Sylvia Mathews Burwell, who shepherded Obamacare, talks about its uncertain future; Q&A

WASHINGTON – As secretary of the Department of Health and Human Services for the past two and a half years, Sylvia Mathews Burwell has overseen the Affordable Care Act, Medicare and Medicaid, the Food and Drug Administration and a wide range of social services from Head Start to family assistance programs.

In a conversation with Tom Fox, Burwell discussed her concerns about impending changes to the Affordable Care Act, the presidential transition, her approach to leadership and playing basketball for President Barack Obama’s national security adviser. Fox is a guest writer for On Leadership and the vice president for leadership and innovation at the nonprofit, nonpartisan Partnership for Public Service. The conversation has been edited for length and clarity.

Q. What are your concerns about the plans by Congress and the president-elect to repeal and replace the Affordable Care Act?

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A. My concerns are focused on the millions of people across the country who rely on the law for coverage and for the protections it provides. It’s important to note that “repeal and replace” is a campaign slogan. We need to separate this rhetoric from the reality of the Affordable Care Act. Today, more than 20 million people have health insurance who didn’t have it before; no one can be discriminated against based on a pre-existing condition, and restrictions like lifetime and annual coverage limits are a thing of the past. Americans don’t want to go backward, back to a world where women can be charged more for health insurance because of their gender or entrepreneurs have to choose between starting a business venture and staying in a job just to keep a health insurance plan. We can make fixes to the ACA without jeopardizing the health coverage of millions of Americans.

Q. How are you addressing this issue with the career employees at HHS who have been involved in implementing the ACA?

A. We remain committed to a smooth transition of power to the next administration, and we are working with the transition team on that effort now. I have expressed great appreciation to the hard-working staff at HHS, and in the days remaining for this administration, I have instructed my team to keep working to finish strong and continue to ensure that every American has access to quality, affordable health care.

Q. What have been your biggest challenges at HHS?

A. One of the biggest issues is that there are always a number of serious challenges at the same time. When I came to the department, I needed to make decisions on technology for the next Affordable Care Act open enrollment, on issues related to the unaccompanied children crossing the border from Central America and the Ebola crisis. There were other pressing issues, such as how to deal with growing opioid abuse. The department’s jurisdiction is so broad and the challenges come all at once.

Q. How would you describe your leadership philosophy?

A. Three things guide how I think about leadership and management. The first is focusing on measureable outcomes. The second is prioritization at all levels of the organization because prioritization leads to appropriate delegation. Prioritization involves issues you should be spending time on, how and when. The third is relationships – internally, in terms of bringing out the best in people, intergovernmental relationships between departments, and developing relationships with Capitol Hill and our stakeholders.

Q. What advice would you give to the individual who will succeed you?

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A. Focus on outcomes and listen to those we serve.

Q. Can you give me an example?

A. When I was doing my first open enrollment for the Affordable Care Act, I went to events and listened to those who were signing people up, the groups on the ground that were part of the organizing efforts and the insurance companies. We would have a conversation where I would say, “What’s working and what’s not working?” I would listen, take the notes and then in the evening I would have a call with my team. So you move it through the organization with the understanding that I care.

Q. What’s something that people would be surprised to know about you?

A. Susan Rice, President Obama’s national security adviser, was my basketball coach for a period of time at Oxford University. Susan also is the indirect way I met my husband.

Q. Is there anything else that you wanted to share?

A. The importance of building relationships is critical to doing this job. The relationships need to be real and not just at the times when you need help. For example, I reached out to every member of the Senate myself when I was going through my confirmation even though obviously it’s a committee process. I thought that was extremely important, and I hand wrote thank you notes after the meetings. It’s important to have frank and forthright conversations and to develop trust, especially during times like these where there is a lot of distrust.

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