Railroaders place to shoot the shit.

By Michael A. Fletcher and Ceci Connolly
Washington Post Staff Writers
Sunday, March 1, 2009; A01

Kansas Gov. Kathleen Sebelius yesterday accepted President Obama's request to become his secretary of health and human services, stepping into a central role in the new administration's ambitious effort to overhaul the nation's health-care system.

Sebelius's nomination comes just days before the White House is scheduled to convene a summit on health reform, an early step in the president's bold plan to vastly expand the reach of the health-care system. A formal announcement of her nomination is scheduled for tomorrow.

The summit, which is expected to be the first in a series of open meetings across the country, is intended to spotlight the challenges presented by the nation's balkanized health-care system -- including soaring costs and gaping holes in coverage. It is also aimed at rallying public support for an overhaul certain to draw ideological and industry opposition. The health session, similar to last week's "fiscal responsibility" summit, will open with remarks by Obama. Participants will then split into working groups led by administration officials.

In his budget proposal unveiled last week, Obama set aside $634 billion for a new reserve fund that over the next decade would serve as a substantial down payment on the cost of moving the country closer to universal health-care coverage. About 46 million Americans lack coverage, a number likely to grow as the economic downturn puts more people out of work.

If confirmed by the Senate, Sebelius would fill a vital Cabinet position originally slated to go to former senator Thomas A. Daschle, who withdrew from consideration last month over his failure to pay $146,000 in back taxes and interest until he had been nominated for the post. The controversy prompted Obama to acknowledge that he had "screwed up."

Steering the costly changes through Congress, which would be a big part of Sebelius's portfolio, promises to be a complicated and politically charged task. The withdrawal of Daschle, a former Senate majority leader steeped in the byzantine ways of Congress as well as the intricacies of the nation's $2.3 trillion health-care system, delivered a significant blow to the administration as it prepared to launch its ambitious agenda on the topic.

Sebelius, 60, would inherit a sprawling department of 65,000 employees responsible for public health, food safety, scientific research, and the administration of the Medicare and Medicaid programs, which serve 90 million Americans. The solvency of the programs is yet another worry confronting the administration, which has vowed to take on entitlement reform. The department's budget, consumed largely by the two programs, exceeds $700 billion.

The Kansas governor served as state insurance commissioner for eight years and has overseen the Medicaid program for the poor during her tenure as governor. Sebelius tried unsuccessfully to expand health coverage in the state through higher cigarette taxes. Still, under her watch, Kansas has added tens of thousands of low-income children to state health programs.

As insurance commissioner, Sebelius rejected the sale of Blue Cross and Blue Shield of Kansas to an Indiana company, citing the prospect of higher premiums. The job, however, had little to do with the delivery of care or the achievement of the sort of quality improvements and efficiencies that Obama and policy experts speak of when describing a high-performing health-care system of the future.

More than a month into the administration, few Obama appointees have been placed in the Department of Health and Human Services, and the president has yet to name a chief for major health agencies such as the Food and Drug Administration or the National Institutes of Health.

"This evening, the president asked Kansas Governor Kathleen Sebelius to serve as his secretary of health and human services, and she accepted," an administration official said yesterday.

An administration source said it is likely that Obama will nominate someone else for a second post Daschle had created for himself: director of a new White House Office of Health Reform. One name mentioned for the job is former Clinton administration adviser Nancy-Ann DeParle, who would take over the effort to conceive, sell and implement a wide-ranging health-care overhaul.

Sebelius, the daughter of a former Ohio governor, is halfway through her second term as governor.

Although she lacks Washington experience, Sebelius is a veteran politician who learned the craft from her father, John J. Gilligan, and later her father-in-law, Keith Sebelius, a Kansas Republican who spent more than a decade in Congress. Kathleen Sebelius, a graduate of Trinity College in Washington, served eight years in the state legislature and was once a lobbyist for the Kansas Trial Lawyers Association.

Sebelius is known for reaching across the aisle in her Republican-dominated state, and in her first gubernatorial bid she chose a former Republican businessman as her running mate.

Sebelius, raised Roman Catholic in Ohio, has endured fierce and often personal criticism from antiabortion activists largely because she vetoed a bill that would have required doctors who perform late-term abortions to report a reason for the procedure. After the veto, the archbishop of Kansas City asked Sebelius to stop taking Communion.