Health and Human Services (HHS) Secretary Kathleen SebeliusKathleen SebeliusWorking for lasting change Former HHS secretary Sebelius joins marijuana industry group More than 200 Obama officials sign letter supporting Biden's stimulus plan MORE said Monday that she did not anticipate how complicated implementing the president's signature healthcare law would be.

"The politics has been relentless and that continues," Sebelius said, according to Reuters. "There was some hope that once the Supreme Court ruled in July, and then once an election occurred there would be a sense that, 'This is the law of the land, let's get on board, let's make this work.' And yet we will find ourselves having state-by-state political battles."

Speaking to students at the Harvard School of Public Health, Sebelius said implementation had been hampered both by the law's slow roll out and red-state governors and legislators who have rejected state-run insurance exchanges. 


"It is very difficult when people live in a state where there is a daily declaration, 'We will not participate in the law,' for them to figure out whether they are going to benefit," Sebelius said.

The HHS secretary said her department was "closely" monitoring state progress on the exchanges and Medicaid expansion, both set to debut at the beginning of October.

“We are doing a lot of very active one-on-one conversations with states around the country,” she said. “It’s a big lift, and I would say it’s a job that no one has ever done in this country before — not to put too fine a point on it.”

Sebelius also defended the law from criticism that health insurance premiums could rise because of the requirements under the Affordable Care Act. Last month, Sebelius became the first Obama administration official to acknowledge that insurance premiums could increase under the law. But Monday, the HHS secretary argued competition would benefit Americans as they sought a healthcare provider.

"For the first time ever in the history of the United States, they'll have to compete for service and customers, not by cherry-picking the market [and] trying to figure out who can only insure people who promise never to get sick," she said.