WASHINGTON — A global flu pandemic loomed in 2009 the very day Kathleen Sebelius took command of Washington’s massive health care bureaucracy, and she had to quickly marshal a response.
A year later, when a BP drilling rig exploded in the Gulf of Mexico, she had to deal with the medical fallout from the worst oil spill in U.S. history.
But throughout her two years as secretary of health and human services, her toughest challenge has been to shoulder the defense — and weather the political blows — of the biggest expansion of America’s health care system in half a century.
“I cannot overstate the pressure she was under during the health care debate, yet she handled it with aplomb and the facts,” said Sen. Barbara Boxer, a California Democrat. “She doesn’t engage in hyperbole. She’s calm. She reflects the no-drama-Obama kind of approach.”
But a year after the 10-year, $1.1 trillion overhaul passed without a single Republican vote, it remains a deep and divisive fault line in American politics.
Bridging it seems out of the question. Opposition to “Obamacare” is the price of admission to being taken seriously in Republican circles. Sebelius’ critics remain implacable.
“I’m not pleased, frankly, with her performance,” said Sen. John Cornyn, a Texas Republican, who opposed her nomination. “I think the law is unaffordable, and costs will explode far beyond the preliminary estimates.”
Sebelius is just as pointed when talking about the House Republicans’ plan to replace Medicare’s guaranteed benefit with a set payment adjusted for inflation that would be paid to private insurance companies.
The nonpartisan Congressional Budget Office has said the plan, offered by Rep. Paul Ryan, a Wisconsin Republican, and passed by the House, would increase health care costs for seniors.
By 2030, they could be on the hook for as much as 70 percent. Supporters of the Ryan plan counter that competition for seniors’ health care dollars would reduce costs.
But at a news conference late last week, Sebelius said that the GOP plan “would destroy this commitment made 46 years ago to the seniors of this country that they won’t go bankrupt based on health care costs. The federal government pays 70 percent of the costs of health care for the very members of Congress who voted to flip that on seniors. It’s a commitment that they haven’t taken on themselves, but they’re willing to put on the seniors of this country.”
It’s just the latest volley in the battle over health care, which rages in the conservative mediasphere, on Capitol Hill and in the courts.
More than two dozen states have challenged the law. They contend that the individual mandate, which requires people to purchase insurance if they don’t get it through work or the government, is unconstitutional. Lower court rulings have so far been mixed, and the case is likely to end up before the U.S. Supreme Court.
Meanwhile, congressional Republicans and the party’s evolving cast of 2012 presidential hopefuls want to repeal it.
“It’s a 2,800-page bill passed on a narrowly partisan basis,” said Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank, who served at Sebelius’ agency during the Reagan administration. “The rules and regulations are going to be imposed outside of legislative channels where you hold people accountable. Americans correctly believe that they have lost a huge amount of freedom.”
Provisions of the law already have taken hold, such as rules against denying coverage to children because of pre-existing conditions.
An estimated 4 million seniors who would otherwise hit an eligibility gap in drug coverage under Medicare — the “donut hole” — now receive a one-time, tax-free $250 rebate. Small businesses are eligible for tax credits to make it easier to offer employee health insurance.
And states are preparing to create “exchanges,” to take effect in 2014, where consumers will be able to choose among a competitive smorgasbord of coverage plans.
More changes will roll out over the next five years.
Convincing doubters that the Democrats’ medicine will be good for them has been difficult. As an avid runner for three decades, Sebelius knows something about endurance.
The 63-year-old former Democratic governor of Kansas, who campaigned feverishly for Barack Obama in the 2008 presidential election, is the front-line defender of what could be his most enduring achievement — or his political undoing.
Perhaps her own as well.
“It fulfills an incredibly important legacy to finally have an opportunity to have health care available and affordable for most Americans and all the children and family services I’ve believed in and worked on all my life,” she said in a recent interview. “I can’t imagine at this point being anyplace else.”
But her exasperation with the attacks and misinformation — who could forget the debate over “death panels”? — is abundantly clear.
During a recent hearing before the House Education and the Workforce Committee, Rep. Todd Rokita, a Republican freshman from Indiana, kept pressing her on when she would get back to him about a mine safety rule on coal dust. Another Indiana Republican had asked her the same question minutes earlier.
“I can’t give you a date certain until I know what it is that we’re looking for,” Sebelius said. “But I can guarantee you all of us heard the question four or five times.”
Jeffrey Levi, executive director of the Trust for America’s Health, a nonpartisan public health advocacy group, calls Sebelius “an incredibly good soldier.”
“She’s someone who bears all the criticism and answers all those difficult questions, most of which are being posed not because of substance, but because of the politics and trying to score political points,” Levi said.
But Sebelius is not above playing politics herself. For example, she was asked at the hearing about what the Ryan Medicare plan would mean for a cancer patient.
“People will run out of money very quickly, and if you run out of the government voucher and then you run out of your own money, you’re really left to scrape together charity care, go without care, die sooner,” Sebelius replied.
The Washington Post’s “Fact Checker” column said that although the Ryan plan is vague and raises questions about trade-offs that seniors would have to make between their savings and paying for health care, Sebelius had inflamed the debate and “should be ashamed.”
She was only mildly contrite: “I certainly didn’t mean to suggest that passing the budget made people die sooner. I do think that shifting costs, which is, no doubt, what the plan would do onto seniors, may well leave some people in very difficult situations where they go without care that they may need.”
Sebelius clearly wants to see health care reform through to the end. But that depends to a great extent on whether Obama is re-elected and keeps her on, and on what her own political future holds.
While she said the possibility of seeking elective office again is “unlikely,” she did not completely close the door.
“I’ve learned that you never say ‘never’ to anything,” Sebelius said. “I’ve never had a clear plot: ‘This is exactly what I want to do next.’ It’s been about doors opening and opportunities and a way to make a contribution.”