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OPINION - New HHS Secretary

by Chris Conley

NEWS BLOG (WSAU) Kathleen Sebelius' resignation is unimportant. She wasn't involved in the key policy decisions behind Obamacare. They were hammered out by Congress and the White House, and were the hatched at the senior administration level. Sebelius had the unenviable job of executing a very complicated bill with fundamental flaws. And for good measure she was the person the Administration offered up to Congressional hearings when the web site didn't work.

She deserves the gratitude of the White House she carried their water for five years and didn't publicly complain about it. In hindsight, staying in Kansas and serving another term as governor would have been a better gig. Her reelection looked shaky in her home state, which is why a Washington job appealed to her in the first place.

(Let's not discount the possibility that the White House wants her out because the Obamacare enrollment numbers are inflated. She could be the fall guy if Congress wants to investigate how many of the 7.5-million enrollees are real, and how many actually paid their premiums to begin their coverage.)

Who replaces her is very important. The text of the Obamacare law is filled with the phrase "...as the secretary shall determine." It means future Health & Human Services Secretaries will be very powerful. In which areas? The HHS Secretary has the power to review health insurance rate increases, and demand they be rolled back. They determine which services will and wont be covered by Medicaid. They set reimbursement rates for hospitals and nursing homes. They determine which insurance policies meet minimum standards and which ones dont. Cost/benefit panels the so called death panels will be created by and report to the HHS Secretary.

President Obama's choice to take over is budget director Silvia Burwell. That indicates to me that the focus will continue to be on the economics (enrollment numbers, premium costs, size of subsidies) will continue to be the dominant storyline. If Obamacare were running better, a doctor or someone with a public-health background would be a more logical choice. For now well have to deal with a health care czar who's actually a bean counter. And keep a close eye on the bean counters when the numbers dont add up.

Chris Conley

Image:U.S. Secretary of Health and Human Services Kathleen Sebelius at the Democratic National Convention in Charlotte, N.C., Sept. 4, 2012, REUTERS / Eric Thayerfrom wsau.com