Meet Sylvia Mathews Burwell, the Woman Getting DC's Worst Job: HHS Secretary

Imagine someone came to you and said, "I will give you this job where you manage one of the most complicated, least popular, and most politically toxic things in the government, but before you get the job, a bunch of senators will be intentionally harsh to you to improve their political positions."

Imagine someone came to you and said, "I will give you this job where you manage one of the most complicated, least popular, and most politically toxic things in the government, but before you get the job, a bunch of senators will be intentionally harsh to you to improve their political positions." President Obama made that pitch to Sylvia Mathews Burwell and she — inexplicably — said yes.

Burwell currently runs the government's Office of Management and Budget, an executive branch agency that helps the president prepare and evaluate the federal budget. Does your workplace have an office manager? This is sort of what Burwell does for the federal government. Prior to her current gig, she worked in the non-profit world, running the Walmart Foundation (a distinct philanthropic offshoot of the corporation) and, prior to that, as an executive with the Gates Foundation. She's also a veteran of the Clinton Administration, working under now-Treasury Secretary Jack Lew when he ran OMB.

The White House didn't waste time singing her praises. An official (who inexplicably asked Politico for anonymity) pointed out that she was confirmed to run OMB unanimously. "She navigated a lengthy shutdown. She has proved to the president and everyone around here that she is a masterful manager and someone who can really run a process and dig in and figure things out. And she’s very well liked on the Hill." Former Treasury Secretary Larry Summers, who has a keen eye for talent, added, "I’ve never met a policy official with more focus on and capacity for execution."

Great, good. But it is impossible to believe that anyone within 45 miles of the Beltway is under any delusion that Burwell will therefore walk through her Senate confirmation hearings and then quietly continue the rollout of Obamacare.

Whoever replaces outgoing HHS head Kathleen Sebelius will take the reins of a horse that veterinarians are still keeping a very close eye on and which Republicans are still trying to trip (to extend the metaphor to its breaking point). Obamacare's role as a government program is almost less significant at this point — seven months before the midterm elections — than it is a political shorthand. It's a pre-ballot checkbox, as sure-fire a descriptor of a candidate's political views as the D or R next to their names.

So when Burwell shows up on Capitol Hill for her Senate confirmation hearings, senators will hammer her over Obamacare because of politics. Arizona Sen. John McCain tweeted his support for Burwell, but he's not running for reelection. There are legitimate concerns over the program, exemplified in the complete debacle that has contributed to Sebelius' hypenated last name ("Kathleen Sebelius-Who-Oversaw-The-Botched-Obamacare-Rollout"). But someone has to run HHS and whoever does would face the same grilling. It's a chance for Republicans to bash the program in front of TV cameras and for Democrats facing reelection in red states to similar walk a hard line. The administration could put a stuffed doll in the hearing chair and let senators yell at it for four days and accomplish nearly as much.

Burwell only needs 50 senators to support her, and it seems unlikely at this point enough Democrats would flake to prevent that from happening. On her first day in the position, she will open the top drawer of the desk in the Secretary's office, remove the ceremonial bib emblazoned with a large target reading "Obamacare," and start the hard work of implementation. Politico walked through the challenges the next secretary will face: working better with insurers, upgrading the still-wobbly website, preparing for the roll-out of the employer mandate.

All of which will need to be done while dodging political bombs thrown from all directions. There is zero chance that opposition to Obamacare will fade substantially after the mid-terms and as 2016 approaches. For the first year or so, Burwell will have the same excuse Obama enjoyed when he first came into office: I'm just cleaning up the previous guy's mess. But that won't last.

Running HHS, as the old saying goes, is a tough job, but someone has to do it. And there are a lot of people in D.C. who are probably exhaling with relief that they aren't the ones that have to do this particular tough job. Including, probably, Sebelius-Who-Oversaw-The-Botched-Obamacare-Rollout.