HHS nominee Sebelius awaits Senate vote

Washington -- President Obama's second choice to lead the Dept. of Health and Human Services had her confirmation hearings on Capitol Hill but did not receive a Senate vote before lawmakers left town for two weeks, continuing a leadership void in the department.

Senators did not vote on whether to confirm Democratic Kansas Gov. Kathleen Sebelius as HHS secretary before recessing April 3. The next opportunity for the upper chamber to consider the nomination will come after lawmakers return to the Capitol the week of April 20.

Obama's first choice for HHS chief, former Senate Majority Leader Tom Daschle (D, S.D.), withdrew from consideration Feb. 3 amid controversy over tens of thousands of dollars in federal income taxes that he failed to pay on time. As a result, HHS is the only Cabinet position that Obama has not yet been able to fill.

Sebelius testified March 31 before the Senate Health, Education, Labor and Pensions Committee and April 2 before the Senate Finance Committee. Finance members vote on whether to recommend the nominee to the full Senate, which votes on whether to confirm the candidate.

During her hearings, Sebelius said she is in favor of reforming the Medicare physician payment formula, providing higher pay for primary care physicians, and pursuing comprehensive health system reform strategies, such as comparative effectiveness research.

Sebelius said the federal government has "a huge opportunity" to redesign the Medicare payment system to better allocate benefits and lower costs for seniors. Addressing a query during the HELP hearing from Sen. Patty Murray (D, Wash.) about the shortage of primary care physicians in her state, Sebelius also said payments need to be adjusted so that "primary care becomes a much more lucrative profession." She provided few details about how she would accomplish those goals.

Sen. Mike Enzi (R, Wyo.) challenged Sebelius on whether she would support lawmakers using the controversial process of reconciliation to enact health system reform. If Senate Democrats were to pursue the reconciliation tactic, they could effectively pass legislation with only 51 votes instead of the 60 usually needed to cut off debate. Republicans have warned that health reform is too important to submit to such a partisan process.

Sebelius did not directly endorse the use of reconciliation nor did she rule out supporting it, replying only that she has "an absolute dedication to engaging Democrats and Republicans."

Sen. Barbara Mikulski (D, Md.) asked Sebelius during the HELP hearing what she would do to avoid a possible health information technology disaster if a transparent national electronic health record system that promotes interoperability did not emerge soon. "Step one is to get a platform where people are talking to each other," Sebelius responded. She also cited the recent appointment of David Blumenthal, MD, as national health IT coordinator as a key move on the part of the Obama administration to address potential gaps in a national EHR system.

Support amid controversy

Sebelius has disclosed that she and her husband recently paid almost $8,000 in back federal income taxes and interest. She also mentioned during the Senate Finance Committee appearance a potential conflict of interest related to stocks in her husband's investment portfolio, though she said he is committed to divesting them.

Failure to pay taxes on time is ultimately what led to the derailment of Daschle's nomination, though the amount in question for the former senator was significantly larger than the amount cited for Sebelius. Despite the potential questions about her nomination, numerous physician and other health-related organizations applauded the pick.

The American Medical Association is one of the groups supporting the nomination. Sebelius "has demonstrated the leadership skills required to direct HHS and help implement health system reform," said AMA President Nancy H. Nielsen, MD, PhD. "In these tough economic times, the need for health system reform that provides coverage and high quality, affordable health care for all Americans is clear."

The American Public Health Assn. also backs Sebelius for the post, said Georges C. Benjamin, MD, the association's director. "Gov. Sebelius' knowledge of health policy issues and the importance of ensuring that all Americans have access to affordable, quality health services, as well as her experience working across party lines, make her an excellent choice."

Abortion issue avoided

Another potentially thorny issue was dodged when lawmakers decided not to question Sebelius about abortion issues, a topic on which she has faced some criticism from anti-abortion organizations. As governor, she vetoed legislation several times that would have limited abortions in the state.

"Gov. Sebelius may not pay her own taxes, but has no qualms about using tax dollars to pay for others' abortions," stated an April 2 letter signed by the leaders of seven anti-abortion organizations, including the Family Research Council, Concerned Women for America and the American Family Assn. "Even before she reported her tax issues, Gov. Sebelius was manifestly unqualified to run America's health care system, as illustrated by her coddling of the abortion industry at the expense of Kansas women's safety."

Groups on the other side of the debate spoke out in favor of the HHS nominee.

"Gov. Sebelius is a strong advocate for health care reform and has a proven track record of increasing access to affordable care," Cecile Richards, president of Planned Parenthood Federation of America, said in a March 2 statement. "Her ability to work in a bipartisan fashion will serve her well as the Obama administration and Congress tackle the critical issue of health care reform for American families."

At least one senator did not seem to think that the controversies would be enough to stop the Finance Committee or the full Senate from acting on Sebelius before long.

"We want to see you get confirmed, and we want to see you get confirmed quickly," said Sen. Ron Wyden, at the Finance hearing.