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Overview

One of the largest civilian departments in the federal government, the Department of Health and Human Services (HHS) oversees the implementation of numerous health and welfare-related programs. HHS’ budget accounts for almost one out of every four federal dollars, and it administers more grant dollars than all other federal agencies combined. HHS’ Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare and Medicaid together provide health care insurance for 25% of Americans. Many HHS-funded services are provided at the local level by state or county agencies or through private sector grantees. With its large size also has come a large number of troubles and controversies involving birth control, prescription drugs, food safety and more.

 

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History:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Before the federal government established a cabinet-level department to address health issues, lawmakers took a number of steps to create programs and agencies that focused on health-related research and regulation. The earliest effort came in 1798 with the passage of an act to help sick and disabled seamen. This led to the establishment of a federal network of hospitals for the care of merchant seamen, forerunner of today’s Public Health Service.

 
During the administration of President Abraham Lincoln, the Bureau of Chemistry was created within the Department of Agriculture. This move represented the earliest attempt to address food-related issues, and it helped lead to the founding of the Food and Drug Administration several decades later.
 
The post-Civil War era would see the appointment of the first Supervising Surgeon (later called Surgeon General) in 1871 for the Marine Hospital Service; the opening of a one-room laboratory on Staten Island for research on disease (the forerunner to the National Institutes of Health); and passage in 1891 of legislation that made the Marine Hospital Service responsible for medical examination of arriving immigrants.
 
Shortly after the turn of the 20th Century, the Public Health Service was officially established in 1902, and four years later, Congress passed the Pure Food and Drugs Act authorizing the government to monitor the purity of foods and the safety of medicines (another key step that led to the founding of the FDA).
 
The era following World War I witnessed the creation of two important offices that would later become part of the health and human services department: the Bureau of Indian Affairs Health Division in 1921 (later to become the Indian Health Service); and the National Institute (later Institutes) of Health in 1930.
 
In response to the economic downturn of the Great Depression, President Franklin Roosevelt’s New Deal brought about several important policy decisions that had long-term impacts on government health programs. The first was the passage of the Social Security Act in 1935, without which future programs like Medicare and Medicaid would not have been possible. In 1938, Roosevelt and Congress adopted the Federal Food, Drug and Cosmetic Act of 1938, which led to the establishment of the FDA. And in 1939, Roosevelt pushed for the formation of the Federal Security Agency, which brought together federal activities in the fields of health, education and social insurance under a single cabinet-level authority.
 
Although the Federal Security Agency did not last, its founding demonstrated a need to make health matters a top priority for federal policymakers. Subsequently, the Eisenhower administration established a successor - the Department of Health, Education and Welfare in 1953. The 1950s and 1960s would constitute a time of important health policy decisions by federal officials. In 1955, the polio vaccine created by Jonas Salk was licensed, helping lead to the elimination of the crippling disease.
 
In 1961, the Kennedy administration conducted the first White House Conference on Aging. The following year, Congress adopted the Migrant Health Act that provided support for clinics serving agricultural workers. In 1964, the Surgeon General released the first report on smoking and health, which launched a new debate on the dangers of a previously unquestioned habit enjoyed by millions of Americans. Even more dramatic was the decision in 1965 to create the Medicare and Medicaid programs, which for the first time made comprehensive health care available to millions of Americans. That same year, the Older Americans Act created the nutritional and social programs administered by today’s Administration on Aging. The Head Start program was also created. In 1966, the Public Health Service launched the International Smallpox Eradication program that would lead to the complete elimination of the disease by 1977.
 
The late seventies saw the Carter administration remove education from the Department of Health, Education and Welfare (creating the Department of Education) and form the Department of Health and Human Services.

 

Historical Highlights of Health and Human Services

 

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What it Does:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Department of Health and Human Services (HHS) is a cabinet-level agency that manages a wide array of health and welfare programs. HHS is responsible for regulating food products and new pharmaceutical drugs (Food and Drug Administration), implementing the nation’s biggest health care programs (Medicare and Medicaid), preventing the outbreak and spread of diseases (Centers for Disease Control and Prevention) and funding some of the most important medical research in the world (National Institutes of Health), among other programs.

