On Thursday morning, Kathleen Sebelius testified before Congress and announced that Obamacare signups had reached 7.5 million people.
On Thursday evening, news broke that Sebelius was stepping down as Secretary of Health and Human Services.
Maybe Sebelius and her supporters hoped that the morning news would put a more positive spin on the evening’s. If so, they were very, very wrong. The first sentence of the New York Times article on her resignation described a “stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act.” Expect more of the same in the coming hours and days.
Sebelius deserves at least some of that treatment. The technological failures of healthcare.gov during October and November—and the failure to anticipate a wave of private plan cancellations—represented low points for the cause of health care reform, the Obama presidency, and liberalism more generally. HHS was in charge of Obamacare implementation and Sebelius was in charge of HHS. In one of her many grueling sessions of congressional testimony, Sebelius said that critics should hold her accountable for those failures. They are now doing that—actually, they've been doing that for some time. That opening Times paragraph is what accountability sounds like.
Sebelius brought two main assets to her job. She had experience regulating insurers and, as a successful Democrat in Kansas, she knew how to work with Republicans. But what Obamacare needed more was a deft, aggressive manager. Case in point: By all accounts, Sebelius did not grasp the severity of tech problems at healthcare.gov until the day it went live and crashed. If she got the warnings, then she should have heeded them. If she didn't get the warnings, then she should have appointed people who would have kept her better informed. Either way, that's a serious management failure.
Still, it’s not as if Obamacare’s implementation difficulties are entirely, or even mostly, the fault of HHS. It’s a typical, if predictable, failure of Washington to demand a fall guy when things go wrong. But responsibility rarely lies with just one person. (That's one reason Obama resisted calls to fire her.) And this case is no exception.
Implementing Obamacare was never going to be easy. The law is full of compromises that, however politically necessary, weakened regulations and depleted funding that would have made introducing the new insurance system a lot easier. And Sebelius never had the kind of control a chief executive officer would. She was always dealing with a host of other players—from superiors at the White House to underlings at the Center for Medicare and Medicaid Services (CMS) to Democrats on Capitol Hill to lobbyists for the health care industry. And that's to say nothing of her war with the congressional Republicans, who were trying actively to sabotage the law through repeal votes, funding cuts, and intimidation of would-be allies.
More important, the law seems to be working, despite all of those early problems. That 7.5 million figure she announced on Thursday is a genuinely big deal—particularly since, from what I hear, the final number is likely to be even higher. It’s now clear that Obamacare is succeeding in one of its primary goals—reducing the number of Americans without health insurance. The only question is by how much. "Secretary Sebelius took and will take her share of arrows for the initial roll out, but she unquestionably deserves credit for the recent successes," says one former Administration official. "Her external cool was sometimes a liability, but it helped internally to avoid the finger pointing and to allow the Department successfully regain their sea legs."
Of course, Sebelius can’t take all or even most of the credit for the Affordable Care Act's improved performance, any more than she should take all or most of the blame for the law’s troubles. But any accounting of her tenure must include such achievements (and others, like improvements to Head Start and stronger regulations on child care safety). To take one obvious example, Sebelius worked extensively with Republican governors who wanted to expand Medicaid in states with hostile conservative constituencies. Some of those efforts succeeded.
Authorities from one of those states, Ohio, reported on Thursday that more than 100,000 low-income residents were getting coverage through the state's expanded Medicaid. The announcement came just hours before the news about Sebelius' resignation broke—and the juxtaposition seems fitting. The memories of Obamacare’s difficult start will certainly linger. But to the millions of people around the country who now have access to affordable medical care, I’m not sure that really matters.
Note: This item has been updated.