When Kathleen Sebelius took the helm of one of the largest civilian departments in the federal government, the first thorny issue on her desk was responding to the H1N1 flu virus, a new pandemic flu strain that seemed to target otherwise healthy young people. After less than a week on the job her first public speech focused on how the Department of Health and Human Services (HHS), which oversees the Centers for Disease Control and Prevention and Food and Drug Administration, was responding to the public health emergency. She released millions of antiviral drugs from the national stockpile and warned against fake flu cures while calling for continual investment into research to stay ahead of future flu outbreaks. Talks about women’s and children’s health, obesity and AIDS soon followed.



It was the spring of 2009 and her future looked bright. She was a much-lauded two-term governor of Kansas, a red state. There were whispers of an eventual vice presidency. She was known as a problem solver who could rise above partisan politics in the heartland. But five years later it’s a different story. There are few opportunities to take a bow when you become the face of the bungled rollout of healthcare.gov, the health insurance enrollment Web site under the Affordable Care Act (aka Obamacare).



Yet the day news started to trickle out that HHS Secretary Kathleen Sebelius was going to resign, she was taking the Beltway equivalent of her curtain call: testifying before the Senate Committee on Finance that 7.5 million people enrolled in the private insurance plans enabled by the Affordable Care Act (ACA), exceeding the first-year Congressional Budget Office projections by half a million.



When Obama announced on April 11 that he had accepted Sebelius’s resignation, he tried to emphasize that relative high point while still acknowledging the colossal misstep that tainted her legacy. “She’s got bumps, I’ve got bumps, bruises,” Obama said in the White House Rose Garden announcement. But, he said, the “final score speaks for itself,” pointing to the enrollment figures.



Sebelius lasted five years in the job, longer than any HHS secretary but Donna Shalala, who served for both of Pres. Bill Clinton’s terms.



The Obama administration has taken pains to point out that Sebelius’s legacy extends beyond the ACA rollout, citing her work to improve children’s health, expand mental health coverage, reduce racial and ethnic disparities and focus on women’s health and AIDS. She tackled Medicare fraud, helping the Department of Justice expose fraudulent billing and recover billions of dollars. She also ushered in greater use of health Internet technology and electronic medical records.



Her real stamp, however, may be her behind-the-scenes work. She helped stitch together a complicated patchwork of states’ needs and infrastructures to make health care reform work at the state level. Separately, she helped craft deals with Republican officials in GOP-controlled states including Ohio, Iowa, Michigan and Arizona to extend Medicaid coverage to their poorest citizens after a 2012 Supreme Court decision decreed that that provision under the new health care law would be optional for states. She also helped convince several Republican governors in other states to support some form of Medicaid expansion, even if no immediate action is expected.



But for better or worse, she will always be associated with the rollout of Obamacare. It seemed appropriate that her farewell speech in the Rose Garden came with a glitch: a page was missing from her text, forcing her to ad-lib.



A new face before midterms

Even as Obama heralded Sebelius’s ability to weather the storm during the tough moments at her post, the relief was almost palpable when he introduced his new pick for her replacement, Sylvia Burwell. A former head of the Walmart Foundation and a past development guru at the Gates Foundation, Burwell has been the budget director at the White House since last April. Perhaps most appealingly, amid partisan rancor she was confirmed for her current post 96–0 last year. Obama says she was a “rock” during the government shutdown last October and a “proven manager” who also played a crucial role helping to get a two-year budget agreement that allowed the government to continue functioning.



Although Burwell’s confirmation hearings will be yet another opportunity to rehash critiques of the health care Web site launch, she is expected to get the votes she needs to take the post. Standing beside Obama and Sebelius in the Rose Garden on April 11, Burwell’s, brief remarks suggested she will focus on affordable child care, implementing the ACA and finding new frontiers to prevent and treat disease.



Her tenure will probably be rocky: She will face monumental tasks, including the second enrollment period for healthcare.gov. Working with the Internal Revenue Service, she will also be the first in her post to collect the penalty fees from people who do not have heath insurance this year. “There is never a good time [to leave],” Sebelius said on Meet the Press during her first postresignation appearance April 14. “There’s gonna be another open enrollment. There are changes down the road. But the president and I began to talk, you know, after the first of the year. And I went back to him in early March and said…‘While the site is working well, I think once we finish this first chapter you really should begin to look for the next secretary who can be here through the end of your term.’"



Ultimately, Sebelius stayed until there was a natural breaking point for her exit. Although critics called for her resignation amid the Web site woes, her choice to leave in May makes sense, providing a physical representation of a “fresh start” at the agency in advance of this year’s midterm elections. Thirty-six Senate seats will be in play come this November: 21 occupied by Democrats and 15 by Republicans. Denouncing Obamacare remains a central Republican campaign strategy.

