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Prescription For Change

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The Associated Press

Published: March 2, 2009

WASHINGTON - A health care system overhaul, weak finances in Medicare, lapses in food safety. Those challenges and more await Kathleen Sebelius as President Barack Obama's health secretary.

Her nomination, expected to be formally announced today, comes just days before the White House is scheduled to convene a summit on health reform, an early step in the president's ambitious plan to vastly expand the reach of the nation's health care system.

The summit, which is expected to be the first in a series of open meetings across the country, is intended to spotlight the challenges spawned by the nation's balkanized health care system - including soaring costs and gaping holes in coverage. It is also aimed at rallying public support for an overhaul certain to draw ideological and industry opposition.

WHAT SHE BRINGS TO THE JOB

Sebelius, 60, is seen as a steady hand, an experienced public official who knows how to work across political lines. As a former state insurance commissioner, she is unfazed by the complexities of health care and insurance issues.

Health Care In Kansas

•She served as the state's insurance commissioner for eight years. The job, however, had less to do with the delivery of health care and achieving the sort of quality improvements and efficiencies that Obama and policy experts speak of when they describe a high-performing health system of the future.

•As governor, she oversaw Medicaid health programs for the poor.

Hits: Kansas has added tens of thousands of low-income children to state health programs. As insurance commissioner, she rejected the sale of Blue Cross Blue Shield to an Indiana company, citing the prospect of higher premiums as the reason. She was successful in having Kansas join a multistate consortium that allowed Kansans to order prescription drugs from Canada, Britain and Ireland, often at a lower price than in the United States.

Misses: She tried unsuccessfully to expand health coverage in the state through higher cigarette taxes, but was thwarted by Republicans.

CHALLENGES FACING THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

•Sebelius would inherit a sprawling department of 65,000 employees responsible for public health, food safety, scientific research and the administration of Medicare and Medicaid, which serve 90 million Americans.

•The solvency of those programs is a worry confronting the administration, which has vowed to take on entitlement reform.

•The department's budget, consumed largely by those two programs, exceeds $700 billion.

•More than a month into the administration, few Obama appointees have been placed in the health agency and the president has yet to name a chief for the major health agencies such as the Food and Drug Administration or the National Institutes of Health. The administration will have to move quickly to name an FDA commissioner.

•A trustees' report due in the spring is expected to highlight the worsening condition of Medicare's finances, hammered by a drop in tax revenue because of the recession.

•Steering Obama's costly health care changes through Congress promises to be a complicated and politically-charged task that will be a big part of Sebelius's portfolio. The withdrawal of Tom Daschle, a former Senate majority leader steeped both in the byzantine ways of Congress and the intricacies of the nation's $2.3 trillion health care system, delivered a significant blow to the administration as it prepared to launch its ambitious health reform agenda.

OBAMA'S HEALTH CARE OVERHAUL

Obama made his opening move on a health care overhaul last week with a speech to Congress and a budget that set aside $634 billion over 10 years as a down payment on coverage for all, a goal that could ultimately cost $1 trillion or more.

•Obama outlined some general policies, such as putting the country on a path to cover all its citizens and preserving the employer's role in providing health insurance. His budget also showed it will require tough choices on spending cuts and tax increases to pay for health care.

•Obama wants to expand coverage while slowing the increase in costs. Administration officials say they are hoping that in the end that will lead to a more affordable system, without the coverage gaps that leave millions of people uninsured.

•Sen. Max Baucus of Montana and Sen. Edward Kennedy of Massachusetts say they want to present legislation by the summer.

•Republicans are concerned about the costs, and about giving the government an even larger role in health care. White House chief of staff Rahm Emanuel signaled that the debate could get contentious.

SHE'S OBAMA'S BACKUP PLAN

Sebelius, who earlier had said she was not interested in a Cabinet position because she wanted to attend to her home state's budget crisis, represents Obama's backup plan.

•Originally, the president had counted on former Senate Majority Leader Tom Daschle to shepherd his health overhaul agenda through Congress.

•Daschle would have worn two hats: health secretary and head of a White House health reform office. He was on a first-name basis with most senators, where health care legislation faces its stiffest test. Yet he dropped out of consideration after his failure to pay taxes on all his earnings came to light.

•Obama plans to name a different person for the White House health care job, raising the prospect of tensions between that office and the health secretary's. One name mentioned for the job is former Clinton administration adviser Nancy-Ann DeParle, who would take over the effort to create, sell and implement a wide-ranging health care overhaul.

WHAT SHE BRINGS TO THE JOB

Sebelius, 60, is seen as a steady hand, an experienced public official who knows how to work across political lines. As a former state insurance commissioner, she is unfazed by the complexities of health care and insurance issues.

CHALLENGES FACING THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

OBAMA'S HEALTH CARE OVERHAUL

Obama made his opening move on a health care overhaul last week with a speech to Congress and a budget that set aside $634 billion over 10 years as a down payment on coverage for all, a goal that could ultimately cost $1 trillion or more.

SHE'S OBAMA'S BACKUP PLAN

Sebelius, who earlier had said she was not interested in a Cabinet position because she wanted to attend to her home state's budget crisis, represents Obama's backup plan.

Information from The Washington Post was used in this report. Keyword: Health Agenda, to learn more about President Obama's health care agenda.

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