Obama taps budget guru, technocrat for health job

President Barack Obama, stands with his nominee to become Health and Human Services secretary, Budget Director Sylvia Mathews Burwell, while speaking in the Rose Garden of the White House in Washington, Friday, April 11, 2014, where he made the announcement. Burwell would replace Kathleen Sebelius who announced her resignation Thursday. AP.

WASHINGTON—Sylvia Mathews Burwell, nominated to run President Barack Obama’s much maligned health care overhaul, would bring a wealth of expertise in economics and government management to one of Washington’s toughest jobs, even though she has little direct experience in the health care industry.

In selecting Burwell to replace Health and Human Services Secretary Kathleen Sebelius, Obama chose a veteran technocrat who members of both parties say is up to the challenge of running a $1 trillion bureaucracy that rivals the Pentagon in complexity. If confirmed, she’ll inherit a beleaguered agency seeking desperately to turn the page on a tumultuous chapter characterized by the problem-riddled rollout of Obama’s health care law and HealthCare.gov.

Although the Senate confirmed her unanimously for her current job as Obama’s budget director, Burwell is unlikely to emerge this time without a few bruises. With an eye toward the midterm elections, Republicans are eager to re-litigate Obama’s health care law in every public setting possible—and a Senate confirmation hearing offers a prime opportunity.

Burwell, 48, was born in tiny Hinton, West Virginia, and rose to become deputy chief of staff in the Clinton administration. The Harvard graduate and Rhodes scholar served as chief of staff to former Treasury Secretary Robert Rubin and as deputy director of the White House budget office during a period in which the federal government saw three consecutive budget surpluses. Taking a respite from government, Burwell was president of the Bill & Melinda Gates Foundation’s Global Development Program and later the Wal-Mart Foundation, before returning to the White House last year to run the budget office under Obama.

Those who have worked with Burwell describe her as meticulous, driven and results-oriented. In announcing her nomination, Obama noted with a hint of pride that in the year since she rejoined the White House, the annual deficit has dropped by more than $400 billion.

“She is a rigorous, relentless, proven manager,” said Brian Deese, Burwell’s deputy in the budget office, in an interview. “That is exactly what HHS needs right now.”

In her current post, she also shepherded the federal government through a 16-day shutdown imposed by Congress last year, and helped secure a budget agreement with Congress that has temporarily averted political brinksmanship over the United States economy. Rep. Chris Van Hollen, the top Democrat on the House Budget Committee, said she reached out early after taking over and has made a point to come to Capitol Hill to brief lawmakers on budget issues. “Members found that she was very responsive,” the Maryland congressman said.

Republicans generally reacted positively to her nomination, with Sen. John McCain taking to Twitter to call Burwell “an excellent choice” to replace Sebelius—a favorite punching bag for the Republican Party as the health law she oversaw faced setbacks and low approval ratings.

While Burwell has not been intimately involved in setting health care policy, her experience rooting out inefficiency and wasteful spending could be useful for an agency struggling with a reputation for mismanagement and a mandate to help slow the rate that health care costs are increasing.

If confirmed, Burwell will join a cadre of female staffers who have taken on increasingly central roles in the Obama administration, following criticism during Obama’s first term that his team was overly dominated by men. Neera Tanden, who worked in the Clinton and Obama administrations, said Burwell helped blaze a path for women in the policy world. When Tanden was a junior Clinton staffer, she recalled, Burwell would burst into meetings exhibiting power and enjoying the clear respect of her boss, Clinton chief of staff Erskine Bowles.

“Erskine would never say she’s the strongest woman. He would say she’s the strongest person,” Tanden said. “That just sent us a really important signal.”