By Elise Viebeck - 04/12/14 06:58 AM EDT
Sylvia Mathews Burwell has a big task ahead of her.
The outgoing White House budget official is poised to take the reins of one of the largest bureaucracies in the United States as it implements ObamaCare, the most sweeping new social program since Medicare.
The HHS secretary is in charge of a volatile mix of programs, politics and stakeholders that makes it among the hardest of all the Cabinet positions.
The job is a magnet for partisan attacks, and Burwell would assume her new role in a high-stakes election year when Republicans hope to use the healthcare law to take back the Senate.
Parts of the health department are mired in dysfunction, adding to the difficulties.
Democratic strategist Chris LeHane compared HHS to the Boston Red Sox before current manager John Farrell whipped the team into shape.
"People were eating chicken and drinking beer in the dugout during games," said LeHane, who worked with Burwell in the Clinton White House.
"It was a mess. Burwell has the skills to turn it around, but right now, she is taking on the Red Sox."
The transition will significantly increase power for Burwell, who now serves as the director of the Office of Management and Budget (OMB).
The choice also represents a lesson learned for the White House, which is still smarting from its tumultuous healthcare rollout even as it celebrates more than 7 million exchange enrollments.
Departing HHS Secretary Kathleen Sebelius was seen as naturally attuned to healthcare issues but disparaged as an ineffective manager.
Burwell, a fiscal prodigy, lacks the experience of a longtime healthcare specialist but is widely commended for her flexibility and organizational skills.
Her nomination echoes Obama's appointment of Jeff Zients, another former OMB director, as the management whiz in charge of fixing HealthCare.gov last fall.
"The president and his senior staff have tremendous confidence in [Burwell’s] abilities," said former Senate Majority Leader Tom Daschle (D-S.D.), who advises Obama on healthcare issues.
"She is renowned throughout the administration and virtually all over town for her enormous professionalism and capacity for leadership."
Burwell will also make use of her already deep ties to the White House, a substantial plus for West Wing officials eager to be in the loop about ObamaCare developments.
Still, the transition will be grueling, even for a seasoned policymaker like Burwell.
"There's no question that any new job of this magnitude imposes a huge learning curve," Daschle said.
"It's no different for her. But she is capable of taking on learning curves quickly. She recognizes that and her preparation is already under way."
Burwell, 48, was largely an unknown figure until President Obama picked her last year to head OMB.
Before that, she spent years managing mammoth philanthropy budgets at the Bill and Melinda Gates Foundation and the Walmart Foundation.
Prior to 2013, Burwell's key experiences in politics came during the Clinton administration, where she worked in several different economic roles.
She served as chief of staff to former Treasury Secretary Robert Rubin and as a Clinton deputy chief of staff alongside John Podesta, who is now a senior Obama adviser.
Burwell flashed policy and political savvy in those roles, according to former colleagues.
"Sylvia is the consummate manager with the heart of a public-health advocate —both critical for leading the next phase of healthcare reform," said lobbyist Rich Tarplin, who worked with Burwell as a former assistant HHS secretary.
Former Clinton chief of staff Erskine Bowles, who was once Burwell's boss, has called her the "single most competent person I've ever worked with."
The day she took the job, "my IQ went up about 100 points," Bowles told Bloomberg Businessweek last year.
Several Republican lawmakers have also praised Burwell’s tenure at OMB.
"My compliments to the president for his judgment" in selecting her, Sen. Tom Coburn (R-Okla.) recently told C-SPAN.
"She's transparent. She's not a turf-protector … She communicates and doesn't hold back."
GOP officials attribute her success to her experience in the private sector.
Burwell notably served as a director at the life insurance company MetLife, and Walmart President and CEO Doug McMillon said that she has a "strong record" of working with business and government.
But others have questioned whether she has the expertise in healthcare policy needed to be an effective HHS secretary.
In one of the strongest criticisms of her nomination, Senate Budget Committee Ranking Member Sen. Jeff Sessions (R-Ala.) said Burwell has a "thin resume" on healthcare and has "never run anything on the scale of HHS."
"I am concerned that Director Burwell may have been chosen because the president believed her to be another political loyalist who would toe the party line," Sessions said Friday.
Tarplin argued that Burwell's experience in the Clinton administration gave her plenty of familiarity with healthcare issues.
"She played a pivotal role on both public health and Medicare and Medicaid financing issues," he said.
When Congress returns from recess, Burwell is likely to face two tough confirmation hearings. Democrats already have the 51 members needed to approve her, so barring a gaffe, her nomination should sail through the Senate after that.
"People at the White House used to say, 'she's going to be a future Cabinet secretary,'" said LeHane. "She always had that feel about her."