Health Reformer in Chief

by Janice Hopkins Tanne
Photograph: Illustration: Jeffrey Smith

As secretary of the Department of Health and Human Services, Kathleen Sebelius is responsible for nearly a quarter of the entire federal budget, overseeing huge operations like the Food and Drug Administration and the Centers for Medicare and Medicaid Services. But right now this former Kansas governor’s biggest job is translating the almost 1,000-page Affordable Care Act—aka health care ­reform—from words into action.

It won’t be easy. While certain portions of the law have already taken effect—such as the rule that children can remain on their parents’ policies until they’re 26—the really controversial parts, such as the requirement that most Americans become insured, won’t be put in place until 2014. Even though one in six Americans currently lacks health insurance, polls show that the country is evenly split between those who support and those who oppose this attempt at providing near-universal coverage. Some people object to this expansion of the government’s role on the grounds of principle, possible cost or both. And some who already do have coverage worry that health reform will mean less choice.

Even though the government has set up a website ( that clearly explains the provisions of the Affordable Care Act, the airwaves are still filled with frightening and untrue claims: that Americans will not be able to pick their own doctors, that the government will decide who will live and who will die, that undocumented immigrants will get insurance coverage. Opposition to health care reform has been substantial and unwavering, and it’s not a foregone conclusion that the new law will be fully implemented in the next few years. Many Republican politicians have committed to undoing, or at least stalling, the reform bill—characterized, in the agenda issued by the Republicans in Congress as the Pledge to America, as “the government takeover of health care.”

On the other side of the political divide stands Sebelius, as committed to making health reform a reality as her opponents are to killing it. As the former insurance commissioner of Kansas, Sebelius appears to have the deep technical knowledge necessary for the job of implementing health care reform, and she has already won kudos for her management skills in the early stages. But does this daughter of a former governor of Ohio, herself elected twice as a Democratic governor in a Republican stronghold, have the political acumen to win the megabattle?

The HHS secretary lives in D.C. and frequently visits the Topeka home she shares with her husband, Gary, a federal magistrate there. Recently the silver-haired 62-year-old spoke with More about health care reform in her offices overlooking the National Mall.

Are you concerned about the lawsuits filed by several states to repeal the health reform act?
I am confident this law is based on sound constitutional principles. The Justice Department is taking the lead, and those cases are likely to work their way through the courts. It has not deterred our work to meet the deadlines and implement the benefits outlined in the law.

How do you deal with charges that you’re a health care czar forcing government-designed plans on Americans?
The notion that this law is a government takeover is just not accurate. The law relies heavily on the private market to grow and provide benefits to Americans.

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