OMB Director Sylvia Mathews Burwell waits for the beginning of her confirmation hearing before the Senate Health Committee. (Alex Wong / Getty Images)
Senators heaped praise upon Sylvia Mathews Burwell, President Obama's nominee for secretary of Health and Human Services, even as Republican politicians blasted the Affordable Care Act.
Sen. John McCain, R-Ariz, called her a friend. Sen. Tom Harkin, D-Iowa, called her "dynamic." Sen. Lamar Alexander, R-Tenn., said she had a reputation for "competence," but continued, "You are going to need it."
Burwell is now the director of the Office of Management and Budget
But Sen. Tim Scott, R-S.C., issued a statement calling for the end of "Obamacare," and Alexander said he'd like to fix a "historic mistake."
In her opening statement, Burwell stuck to the middle ground, saying she hoped to lower costs and improve access to the health care system, and that she would focus on keeping people safe.
"The issues are fundamental to all of us — whether it is the chronic condition of a child we love, the safety of the food we eat every day, or improving quality, lowering the cost and expanding access in our health care system," she said. "So I respect the importance of the challenges before us."
But she also wasn't afraid to praise the new law, saying health costs would be greatly reduced.
Burwell's hearing came a week after HHS announced that 8 million people had signed up for private health care through the exchanges--one million more than the Congressional Budget Office originally projected, and two million more than CBO's most recent projection.
That came under the leadership of HHS Secretary Kathleen Sebelius, who said 13 million people have gained insurance through Medicaid and the adults younger than 26 who gained coverage through their parents' plans. Sebelius announced her resignation last month on the same day she announced the administration had surpassed its goals.
Murphy called Sebelius' service "admirable," adding that "she carried out the law."
But Burwell also would inherit, should she be confirmed, a federal exchange site that had a disastrous launch in October, before being fixed in November at the user end. It still has problems at the back-end, for insurers and payment processing, insurers testified at a hearing Wednesday.
And a November election that will likely focus on the Affordable Care Act to boost or bring down politicians could bring continued stress to whomever head HHS.
Senators expressed hope that Burwell's leadership at OMB, as well as her ability to work with both parties, would smooth the transition to a new secretary.
Sen. Elizabeth Warren, D-Mass., said that so far, Medicare spending has gone down under the ACA, and that it will be $500 billion less than originally projected from 2017 to 2026. She added that that's more than any of the budget cuts made recently.
Burwell said federal costs have been cut by $900 billion, according to the Congressional Budget Office.
"The implementation of the changes in the Affordable Care Act are reducing the deficit and providing great savings," Burwell said. She said the law would extend the life of the Medicare Trust Fund by five years.
Sen. Barbara Mikulski, D-Md., asked what experience Burwell has that could help her "wrap your arms around this huge bureaucracy."
Burwell said she needed to create a goal list, building strong teams and empowering them, and understanding when analytics versus emotion are leading the charge. While she served as president of global development at the Gates Foundation, she said she had to use those abilities to lead health programs worldwide.
Sen. Pat Roberts, R-Kan., asked if she understood there was a difference between implementing the law and pushing an agenda. Burwell said she looked forward, if confirmed, to expanding access and continuing
Roberts then asked about the Independent Payment Advisory Board, which has no members yet, and if she would use the board to control Medicare costs. For now, Congress is advised by the Medicare Payment Advisory Commission, and Congress may choose to act on those recommendations. If IPAB comes into play, its recommendations would be automatic unless Congress voted to stop an action.
"I am confident that IPAB will never need to be used," she said, saying the board only goes into place if Medicare costs reach a certain limit, and Medicare costs have been remaining stable.
"I'm afraid I'm not as confident about that as you are," Roberts said.
Sen. Michael Enzi, R-Wyo., asked about the failure of the Healthcare.gov when it launched, when users were met with an overwhelmed website. He asked what role she played. Burwell said her office worked to provide IT resources to fix the site.
Enzi said much of the back-end portion of the website are still behind, and asked about a no-bid contract awarded to Accenture. Burwell said the issue would be a top priority for her, but that she was not involved in the contract process.
Enzi then asked about how many people had paid their premiums, citing figures of 1 in 5. Wednesday, insurers said in a House hearing that between 80 and 90% of people had paid their first month's premiums.
"With regards to the specific data HHS has, I'm not privy to this knowledge in my current role," Burwell said. But she said insurers have not given final numbers to the administration.
Lisa Murkowski, R-Alaska, said premiums had doubled in her state, and that a low number of people signed up for insurance through the exchanges. Alaska has some of the highest premium prices in the country, as they did before the new health law was enacted, according to data from the National Conference of State Legislatures.
Sen. Tammy Baldwin, D-Wis., said healthcare has lacked transparency historically, and that patients have not been able to look at costs before making healthcare decisions.
Burwell said getting the information, and getting to both the patients and the providers, is a priority.
"I believe this is an important part of both quality and cost," Burwell said.
Sen. Tim Scott, R-S.C., asked if Burwell would be willing to be open and honest about implementation, regardless of what the Obama administration said. He called Sebelius the "ambassador of Obamacare." Burwell said her guiding principles would be accuracy and transparency.
Sen. Richard Burr, R-N.C., asked about health as a matter of national security, especially as it applies to pandemics.
"Senator, I do believe it is a matter of national security," Burwell said. "I think they are very important in terms of thinking about what are the tools we have, and what access do we have to them."
Burr continued with more praise:
"I support her nomination and I will vote for her," Burr said. "She comes with a portfolio of experiences" that make her qualified for the position.