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Sebelius Confirmed as HHS Secretary

By Alex Wayne, CQ Staff

April 28, 2009 -- The Senate filled the remaining vacancy in President Obama's Cabinet on Tuesday, voting to confirm Kansas Gov. Kathleen Sebelius as Health and Human Services Secretary.

The tally was 65–31. Sebelius, 60, will lead a sprawling bureaucracy with a budget in excess of $600 billion, rivaling defense spending. Her responsibilities include the nation's biggest health and welfare programs, including the health entitlements Medicare, for the elderly and disabled, and Medicaid, for the poor.

Her most important job this year, though, will be to help shepherd through Congress the president's proposed overhaul of the health care system. Obama wants to expand insurance coverage to most of the approximately 46 million Americans who lack it, while reducing the growth of costs of care and improving quality. To those ends, he has proposed in his fiscal 2010 budget to set aside $634 billion over 10 years as a "downpayment" on an overhaul; the total cost may approach twice that figure.

"Congress needs a strong partner at HHS to pass comprehensive health reform," said Sen. Max Baucus, D-Mont. "Governor Sebelius is the right person for the job. She has the political experience, determination, and bipartisan work ethic to get the job done."

Sebelius has served as governor of Kansas since 2002; prior to her gubernatorial election, she was the state's insurance commissioner for eight years.

Sebelius was Obama's second choice to lead HHS and his health overhaul effort. Former Senate Majority Leader Tom Daschle withdrew his nomination after disclosing in January that he had paid about $140,000 in back taxes.

Sebelius had her own tax issues, though they were minor in comparison: she paid about $7,900 in back taxes and interest after an accountant she and her husband hired ahead of her confirmation hearings found errors in her returns. Senators evinced little concern about the issue.

Sebelius' position on abortion was much more problematic. She is a strong supporter of abortion rights, which was to be expected from an Obama nominee. But Sebelius submitted a report to the Senate Finance Committee that initially understated the amount of campaign contributions she had received from a Kansas abortion provider, George Tiller. She was forced to amend the report, disclosing an additional $27,000 received from Tiller, after Operation Rescue, an anti-abortion group, distributed Kansas campaign finance records documenting the contributions to reporters.

Anti-abortion groups pressured conservative Republicans to obstruct her confirmation. They succeeded in delaying it, first postponing a vote by the Finance Committee until after the Senate's two-week spring recess, and then pushing the vote by the full Senate back by a week.

In the meantime, the Kansas state legislature rapidly advanced a bill that would cause one final disruption for her confirmation. The bill, aimed at Tiller, would have imposed new restrictions on abortion providers who perform the procedure late in a pregnancy. Tiller is the only doctor in Kansas known to perform abortions in the third trimester, and one of the few in the nation.

Sebelius waited until 10 days after the measure cleared the legislature—the maximum allowed under the Kansas constitution—and then vetoed the bill on April 23. That led an early supporter, Sen. Sam Brownback, R-Kan., to announce he was reconsidering his position. Brownback, a social conservative, is expected to run for governor in 2010. Brownback voted for Sebelius on Tuesday.

Some Republicans expressed concerns about Sebelius for, they said, reasons other than abortion, or in addition to her abortion position.

Sen. Lisa Murkowski, R-Alaska, said last week that Sebelius had shown insufficient concern about the Indian Health Service in statements to the Finance Committee. Murkowski says the IHS is badly underfunded. Murkowski voted against Sebelius.

And Sen. Jon Kyl, R-Ariz., said that he was suspicious of Sebelius' position on a policy known as "comparative effectiveness research." Obama has sought to boost funding on studies of the relative value of different medical treatments and drugs. Some Republicans fear the results of the studies might be used by Medicare and other government health programs to deny payment for treatments deemed ineffective, or not cost-effective.

"She did not provide any assurance that Health and Human Services, federal health care programs, or any new government entity—such as the Federal Coordinating Council—will not use this tool to ration or deny care," Kyl said. The Federal Coordinating Council is a body created by Obama's economic stimulus law that would guide government investments in comparative effectiveness research.

Sen. Arlen Specter of Pennsylvania, who announced Tuesday that he will stand for re-election in 2010 as a Democrat, voted for Sebelius. His spokeswoman had said Monday that Specter was undecided on Sebelius' confirmation and that she had requested a meeting with him this week.


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