Health Care

OK, How About Sebelius for HHS, Then?

by Tim Foley

categories: Medicare And Medicaid, Obama And Congress

Published February 18, 2009 @ 09:28PM PT

Note to self:  just stop writing about the Secretary of Health and Human Services until that position is filled.

During Daschle’s troubles, I erroneously predicted that he would likely be confirmed anyway, only to have him remove himself from consideration the next day.  Today, I’ve written a post saying Howard Dean should get more than a cursory look as HHS Secretary.  A few hours later, The New York Times reports that the president has settled on Kansas Governor Kathleen Sebelius as his choice.  Let it not be said I’m not the first to admit when I’m an idiot.  Luckily for us, Kathleen Sebelius is not only a good manager, she has health care street cred from taking on insurance companies – and winning.

There are few positions in the Cabinet that Kathleen Sebelius wasn't rumored to be in the running for.  Before that, she received strong VP consideration for both John Kerry in 2004 and Barack Obama in 2008, especially after she endorsed Obama early and enthusiastically during the primaries.  She even had some (mild) buzz as a presidential candidate herself for 2008, though clearly nothing came of it.  Most pundits focus on her management skills – reducing state debt, fighting waste, balancing the budget and even expanding funding for education without raising taxes in her two terms in office – and a bipartisan track record essential to getting anything done in still-conservative Kansas.  Dramatically, both Lt. Governors who served under her have been Republicans.

But none of that – except for the close relationship with Obama – makes her a particularly good candidate for HHS Secretary.  The politics of the pick is debatable.  Bipartisan in Kansas does not necessarily translate to bipartisan in Washington, and tapping Sebelius would flip the governorship to a Republican and remove the best chance for Democrats to take a Kansas Senate seat in 2010.

But Sebelius is not just your average governor, and she did more than just find ways to improve Medicaid and health care services in her state.  She gained prominence as the State Insurance Commissioner from 1994 to 2002.  Before Sebelius, the position had been rather cozy with the insurance companies and HMOs operating in the state.  But during her improbable first run, Sebelius refused to accept contributions from the insurance industry – a foretaste of things to come.  When Blue Cross Blue Shield of Kansas wanted to merge with an Indiana insurer, she not only refused to rubber-stamp the deal, she blocked it.  She turned the office of the Insurance Commissioner into an activist regulator, pursuing HMOs who denied care and pushing for cheaper prescription drugs for seniors.  And here’s the kicker – she did so while also reducing the operating budget by 19% over her tenure.

An HHS Secretary who knows how to take on insurance companies, understands the prescription drug issue intimately, and knows how to do more with less?  OK, if you insist.

The timing is intriguing, since Kansas has just resolved its budget crisis this week whereas it was still in progress when Obama made his other appointments.  We’ll see if she finally makes the leap to the Executive Branch this time.  I expect to see a lot of grumbling on Daily Kos about the Senate race in Kansas.  But that's massively underestimating the potential of this appointment at this moment in the health care debate.  If Democrats don’t increase their majorities in 2010, one seat in Kansas won’t be the sole reason.  More importantly, being 1 Senator out of 100 (as Obama himself learned) does not compare with the amount of good that can be done by an HHS Secretary with insurance-fighting cred who’s looking to take on the problems of Medicare Advantage and the prescription drug waste of Medicare Part D precisely at the moment when reforming Medicare will do the most good to health care reform in general.  No Sebelius isn't Howard Dean... but her record is enough to make you dream about what tomorrow may bring.

(And if Sebelius doesn’t take the job, I’m going to keep my damn mouth shut until someone does and gets confirmed by the Senate.  No more egg on the face for me!)

(Photo credit:  WEBN-TV on Flickr.)