Kathleen Sebelius

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From the moment that former Senate Majority Leader Tom Daschle took his name out of the running for HHS Secretary, Kathleen Sebelius has been the name that everyone is talking about. And it’s easy to see the appeal: She is an enormously popular Democratic Governor in a state where Republicans outnumber Democrats two to one. (And has gotten high marks while doing it: In 2005, TIME named her one of America’s five best governors.)

Though she is Barack Obama’s second choice, after the Daschle nomination flamed out over unpaid taxes, Sebelius also brings to the post a deep understanding of the subject matter that comes not only from her gubernatorial tenure–in most states, Medicaid is the biggest item in the budget outside of education–but from a previous stint serving two terms as Kansas’ insurance commissioner. And she well knows how treacherous the politics of health care reform will be. Her own record of success is mixed: In Kansas, she tried several times to expand health coverage, but couldn’t get the GOP-controlled legislature to go along with the cigarette tax she proposed to fund it; however, she did oversee the addition of tens of thousands of low-income children to the state health care program.

What Sebelius lacks is experience with the legislative process in Washington. And indications are that she will not be named to the second job that Daschle had created for himself, the post of White House health czar. Word is that the leading candidate for the White House job is Nancy-Ann Min DeParle, who during the Clinton Administration directed the Health Care Financing Administration (a huge bureaucracy, since renamed the Centers for Medicare and Medicaid Services, which runs the Medicare program and directs the federal portion of Medicaid).

So what does Sebelius’ selection mean? People I have talked to around this issue say that the White House is giving Congress a specific mandate–universal coverage–but broad latitude in deciding how to reach that goal. Unlike in 1994, when Hillary Clinton’s task force worked out a detailed plan in secret, and then delivered it to Capitol Hill, Congress will be driving the train this time. Sebelius’ primary role, I think, will come in helping win votes and in selling the public on whatever plan emerges. If the past wars over health care reform are any indication of what lies ahead, that may be the most difficult job of all.

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