Does the resignation of Kathleen Sebelius as Secretary of Health and Human Services mean that Obamacare is succeeding or that it is struggling—or even that it has failed? The best answer may be that the Obama Administration has decided that Obamacare has a real chance of being the sort of victory they’d always envisioned. That means that Sebelius’s departure, which the Times and others reported late Thursday, won’t have to represent a surrender. When the Affordable Care Act’s online exchange was launched, in October, and didn’t work, calling for Sebelius to go was a way of saying that the whole project ought to be discarded. There would have been a broad effort to send pieces of the A.C.A. out the door with her, as if they were personal items thrown into a cardboard box. Now, the Administration seems confident enough that the law will live; they can let her go without being quite as afraid that anyone but Sebelius herself is paying a price.
President Obama will nominate Sylvia Mathews Burwell, the head of the Office of Management and Budget, as the next Secretary. “The president wants to make sure we have a proven manager and relentless implementer in the job over there, which is why he is going to nominate Sylvia,” Denis McDonough, Obama’s chief of staff, told the Times. “The job over there” could mean any part of what the D.H.S. does—the Food and Drug Administration, Centers for Disease Control, and Medicare are all in its purview. But the one that needs a “relentless implementer” is Obamacare, and there is no mistaking that it is what Burwell (who earlier served as the chief operating officer of the Bill and Melinda Gates Foundation) must do right in order to be seen, inside and outside of the Administration, as a success.
Was Sebelius a failure? Does she deserve this? She wasn’t alone on the Obamacare rollout, and her defenders have pointed to how hard she worked to get the law passed, and the important decisions she made in drawing up the rules that made women’s health a priority. (One of those, on contraceptive-care coverage exemptions, is the subject of a Supreme Court case.) There was a point when she was seen as a possible future Presidential candidate, when Obama was picking the Jayhawks to win the N.C.A.A. tournament, in 2010, as a shout-out to Sebelius, who used to be governor of Kansas. On Thursday, which would be her last day as Secretary, she testified before the Senate about how the number of people enrolled in private health plans through the A.C.A.’s exchanges looked to be seven and a half million—even more than the seven million that had put Obama in a triumphant mood on April 1st. Those are real accomplishments, and it’s too easy, and a little cheap, to just dismiss her as a disaster.
But the very solidity of the numbers makes the problems with the rollout look even more painful. This was a good law, offering something that people wanted. The department Sebelius was in charge of was supposed to get it to them. Instead, what it presented to the world was a big mess. Obama was also humiliated when his assurances about people getting to keep their plans turned out to be false. From the perspective of the Obama Administration, the rollout—Sebelius’s rollout—made something majestic look grubby. Sebelius, for her part, told the Times that if she could take “all the animosity. If that could just leave with me, and we could get to a new chapter, that would be terrific.”
Confirmation hearings for Sebelius’s successor—any successor—would also have been untenably ugly a few months ago. And a few months, or even a few weeks, from now, it would have been too enmeshed in the midterm elections. Even now, at a sort of middle point, the confirmation process is still likely to be very loud and very mendacious. (Burwell was, however, confirmed for her current job unanimously, less than a year ago, making any Republican revelations about her character less credible.) There are still so many remaining battles around Obamacare, from making sure that the enrollment numbers translate into something solid to the next round of premium changes and the incomplete expansion of Medicaid benefits, for which only about half the states have signed on. Sebelius would have always been a defendant.
Photograph by Susan Walsh/AP.
