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Obama's New Health Secretary Could Change How Washington Works

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Sylvia Mathews Burwell is about to inherit one of the most difficult jobs in Washington. As President Barack Obama's nominee to lead the Department of Health and Human Services, she could soon be responsible for overseeing a massive and complex bureaucracy still reeling from Obamacare's botched implementation, with many challenges ahead.

It's a job that could conceivably have her working around the clock -- a situation not at all foreign to high-level Washington insiders. But according to Burwell's friends and colleagues, she exhibits a style of leadership that's a bit unusual in one of the nation's most overworked cities.

"I understand it's a hard, fast rule that she's out of the office at 6 and home with her kids," said Neera Tanden, president of the Center for American Progress and a friend who worked with Burwell when they both served in the Clinton administration. "She worked kind of manic hours in the Clinton White House, but now she has children. They'll just pick up the phone and yell, 'Where are you?'"

Burwell has apparently maintained this balance even while overseeing the White House Office of Management and Budget, where she has served as director since April 2013. Yet leading HHS may be even more demanding. The department has the largest budget of any Cabinet-level agency in the federal government and will spend about $1 trillion in the coming fiscal year -- more than 1 1/2 times what the Pentagon will spend. HHS is composed of 11 agencies and even more offices and programs that employ the equivalent of nearly 80,000 full-time employees.

Burwell will also take over from current HHS Secretary Kathleen Sebelius in a supremely challenging environment. After the highly public, embarrassing initial failure of Obamacare's health insurance exchanges last fall, Burwell will be responsible for ensuring that the second sign-up period, which begins Nov. 15, goes more smoothly amid ceaseless political rancor over the program. Maintaining any semblance of a private life in an atmosphere like that could test Burwell's convictions.

A mother of two young children and a native of Hinton, West Virginia, Burwell appears to be up to the task. She worked on President Bill Clinton's economic team, held major leadership positions across the public and private sectors, and earned the approval of both Republicans and Democrats in Congress along the way.

Her résumé rivals that of any Washington power player. After working in the Clinton White House, the Harvard graduate became deputy director to then-Office of Management and Budget Director Jack Lew, and after that was chief of staff to Treasury Secretary Robert Rubin. She went on to run global development for the Bill and Melinda Gates Foundation and took over the Walmart Foundation before returning to Washington to oversee OMB.

Concerns about how the OMB job might affect her family played a large role in her deliberations about whether to take the position. “I sat there with the yellow pad and [was] like, OK, what are the pros and cons, what will be the things that will be difficult, let me think through this before we make a decision as a family,” Burwell told the Christian Science Monitor recently. Burwell's husband, Steve Burwell, is a lawyer in Washington.

An HHS spokesman said Burwell would not comment for this article because she is still in the confirmation process.

Last month, the Senate Finance Committee overwhelmingly approved Burwell's nomination to lead HHS, and people with whom she has worked over the years say they are not surprised her confirmation process has been so smooth.

"You don't often see leadership like this woman brings to the table," Erskine Bowles, the former chief of staff to President Clinton and Burwell's former manager, told The Huffington Post. "She's exceptional, and whether she was a man or a woman, she would have broken every ceiling you could find. I don't know anybody I've ever worked with in the public or private sector that I would endorse more than her."

Lew said when he hired Burwell as his deputy director at the OMB, she easily broke into a "budget fraternity" that is typically pretty hostile to outsiders. "Someone who comes in from the outside often has a bit of a hazing, and she was a White House person," he told HuffPost. "But the first budget cycle, people would just as soon talk to her as me, or maybe even prefer to talk to her than me, because they had huge respect for her integrity, her judgment, and her ability to get things done."

Working high-level federal government jobs can mean grueling hours and having no life outside of the office. The Clinton White House in particular was a notoriously frenetic work environment.

But Burwell is known for making it a point to turn the light off in her office and shut her computer down when she leaves work every day, to make it clear to her staffers that she's gone and that they can go home too.

"She has a lot of respect for work-life balance and tries very hard to make sure that people are not being kept in the office when they don't need to be there," said Lew, who is now secretary of the Treasury. "I think Sylvia's very careful not to pull people into unnecessary false crises."

But turning off the lights and going home for the night is no easy feat when you're the secretary of Health and Human Services, said Michael Leavitt, who held the position during President George W. Bush's second term.

