ObamaCare reboot a test for Burwell

Greg Nash

Health and Human Services (HHS) Secretary Sylvia Mathews Burwell is under pressure to deliver what her predecessor couldn’t: a smooth enrollment period for ObamaCare.

With new insurance sign-ups set to begin Saturday, Burwell has sought to manage expectations, touting improvements to HealthCare.gov while warning that there will be bumps along the way.

“Will we have challenges? Yes. But the experience is one, overall, that will be a positive one,” Burwell said Monday in a discussion hosted by the Center for American Progress.

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The cautious approach stands in contrast to former HHS chief Kathleen Sebelius, who was lampooned by both parties for her repeated assurances about HealthCare.gov’s readiness before its disastrous debut.

HHS on Monday tried to scale back expectations for Obama-Care’s second year, slashing the enrollment projection by about 3 million people.

The new projection puzzled many healthcare consultants, who said they were confident the administration would exceed the 9.1 million target.

“The administration is being conservative,” Jonathan Gruber, a consultant on both the federal and Massachusetts healthcare reform laws, said on MSNBC. “I believe the number is likely to be higher than that.”

Some experts speculated that Burwell was deliberately lowering the bar to ensure that the final enrollment total comes in around expectations — or perhaps even exceeds them.

“I think they’re doing everything they can to lower expectations, so there’s no big surprises,” said Teresa Miller, a healthcare consultant who has advised HHS on its healthcare exchanges.

“For them, the worst thing is to say, ‘Everything is going to fine’ and then have a repeat of last year,” she said.

The enrollment drive is a major test for Burwell, who built a reputation as an executive whiz during stints at the Gates Foundation and the Office of Management and Budget.

She has been raising her public profile ahead of the website reboot, traveling the country for public appearances while rattling off data about the healthcare law and its impact on the country.

Observers say Burwell’s managerial style could help HHS tamp down any fireworks that arise on Saturday, when HealthCare.gov and state-run exchanges begin accepting new enrollees.

“I think Secretary Burwell’s job right now is execution and not politics. And we know that the best politics is good execution,” said former HHS chief Michael Leavitt.

Burwell already has several advantages over Sebelius, who was President Obama’s second choice for leader of HHS.

A former Kansas governor, Sebelius’s stiff formality when answering questions about the rollout made her a punching bag in conservative media and the butt of jokes on “Saturday Night Live” and “The Daily Show.”

Sebelius also had strained relationships with Republicans, often complaining bitterly about her treatment during visits to Capitol Hill.

Burwell, on the other hand, appears friendly and direct despite her fondness for corporate jargon. She often weaves personal stories into speeches, including tales from her childhood in rural West Virginia.

“For better or worse, Secretary Sebelius was perceived to be chilly and not very engaged. I think so far, Burwell is perceived to be much better,” said Tom Scully, a healthcare lobbyist who served as the Medicaid-Medicare administrator under President George W. Bush. “She’s not only done well, she’s also more popular than she started.”

Burwell has a number of Republican fans on Capitol Hill, including Sen. John McCain (R-Ariz.), who gave her a glowing introduction at her confirmation hearing for HHS secretary earlier this year.

The GOP support — a rarity for members of Obama’s Cabinet — could shield Burwell from personal attacks if the website again runs into trouble.

Still, Burwell is facing a somewhat easier task than Sebelius, and without the same level of public scrutiny.

As HealthCare.gov stumbled out of the gate last October, the government was headed into a shutdown, as Republicans fought to stop funding Obama-Care. Pieces of the system were failing, and the administration was forced to delay more than a dozen requirements under the law.

In the ensuing months, Republicans portrayed the exchanges as unworkable and assailed Sebelius as evasive and untrustworthy. The attacks faded somewhat in the spring, when repairs allowed the site to enroll millions of new customers.

Amid the broader political fight over ObamaCare, Burwell has refused to enter the fray. When asked Monday about the GOP attacks against Obama-Care, Burwell held back.

“When someone is fighting against, versus ‘How can I make it better,’ that’s difficult. I will not say anything other than, that is extremely difficult,” she said during a panel discussion moderated by former Ohio Gov. Ted Strickland (D).

As Burwell avoids political confrontation, she is also angling to regain some of the public trust that was lost during Sebelius’s tumultuous tenure.

Miller, the HHS consultant, said Burwell’s effort to be transparent will help her to “level with people about what to expect”

“It makes it more likely that people will trust them,” Miller said.