WASHINGTON -- Sylvia Mathews Burwell, President Barack Obama's nominee for secretary of health and human services, plunged into a confirmation hearing Thursday with a strong endorsement from Sen. John McCain, R-Ariz.
Burwell, 48, a native of Hinton, W.Va., was introduced by McCain and Sen. Joe Manchin, a Democrat.
"Regardless of my objections to the Affordable Care Act, the Department of Health and Human Services needs competent leadership," McCain said. "I believe Ms. Burwell has the qualifications to run Health and Human Services."
McCain predicted that Burwell would be more responsive to members of Congress than the current secretary, Kathleen Sebelius, has been.
During her testimony, Burwell refused to say whether she would support proposals to let people keep insurance policies that do not comply with the law's coverage standards.
Republicans stacked a large pile of documents behind the dais wrapped up in red tape and labeled "Obamacare Regulations," and prodded Burwell on aspects of the law.
"What we are trying to do is common-sense implementation within the law. That is the objective," Burwell replied.
In response to a question from Sen. Pat Roberts, R-Kan., Burwell said she had no intention of pushing for a single-payer health-care system, financed by the government.
"I will implement the law, and the law is a market-based system," with private insurance policies sold by competing carriers in federal and state marketplaces, she said.
Burwell defended the health-care law, asserting that it has improved the economy, held down the growth of health costs, reduced premiums and expanded coverage.
The law "is making a positive difference in the lives of our families and our communities," Burwell said in testimony before the Senate Health, Education, Labor and Pensions Committee.
Burwell said the administration had not provided an estimate of how many people signing up for insurance had paid their initial premiums because "insurance companies have not given us final numbers."
Sen. Tom Harkin, D-Iowa, said Burwell was "eminently qualified" to lead the sprawling agency. The Department of Health and Human Services provides insurance to more than 100 million people through Medicare and Medicaid, regulates food and drug products that account for roughly one-fourth of consumer spending, and sponsors biomedical research that has saved or extended millions of lives.
Harkin is chairman of the committee, which won't actually vote on Burwell's nomination; that task falls to the Senate Finance Committee, which is expected to hold a hearing in coming weeks.
A floor vote in the full Senate could happen as early as this month.
Sen. Lamar Alexander of Tennessee, the senior Republican on the health committee, said Thursday: "Ms. Burwell, you have a reputation for competence. You are going to need it. If you are confirmed, you by yourself will be in charge of supervising nearly $1 trillion in annual spending."
Sen. Jay Rockefeller, D-W.Va., said that as a Clinton administration official Burwell had "learned how to work with Congress and across the aisle" and helped devise budgets that produced several years of surpluses.
Sen. Richard M. Burr, R-N.C., said he intended to vote for Burwell because she had "a portfolio of experience that would make her a tremendous asset" to the Department of Health and Human Services.
Burwell, a Harvard graduate who attended Oxford University as a Rhodes scholar, is the director of the Office of Management and Budget; the Senate confirmed her for that job in a 96-0 vote in April 2013. She also worked in the Clinton White House, at the Wal-Mart Foundation and at the Bill and Melinda Gates Foundation.
The earlier unanimous vote does not guarantee smooth sailing this time. Republicans hope to win a Senate majority in November on the strength of their opposition to the health-care law, and they have made it clear that they will use the confirmation hearings as a forum to investigate the law's operations, including the penalties for people who go without insurance and for larger employers that do not offer coverage to full-time employees.
If confirmed, Burwell would succeed Sebelius, 65, who announced her resignation last month but is staying on the job until a replacement is approved. Sebelius was widely criticized after problems with the health-care law's website, healthcare.gov, prevented many people from signing up in the early weeks of the enrollment period.
Unlike Sebelius, Burwell has extensive experience as a federal manager. She also has the full confidence of White House officials, including those in Obama's inner circle.
When the White House announced her nomination, Denis McDonough, the White House chief of staff, said, "The president wants to make sure we have a proven manager and relentless implementer in the job over there, which is why he is going to nominate Sylvia."
Burwell also can claim the support of the health insurance industry. Karen Ignagni, head of America's Health Insurance Plans, called her "uniquely qualified to lead HHS during this critical time."
Sebelius, a former state insurance commissioner and governor of Kansas, had appeared to be well prepared for the job she took on in April 2009. But she grew distant and fell out of favor among Republicans, ignoring many of their questions and requests for information. Many administration officials have a low regard for congressional Republicans, but Sebelius sometimes appeared to flaunt her distaste for them.
"I've never really talked to her," Sen. John Barrasso of Wyoming, a point man for Republicans on health care, said last summer.
Rep. Michael Burgess, R-Texas, chairman of the Congressional Health Care Caucus, said Sebelius had been "operating with a fortress mentality."
In praising Burwell, Manchin emphasized her upbringing.
"If you want to know Sylvia, you should look at her small hometown of Hinton and the surrounding Summers County that she grew up in, because that is her grounding," he said. "It is pure Americana, a onetime railroad boom town woven into the mountains of Appalachia."
Manchin said Burwell's parents had been community leaders for more than a half-century.
"Her father, Dr. William Mathews, is a longtime optometrist," he said, "and her mother, Cleo Mathews, previously served as the mayor of Hinton."
He added that Burwell had tried to help families "achieve the American dream her Greek immigrant grandparents found in this country."
Information for this article was contributed by Robert Pear of The New York Times and by Erica Werner and Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 05/09/2014