"It was a very demanding time for our family," said Leavitt, who is now chairman of Leavitt Partners, a health care consulting firm in Salt Lake City. "I think we all feel strongly about the need for life balance, and I will admire her greatly if she's able to achieve a high degree of it."

Burwell's discipline may be tested more than ever in the next few years. HHS is a vast and sprawling bureaucracy made up of vital health agencies like the Food and Drug Administration, the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, and its purview reaches even further to include welfare, programs for the aging, homeland security and global health issues.

"It's a big department. It takes months just to master all the acronyms," Leavitt said.

A major challenge for the next HHS secretary will be continuing work on the Affordable Care Act rollout. While the Obamacare exchanges surpassed initial targets and 8 million people secured health insurance during the first sign-up window, there's still more that needs to be done. Key components of HealthCare.gov, the web portal for enrollment in more than 30 states, have yet to be built, and others still require overhauling. Burwell also would be at the center of the next big fight about the cost of health insurance, as prices for exchange plans trickle out over the coming months against a backdrop of the congressional elections, amplifying the attention this still-unpopular program will get.

As if that weren't enough, the HHS secretary must also deal with unexpected emergencies -- from outbreaks of infectious diseases like avian flu to tainted food scares to unsafe medicines shipped from foreign factories.

"There are dozens of things that could ultimately demand attention that could become tomorrow's headline," Leavitt said

Lew said he is skeptical that Burwell would ever sacrifice her grip on the job to have more of a family life -- particularly if a crisis arises. As OMB director, she ordered and managed the shutdown of the federal government after a congressional impasse last year, and did not get a lot of sleep during that time, Lew said.

"She didn't have a deputy at OMB," Lew said. "She managed OMB and the government shutdown by herself, and she was working 20 hours a day probably. I don't think anyone who knows Sylvia would have a moment's hesitation but to know that she does not stop until the job's done."

"But," Lew added, "if she can do that and have dinner with her kids and go back to work after, my hat's off to someone who can manage their life to do that."

The Senate appears poised to confirm Burwell's nomination easily, despite the politics of Obamacare and signals of opposition from tea party Republicans like Sens. Ted Cruz (Texas) and Mike Lee (Utah). Other Republicans are vocal Burwell supporters, including Sens. John McCain (Ariz.) and Tom Coburn (Okla.), who introduced her at her confirmation hearings. The Senate confirmed Burwell to her OMB post on a 96-0 vote.

Burwell gets that level of bipartisan backing because lawmakers see her as a member of their tribe, said Donna Shalala, who served as Health and Human Services secretary during President Clinton's two terms and knows Burwell from that time.

"People that are Washington insiders always have an easier time getting confirmed. She's a known quantity," said Shalala, who is now the president of the University of Miami. "She understands that you have to have good access and relationships. They have to feel like they have access to you. They'll take a 'no' as long as you listen."

Even some lawmakers who support Burwell are skeptical that anyone could be successful in the HHS job, however. “I advised her against taking the leadership position at HHS,” McCain said at Burwell's hearing before the Senate Health Committee. “After all, who would recommend their friend take over as captain of the Titanic, after it hit the iceberg?”

If Burwell does manage to succeed in smoothly implementing Obamacare without burning the midnight oil every night, it could potentially recraft the conversation about work habits in Washington.

"We have to set up a structure in Washington where it's not a choice for women between work and family," Tanden said. "We're not going to have the women leaders we want and need if you're taken out of the pool when you have kids."

Shalala said that, based on her experience as HHS secretary, having a life is necessary not only to avoid burnout, but also to do the job well. "The president hired us for our judgment, not for our energy level," she said. "And to keep your judgment sharp, you have to be rested, and you have to find that balance."

Shalala said she thinks it's possible. "These are very complex jobs and complex agencies, and they can be run with a certain amount of balance, even when the White House is staying up all night," she said. "There were no divorces in my department at the upper levels while I was there."

Burwell might be able to find time for her family, too, while managing a massive Washington agency and an embattled health care law. But that doesn't mean she won't be responding to emails from the dinner table, those who know her surmise.

"She may turn her light off, but she doesn't turn her engine off," said Lew.

CORRECTION: A previous version of this story said Burwell was deputy chief of staff for Jack Lew at the OMB. She was his deputy director.

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