If confirmed by the Senate, her first task would be to get the
upper hand on two issues that could spiral out of control for
Democrats just before the November elections: rising health
insurance costs and the potential for a new wave of policy
cancellations for small businesses.
Both issues are grist for the Republican campaign mill to win
control of the Senate by making the November 4 poll a referendum on
Obamacare. The last thing Democrats need is a new self-inflicted
wound akin to the fiasco last year, when HealthCare.gov crashed on
launch and millions of Americans found themselves with canceled
health insurance policies.
Then there are the non-Obamacare challenges, with funding and staff
shortages - and resulting low morale - at the Department of Health
and Human Services agencies that regulate prescription drugs, combat
disease outbreaks and oversee biomedical research.
Burwell's Senate confirmation process begins Thursday with a hearing
before the Senate Health, Education, Labor and Pensions Committee. A
second hearing before the Senate Finance Committee has not been set
but Democrats hope for a final vote before the Memorial Day holiday
on May 26.
Burwell's supporters say the 48-year-old White House budget director
is perfect for the job: a seasoned problem-solver known for her
ability to engage with people of diverse interests and produce
acceptable decisions under difficult circumstances.
It was Burwell, as deputy chief of staff, who kept the Clinton White
House focused on policy during the Monica Lewinsky scandal. For the
past year, she has been watching Obamacare policy unfold as director
of Obama's Office of Management and Budget, a job that has made her
a powerful West Wing figure who has the president's trust.
"She walks in with a lot of capital," said John Podesta, a senior
Obama adviser who worked with Burwell in the Clinton White House.
Last year's uproar over the Obamacare roll-out under outgoing Health
and Human Services Secretary Kathleen Sebelius led to the biggest
domestic policy debacle of the Obama presidency, and the scope for a
new one is palpable.
Republicans are ready to pounce on evidence of higher health
insurance premiums, due to emerge before November's elections. A
large number of small-group health policies held by businesses and
nonprofits also come up for renewal in the fall, and the small group
market, with 17 million beneficiaries, is bigger than the individual
market that spawned outrage last year.
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"You won't see Sylvia dragged down into the partisan politics. It's
just not where she is. She'll be focused like a laser on making
things work smoothly," said Erskine Bowles, the former Clinton chief
of staff who hired her in the late 1990s.
The federal government has relatively little authority over
insurance markets, which are traditionally regulated by states.
To avoid problems, Burwell, a technocrat also known for her West
Virginia drawl and mussed shoulder-length hair, will have to act
quickly to persuade health insurers to restrain premium increases on
Obamacare plans that would be sold in the federal marketplace next
year. The deadline for plan submissions is June 27.
Burwell will also need to confront insurers and state regulators to
avoid a damaging new surge of cancellations or big cost increases on
small group plans, particularly in states that refuse to allow
policy holders to renew plans that fail to comply with Obama's
Patient Protection and Affordable Care Act.
"Her drive and determination to work with players (at HHS) and
players at the White House, at Treasury, at OMB, to get a good
result, that will be front and center," Podesta said.
(Reporting by David Morgan; Editing by Jim Loney and Dan Grebler)
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