And HHS will need to mount an ongoing education campaign aimed at the general public about the law's rules and benefits. Polls have repeatedly suggested that too many people remain ignorant about key provisions of the Patient Protection and Affordable Care Act, including the availability of subsidies for households that compose 400% of the federal poverty threshold.
Joseph Antos, a healthcare policy expert at the conservative American Enterprise Institute, questioned Burwell's lack of business experience. He pointed out that many businesses are frustrated by the law's bumpy rollout and repeated rule changes.
But even though her nomination is complicated by the toxic politics of Obamacare, Burwell isn't expected to face a serious confirmation threat. She was approved in her current post by a 96-0 vote last year.
In addition, Democrats rewrote the rules in November to eliminate filibusters for most presidential nominees. That means only 51 votes will be needed for Burwell to gain confirmation. And one of the foremost Democratic critics of the healthcare law, Sen. Joe Manchin, immediately issued a statement supporting the nomination of Burwell, a fellow West Virginian.
“There will be a huge amount of sturm und drang,” said Theda Skocpol, a government and sociology professor at Harvard University, “and there will be a lot of yelling and screaming, but she'll be confirmed.”
The struggles of HealthCare.gov, and the partisan rancor that it sparked, drew most of the media attention during Sebelius' tenure. But Joel Ario, managing director at Manatt Health Solutions and former director of HHS' office overseeing the health insurance exchanges, points to her close work with insurance companies and state governments as a crucial legacy that she'll leave behind.
“She was a very effective secretary with the constituencies that were most important here,” Ario said. “I think a lot of the things that she wasn't able to do is a problem with our politics, which it's hardly fair to blame her for.”
Follow Paul Demko on Twitter: @MHpdemko