“There is still a tremendous amount of work to do for the Affordable Care Act implementation to be completed,” he said.
Burwell will have to carry out that work under political opposition to the ACA that remains as intense as it was four years ago when it was enacted. HHS still has to resolve problems with the state and federal exchanges' back-end technology to make sure the marketplaces are functioning effectively when 2015 open enrollment begins Nov. 15. In addition, Burwell will need to work closely with insurers to keep them on board with the multiyear rollout of the exchanges.
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 law.
Joseph Antos, a healthcare policy expert at the conservative American Enterprise Institute, questioned Burwell's lack of business experience. Many businesses are frustrated by the law's bumpy rollout and repeated rule changes, he said.
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 last year in her current post by a 96-0 vote.
“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.”
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