With the resignation of U.S. Health and Human Services Secretary Kathleen Sebelius on Friday, the Affordable Care Act -- the Obama administration's chief domestic policy initiative -- will get a fresh face.
But turning around public perception of the controversial health care-reform law in a politically charged mid-term election year poses an enormous challenge for the department's next leader, policy experts said.
President Barack Obama on Friday nominated Sylvia Mathews Burwell, the current director of the Office of Management and Budget, to succeed Sebelius, whose tenure was marred by the botched rollout of the Affordable Care Act's major insurance expansion.
"Certainly, this is an opportunity for a slightly new take on the ACA," said Elizabeth Carpenter, director of the health reform practice at Avalere Health L.L.C., a Washington, D.C.-based consulting firm.
"There's an opportunity to potentially reach out to Congress," Carpenter added. "But I think anyone is going to struggle to truly press the reset button. And, obviously, this is so highly political that I think anyone assuming this role is going to have a difficult time."
The Affordable Care Act -- sometimes referred to as Obamacare -- is intended to bring health insurance coverage to millions of uninsured Americans. But the nearly 4-year-old law remains unpopular with many people and virtually all of the Republican establishment.
Robert Field, professor of health management and policy at Drexel University's School of Public Health in Philadelphia, agreed that the next secretary faces an uphill battle because of the administration's failure to highlight the law's positive aspects.
"I think they need a strong, clear, consistent message, which so far they haven't done," Field said.
"I think they should be referring to it as the guaranteed coverage law," he added, noting that the "Affordable Care Act" isn't really affordable for everyone. "But what the law does do is it guarantees that everyone who wants coverage can get it."
If confirmed, Burwell will lead a sprawling department whose agencies include the Centers for Medicare & Medicaid Services, the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, just to name just a few.
Sebelius' resignation follows the official close of the first enrollment period for the Affordable Care Act. As of April 1, some 7.1 million Americans had signed up for insurance coverage through the federal and state online marketplaces, or exchanges, exceeding expectations. (Under a current grace period allowing people who had trouble signing up to complete their enrollment, that number has since grown to 7.5 million, Sebelius told the Senate Finance Committee on Thursday.)
But due to website glitches and insufficient system capacity, the federal marketplace -- HealthCare.gov -- and some state exchanges got off to a disastrous start last October, foiling attempts by many Americans to enroll in coverage. The troubled rollout only served to dampen public perception of the health-reform law and fuel Republican lawmakers' attempts to repeal it.
Obama touted the unexpectedly large 7.1 million enrollment figure during an April 1 Rose Garden ceremony at the White House, but he never acknowledged Sebelius for her role in implementing the legislation.
Obama defended Sebelius publicly during the bungled rollout of the Affordable Care Act, but behind the scenes it was apparent that her relationship with the White House had been damaged. Administration officials said they felt "blindsided" by the size and scope of the technical problems that plagued HealthCare.gov, which was eventually repaired by a longtime Obama adviser, the Associated Press reported.
Perhaps Burwell's biggest challenge is changing the public's impression of the Affordable Care Act and its benefits, the analysts said.
"I think that the best thing anyone can do for the public perception of the Affordable Care Act is to ensure that the products people enroll in are working, and certainly that the [next] open enrollment period [which starts Nov. 15 for coverage in 2015] goes much smoother than it did this year," Carpenter said.
Richard Hirth, associate chair of the University of Michigan department of health management and policy, said the next health secretary must "be the communicator-in-chief."
"Lots of people still don't understand key features of what's available [through the health-reform law]," such as subsidies for middle- and lower-income individuals, Hirth said.
It would also be helpful if the new secretary worked with states that have not expanded Medicaid to persuade more of them to expand eligibility for the public health program, he said.
In nominating Burwell on Friday, Obama called her "a proven manager" who gets results. Her selection seemed designed to head off an election-year confirmation battle in the Senate, which confirmed Burwell to her current post last year by a 96-0 vote.
"Last time, she was confirmed unanimously," Obama said. "I'm assuming not much has changed since that time."
Burwell, 48, is a Washington veteran who has a low profile but the respect of some Congressional Republicans. She held several White House and Treasury Department positions during President Bill Clinton's administration, the AP reported.
Burwell has also served as president of Wal-Mart's charitable arm and led the Bill and Melinda Gates Foundation's global development program, according to the AP.