Apr. 11—U.S. Health and Human Services Secretary Kathleen Sebelius has decided to resign, according to published reports. The Obama administration planned to replace her with Sylvia Mathews Burwell, director of the White House’s Office of Management and Budget.

Sebelius’ five-year tenure atop the Department of Health and Human Services (HHS) came during the politically contentious efforts to enact and implement President Barack Obama’s signature policy, the Affordable Care Act (ACA). Her departure followed months of calls for her resignation after the deeply flawed launch of the government-run insurance marketplaces, which are the heart of the law’s efforts to reduce the nation’s number of uninsured residents.

A HHS spokeswoman did not respond to requests to comment on the reported leadership change.

Early Signs of Departure?

Sebelius made the decision to resign and was not forced out, according to news reports.

However, policymakers noted her absence from the stage when Obama recently announced the enrollment of 7.1 million people in marketplaces, as well as his lack of reference to her when describing the accomplishment.

Critics have blamed a lack of oversight and leadership for the early—and some continuing—technical failures of the federally and state-run marketplaces.

“Much of the media coverage of this event is focused on the dark days of fall 2013, when the much-heralded launch of the exchanges became a debacle,” Tim Jost, an ACA expert and supporter, wrote in a Health Affairs blog post. “Some of those responsible for the launch certainly seem to have been guilty of deception or delusion, and Sebelius was ultimately in charge.”

The former governor of Kansas has led the administration’s response to numerous thorny issues involved in the ACA’s implementation, including controversies over mandatory contraception coverage and efforts to get states to implement its Medicaid coverage expansion. So far, only 26 states have opted to expand their Medicaid programs to the extent authorized by the ACA, although limited flexibility Sebelius offered encouraged several conservative-leaning states to do so. 

Burwell Healthcare Experience

Sebelius’ expected replacement is not without healthcare policy experience. Although her background is in economics, Burwell has delved deeply into healthcare policy as part of the budget process because it is such a large part of federal spending.

Burwell is expected to have to grapple with implementation of numerous provision of the ACA that the administration had delayed or only partially implemented, such as the employer coverage mandate. Additional ACA provisions scheduled for implementation over the next several years also could prove thorny. For instance, the controversial Independent Payment Advisory Board (IPAB) is scheduled to begin issuing recommendations to limit Medicare cot growth in 2015. If the Senate is unable to confirm IPAB’s members, then the secretary is required to issue payment cuts. 

Publication Date: Friday, April 11, 2014