Different Horses

The saying “different horses for different courses” came to mind yesterday when I saw President Obama introducing his new Secretary of Health, Sylvia Matthews Burwell, while thanking her predecessor, Kathleen Sebelius. Ms Sebelius had run the good race in the thankless task of implementation, that is establishing the Affordable Care Act following its passage into law.

She lead her organization through uncertainties ranging from the Supreme Court, State Governments’ confusion, and open hostility from the House of Representatives. She did this while the major cheer leader in chief, President Obama, remained too often in the background. This was dirty, tough, work requiring great patience and poise, (work that frankly bored the President).

Someone had to slog it out, and Ms Sebelius did with great dignity.

Her resignation, of course, was not a surprise. Following the near disastrous roll out of “heathcare.gov” and the initial damage that the roll out did to ACA’s reputation, many had called for her resignation. The President stuck with her not allowing anyone the space to claim he had picked an incompetent Cabinet member.

In the end, Ms Sebelius has been exonerated. The ACA has added over 7 million people to the rolls of insurance holders despite the rocky start. Without a doubt, this was a mark of success.

Looking ahead, however, the challenges are different. The ACA must be managed in a way that it becomes user friendly and ultimately depended upon by enough Americans that repealing it will be a sure way to lose an election. The President’s choice of Mathews-Burwell signals clearly this recognition, less political, more management.

In an unexpected way, President Obama has steered this difficult situation so that there can be two cabinet winners. Oh, and don’t forget, the biggest winner will be all those who now have access to healthcare coverage.

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