The Senate Finance Committee on Wednesday backed President Obama's pick to lead the Health and Human Services Department, clearing the way for Sylvia Mathews Burwell to become the new face of Obamacare and oversee an agency responsible for about $1 trillion in federal spending.
Mrs. Burwell breezed through the committee, clearing on a 21-3 vote, setting up a final floor confirmation vote, likely when the Senate returns from a week-long Memorial Day vacation.
"She will be a force for bringing people together in a bipartisan way and forging common ground," said Finance Chairman Ron Wyden, Oregon Democrat.
Mr. Obama selected Mrs. Burwell — then his White House budget chief — to replace Kathleen Sebelius, who announced in April that she would step down after the flawed rollout of the federal exchange system, HealthCare.gov.
Republicans sparred frequently with Mrs. Sebelius over the law's problems, but that friction did not surface during the senators' grilling this month of Mrs. Burwell, a West Virginia native whose resume includes work for the Walmart Foundation and the Bill and Melinda Gates Foundation.
Instead Republican members praised the nominee's record of competence and then rattled off a list of complaints about the health overhaul, ranging from cuts to Medicare Advantage plans to the millions in federal grant dollars that were spent on failed state-run health exchanges. In all, Republican members signaled their concerns were about the law itself, and not about the person in charge at HHS.
The three Republicans who voted against her nomination were: Sens. John Cornyn of Texas, Pat Roberts of Kansas and John Thune of South Dakota.
Sen. David Vitter, a Louisiana Republican who does not sit on the committee, said he will oppose Ms. Burwell's nomination on the floor in protest of an administration decision that lets Capitol Hill staffers collect government subsidies to pay for their health coverage, even though they are part of the health exchanges.
But Sen. Lamar Alexander, Tennessee Republican and ranking member of the Senate's health committee, said in an interview that he will support Mrs. Burwell.
"I think she's competent, and she's going to need that competence to preside over such a big mess," he said, referring to Obamacare.
If confirmed, Mrs. Burwell will inherit health-law headaches that crop up between the overhaul's enrollment periods, including two that are reverberating this week.
House Republicans asked the Treasury on Wednesday to halt its Obamacare subsidy payments to health insurers until they can prove they are not making erroneous payments, citing concerns that taxpayers will be required to pay back amounts that did not sync up with their income levels, simply because the federal HealthCare.gov was not fully built.
They cited a Washington Post report from over the weekend that said more than 1 million Americans may have obtained subsidies that were too high or too low.
"We now know we were right to be concerned," they wrote in a letter to Treasury Secretary Jacob Lew.
Also Wednesday, the Los Angeles Times reported that a little-noticed section of new HHS regulations will allow the administration to tap funding appropriated for other health programs to help pay for Obamacare's risk corridor program, a type of backstop against excessive losses among insurers who participate in the new health exchanges.
The GOP is hoping to rally populist anger against the risk program by portraying it as a "bailout" — a politically loaded term after the government rescued banks and auto manufacturers during the 2008-2009 financial collapse.
But the government also takes in money from insurers that end up with healthy risk pools, redistributing it to insurers that did not fare as well and potentially running a surplus for the government.
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