There's already a mountain of problems waiting for Sylvia Mathews Burwell at HHS. And that mountain will probably grow even bigger by the time she's confirmed.
Burwell's confirmation process begins Thursday with a hearing in the Senate Health Committee, followed sometime soon by a Finance Committee hearing. She'll likely be confirmed. Democrats have enough votes on their own, and she's already drawing some bipartisan support.
And if she is confirmed, she'll then have to actually take over a sprawling, poorly managed department responsible for the president's top domestic priority — not to mention the country's most expensive entitlement programs, its food and drug regulations, and its most important medical research.
Obamacare implementation would certainly be Burwell's biggest responsibility, and there's still a lot that needs to be done. The new secretary would face an immediate political challenge as insurers begin to file their premiums for plans sold through the health care law's exchanges, and she also would have to navigate unfinished policy and technological work.
HHS is already looking for new contractors to overhaul HealthCare.gov, the primary Obamacare enrollment site, in time for the next sign-up period. Those contractors will have to build new systems, repair or replace old ones, and have the whole thing tested and ready to open for business on Nov. 15, while also integrating the systems of states that are giving up on their own exchanges and turning to the federal government instead.