Senate Committee Warms to HHS Nominee Burwell

Civil tone notwithstanding, several Republican senators say they will demand more transparency about the successes and failures of Obamacare from Sylvia Mathews Burwell than from her predecessor, Kathleen Sebelius.

Thursday's U.S. Senate confirmation hearings for Sylvia Mathews Burwell had all the makings for a donnybrook.

Instead, it was more like a love fest as several Republicans joined every Democrat on the Senate Health, Education, Labor, and Pensions Committee in voicing support for President Obama's nominee to lead the Department of Health and Human Services.

The two-hour hearing came as Republicans and Democrats fight to establish their campaign narratives on the success or failure of the Patient Protection & Affordable Care Act in the months before November's mid-term elections.

And while Republicans on the 22-member committee frequently criticized the PPACA, President Obama, and departing HHS Secretary Kathleen Sebelius, they lobbed no direct shots at Burwell, who is well known to members of Congress through her most recent work as director of the Office of Management and Budget.

"Many of in this room… disagree about the merits of Obamacare and what the path forward should be to reform our healthcare system," Sen. John McCain (R-AZ), told the committee during his introduction of Burwell. "I know of no one who does not have but the highest praise for her work as director of OMB [which makes] her well qualified to be secretary of HHS."

The committee did not vote on the nomination. That is the task of the Senate Finance Committee later this month, and there is no indication that the nomination is in trouble.

Sen. Richard Burr (R-NC), praised Burwell's experience leading both the Global Development Program for the Bill and Melinda Gates Foundation, and the Walmart Foundation, along with her service as deputy chief of staff in the Clinton White House, and her service on OMB.  

"I support her nomination and I will vote for it in the Finance Committee," Burr told the committee. "And it is for one primary reason. It's because she doesn't come with a single experience that would make her a good secretary. She comes with a portfolio of experience that would make her a tremendous asset at addressing some of the challenges that that agency specifically and uniquely has. I look forward to her confirmation being quick."

Even with the civil tone that surrounded the questioning, several Republicans said they will demand more clarity and transparency about the successes and failures of Obamacare from Burwell than from her predecessor.

Sen. Tim Scott (R-SC), told Burwell that he voted for her as director of OMB and that he respects her integrity and intellect, but he wanted assurances that as HHS secretary she would not become a shill for the Obama administration.

"I'd ask you simply, as secretary of HHS," Scott said, "would you in fact be the Health and Human Services secretary for the American people or will you be, as your predecessor has been, the ambassador of Obamacare?"

"I am here to serve the American people," Burwell replied. "I am part of the President's administration and I am honored to be appointed. But first and foremost I serve the American people. I believe the president and his policies are aligned with that, but I am here to serve the American people."

On the Issues
The Senators used their allotted time to assess Burwell on key issues before HHS. A career bureaucrat, Burwell ably avoided specifics.

HIX and the Single Payer
Sen. Pat Roberts (R-KS), asked Burwell if she supports expanding the PPACA beyond the exchanges and to a single-payer system.

"If I am confirmed, I will implement the law and the law is a system that has a market-based system and that is why the exchanges are up and running and putting people in systems that are private insurance systems," Burwell replied.

Interstate Commerce and Medicaid
Sen. Lamar Alexander (R-TN), the ranking Republican on the committee, asked Burwell if HHS would support allowing consumers to purchase health insurance across state lines.

"If I am confirmed, that is something I want to look into and understand," Burwell replied. "When one looks into that question what you have to consider is can the markets work in each of the states. When you go across states can you still keep the system up and working and care being provided?"

Alexander also asked about giving states more flexibility to design their Medicaid programs.

"There have been a number of examples where flexibility has been granted," Burwell replied. "Flexibility is important. Principles are important. Where you meet in that space, having enough standardization that meets the principles, but flexibility to meet the varying needs of states is something that I think is important in how I would think about it."

Resistance to Reform
Sen. Chris Murphy (D-CT), asked Burwell how she would work with states that are less than enthusiastic or even hostile toward the PPACA.

"Flexibility is one of the points. What is important is to send a signal that folks are willing to have the conversations," she replied, adding that states that have rejected Medicaid expansion money may warm to the idea when they see success stories from other states that have embraced the reforms.

Technology
Sen. Kay Hagen (D-NC), asked Burwell what lessons could be learned from the technical failures in the Obamacare rollout. Burwell stressed a need for individual ownership and accountability for IT projects, improved communication between stakeholders and their IT teams, and a new model for building IT systems.

"Generally, in procurement, we have had a waterfall approach, a building approach," she said. "When one is doing information technology, a more iterative approach where one tests in small pieces and moves and learns is a better approach to [the way of] doing procurement. We are not set up to do that in terms of how we set standards and do expectations."

Bundled Payments
Sen. Elizabeth Warren (D-MA), asked Burwell if she would exercise her statutory authority under the PPACA to expand the use of bundled payment models that have been shown to reduce costs and improve quality.

"You want to find the models which are the most successful and which are the most likely to scale, because that is what we need across the nation," Burwell replied.

"You have to consider both questions when considering what you would scale because you want to get the largest impact you can. That impact is a combination of both what the measures are of success, but it is also your ability to make it go broadly across the nation."