HHS Nominee Burwell Aces Senate Finance Hearing

Instead of grilling Sylvia Mathews Burwell, who is expected to be confirmed as the next head of the Department of Health and Human Services, many Republican senators on the committee used their allotted time to rail against the Patient Protection and Affordable Care Act.

For the second time in a week, President Obama's nominee to lead the Department of Health and Human Services emerged unscathed from a Senate confirmation hearing.

For the most part, Sylvia Mathews Burwell was subjected to high praise from Senate Finance Committee members from both parties during the two-and-a-half-hour hearing on Wednesday afternoon.

A date for the committee vote has not been scheduled, but Burwell is expected to sail through the nomination process. Last year the Senate approved her nomination as director of the Office of Management and Budget on a 96-0 vote.

Instead of grilling Burwell, many Republican senators on the committee used their allotted time to rail against the Patient Protection and Affordable Care Act, which will be a critical issue in the upcoming midterm elections. Sen. Charles Grassley (R-IA), told Burwell that he was frustrated with what he said was the Obama administration's longstanding lack of accountability with Congress.

"As I said on the day you were nominated, you have a fresh start with the Congress and the public," Grassley told Burwell. "But if you are going to make the most of that opportunity you are going to have to do things differently than they have been done."

"I will use Marilyn Tavenner as an example. She sat in the same chair you're in a few months ago. She committed to do things differently. Now it seems like she's gone into the witness protection program, it's been so long since she was last in that chair or at my door. I hope that doesn't happen with you. I hope you don't disappear into the same bunker. Do you think it is possible for you to change the by-any means-necessary culture at HHS that some of us in Congress view as bordering on lawless?"

Burwell replied in part that her role as director of OMB often means that she has to present Congress with difficult news and that she expected to do the same while leading HHS.

"I take the issues very seriously. This is a space where I actually hope that there will be actually direct communications if there are concerns," she said.

The hearing got somewhat lively when Sen. John Thune (R-SD), questioned Burwell about "selective enforcement" of rules that he said favor political allies of the Obama administration. Specifically, Thune questioned why some labor unions were exempted from a tax imposed on self-administered, self-insured plans and whether other groups outside of the exemption would have to pay more in taxes to make up the difference.

"All I am simply saying is that as a matter of fairness in the way this is implemented, carving out favored groups shouldn't be the modus operandi…. and this particular one was a rule that was issued by OMB under your direction," Thune said.

Burwell replied that legislation as sweeping as Obamacare requires some leeway so that HHS can act on stakeholders' concerns.

"When one finds places where you can implement better within the law you seek to do that," she said. "What we heard was that the private sector was having difficulties in terms of doing the reporting requirements they would need to do to do this accurately. As one moves to implement you do listen and try to implement in a better fashion in terms of trying to hear and listen and make the transition one that is workable."

Burwell, who is well known and admired in the Senate through her work at OMB, nodded attentively and agreed with Senators from both parties when they raised concerns on issues ranging from Medicare solvency to Medicaid expansion, to the 96-hour rule on critical access hospital admissions. However, she adroitly avoided specifics on actions she would take as secretary of HHS.

In a typical exchange, Sen. Orrin Hatch (R-UT), asked Burwell if she foresaw any unilateral delays or rules changes from the Obama administration in the rollout for the Patient Protection and Affordable Care Act.

Burwell replied: "With regard to the implementation of such a large and complex thing that is part of such a large part of our economy I am not sure I can sit and predict. But I think what is important is as one moves along and is implementing is listening and learning as you go, making those common sense changes within the context of the law, and when there are changes that require legislative changes to work with the Congress to do it."

Sen. Pat Roberts (R-KS), asked Burwell if she would support repealing the Medicare Independent Payment Advisory Board.

Burwell replied: "With regard to the repeal, one of the things that is hopefully a helpful thing is having belts and suspenders in place to help us all get to the place we all need to with regard to reducing healthcare costs."

"I don't know about a belt and suspenders," Roberts replied. "Maybe barbed wire would be a better way to put it."