Sebelius Faces Public Health Challenges

Janice Simmons, for HealthLeaders Media , April 29, 2009

Kathleen Sebelius, who was confirmed by the Senate in a 65-31 vote as secretary of Health and Human Services yesterday, was sworn in at the White House earlier today by President Barack Obama on the 100th day of his administration.

"Obviously, we have a lot to do to make sure that healthcare is affordable for the American people [and] to deal with critical issues like food safety. But we wanted to swear her in right away because we've got a significant public health challenge that requires her immediate attention," Obama said, referring to the current global concerns over swine flu.

"I expect her to hit the ground running, and I have every confidence that given her experience as a governor who's managed crises before, who's worked on public health issues since she's been in public life, she is the right person at the right time for the job," Obama said. Sebelius resigned her position as Kansas governor last night.

The confirmation finally fills President Barack Obama's last cabinet post. It comes at a time when other healthcare issues, including healthcare reform, are dominating the headlines--seemingly foreshadowing the busy agenda Sebelius will encounter as she begins her new position.

What's next for Sebelius
As new HHS secretary, Sebelius will lead an agency of 65,000 employees and a $750 billion budget that overseas HIPAA-related activity.

The leader of HHS is charged with defining countless regulations of the American Recovery and Reinvestment Act of 2009, signed two months ago, namely ones surrounding the effort to move hospitals to complete electronic health record adoption by 2014; these are included in the Health Information Technology for Economic and Clinical Health Act (HITECH Act).

HHS already is on top of HITECH deadlines, and the delay in Sebelius' nomination does not push off the HITECH deadlines, says Rebecca Herold, CISSP, CIPP, CISM, CISA, FLMI, of Rebecca Herold & Associates, LLC, in Des Moines, IA.

HHS beat the 60-day window imposed by Congress to define "unsecured protected health information" on April 17, when it issued its draft guidance.

David C. Kibbe, MD, MBA, senior advisor to the American Academy of Family Physicians, says HHS has been working with a small staff.

"Someone told me in jest there are seven people working in HHS right now, and they're peddling as fast as they can," said Kibbe, who also chairs the ASTM International E31 Technical Committee on Healthcare Informatics and is a principal for The Kibbe Group LLC, in Raleigh-Durham, NC.

Kibbe says there is a "certain fogginess" over HHS the last few months, but Kibbe adds healthcare leaders should focus on what happens in-house from here.

A good place to start is with Rahm Emanuel, Obama's chief of staff, and Peter Orszag, the president's budget director, says Joseph Paduda, principal, Health Strategy Associates, LLC, in Madison, CT.

Those two are the "centers of power" in healthcare reform, Paduda tells Healthleaders Media. Emanuel does not want to take on the doctors and big pharma right now, but Orszag believes that you can't fix the economy without fixing healthcare.

"And therefore the two are inextricably intertwined," Paduda says. "Sebelius, while a great choice and a strong candidate, is likely not going to play as significant a role in reform as these two heavyweights."

"Who is the head of HHS is not going to change what's already been written," Herold says. "Enforcing regulations is the goal."

Sebelius will also need to fill several key positions including the head of the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Centers for Disease Control, and the U.S. Surgeon General.

Dom Nicastro, a managing editor with HCPro, Inc. contributed to this report.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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