reaching changes to U.S. healthcare.
The law re-regulates health insurance, creates a new venue for purchasing it and offers expanded Medicaid benefits for states that accept them.
It is expected to affect 100 million people — double the number affected by the Medicare drug benefit that went into effect in 2006.
Tom Scully, the former Medicare-Medicaid administrator who helped design the drug benefit, said he got an "amazing amount of crap" during that time.
"I can't fault [Sebelius]," he said. "It's easy to pick on what she's done. A lot of people will throw grenades, and she has to catch all of them."
Leavitt said Sebelius is "reliving" his experience implementing Part D.
"The Democrats were anxious for it not to succeed," Leavitt said. "They were sure it wouldn't. Now it's playing out in the reverse. People lacked knowledge about the law, but had high expectations. It is almost predictable, what is happening now."
Observers said it will take until next July to understand whether the law will run smoothly. The bulk of it goes into effect on Jan. 1, 2014.
As of May 10, according to the Kaiser Family Foundation, 17 states will run their own exchange, seven will partner with the federal government and 27 will default to a federally run exchanges.
Another 29 support the Medicaid expansion, while two are weighing their options. The rest will not accept the expansion.
The administration received welcome news on Thursday as California released rate filings for policies that will be sold through its exchanges. They were substantially cheaper than expected, with an average monthly premium of $400.
Scully said Marilyn Tavenner, Obama’s new Medicare-Medicare administrator, is "privately optimistic" about how implementation is going, which reflects well on Sebelius.
"I consider [Tavenner] a friend, and she tells me things are coming together. So who the hell knows?" Scully said.
"No matter what, there are going to be some people who are unhappy. But there are also going to be a hell of a lot of happy people receiving benefits. People like free benefits."