           
HHS’ primary offices are as follows:
Services
Centers for Medicare and Medicaid Services CMS is the federal body responsible for administering Medicare and Medicaid programs. CMS also runs the State Children’s Health Insurance Program (SCHIP), which is jointly financed by the federal and state governments and administered by individual states.
 
Medicare is a federal social insurance program established in 1965 to provide healthcare coverage for people over 65. The program was expanded in 1972 to include people under 65 with permanent disabilities. Most Americans are entitled to basic coverage under Medicare if they or their spouse have contributed payroll taxes for more than 10 years. Medicare is financed by payroll taxes, FICA and the Self-Employment Contributions Act of 1954. Medicare currently covers more than 40 million people, but with significant coverage gaps—in vision, dental and long-term care. Accounting for a current 14% of the federal budget, Medicare is a highly debated system that draws bipartisan criticism. The gradual privatization of the system—including recently reformed prescription drug coverage—is also highly contested among advocates, lawmakers and lobbyists.
 
Medicaid is a complex entitlement program for many people who can’t afford adequate health care, including single parents and their children, the disabled and the elderly (some of whom also receive Medicare benefits as so-called “dual eligibles”). It is funded as a joint venture by states and the federal government, with each state determining the exact scope of its program, payment rates and specific eligibility standards. The federal government, meanwhile, establishes general guidelines for the programs and monitors their enforcement through the Centers for Medicare and Medicaid Services (CMS). Participation is voluntary; however, every state has been signed up since the last holdout, Arizona, created its Medicaid variant in 1982. The major sticking point for Medicaid can be summed up in one word: money. Many people view with alarm the gradually escalating costs associated with the program, and some states have had to devote as much as one-fifth of their budgets to sustaining it. Fraud is also a major issue. Medicaid reform of some kind or another is therefore a perennial item on the political agenda.
 
Administration for Children and Families ACF is a key division within the Department of Health and Human Services.ACF oversees and finances social and economic programs for vulnerable children and families designed to help them develop more independent, self-reliant lives. Targeted groups include Native Americans, persons with developmental disabilities, refugees and legalized aliens. Programs are carried out by state, county, city and tribal governments, as well as public and private local agencies. Critics argue that ACF, a relatively new administration, has been deployed as a forum to push the Bush administration’s more conservative initiatives—funneling money to (discredited) abstinence-only programs and marriage promotion grants.
 
Health Resources and Services Administration HRSA is responsible for improving access to healthcare for those who are uninsured or otherwise marginalized and/or medically vulnerable. The agency identifies areas of the country that have a shortage of primary and dental care and medical professionals. HRSA administers about 90% of its funding in the form of grants directly to states and public and private healthcare providers, including health professions training programs and a network of 1,000 health clinics.
 
Indian Health Service IHS provides preventive, curative and community health care to approximately 1.9 million of the nation’s 3.3 million American Indians and Alaska Natives. IHS currently provides health services to approximately 1.5 million of these American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units. According to US Census data, American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher).
 
Substance Abuse & Mental Health Services Administration SAMHSA makes grants to various agencies to prevent and treat addictive and mental disorders and furthers its work through public campaigns, system reform, policy and program analysis. SAMHSA seeks to improve the quality and availability of prevention, treatment and rehabilitation services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. At times the agency has taken public stances on controversial issues, such as treatment of heroin addiction and homosexuality and transgender identity.
 
Administration for Community Living ACL is the official federal agency responsible for home and community-based services and programs related to aging. It also focuses on helping empower Americans before and during their later years to make informed decisions about health care options; ensuring the rights of the elderly to prevent their abuse, neglect and exploitation; and facilitating society to prepare for an aging population. ACL, funded by the Older Americans Act, is part of a federal, state, tribal and local partnership called the National Network on Aging, which currently helps about seven million older people and their caregivers, via 29,000 service providers and thousands of volunteers.
 
Research
National Institutes of Health NIH produces some of the most important medical and scientific research in the United States. Eighty three percent of NIH’s funding is distributed to scientists, medical researchers and university professors both in the US and abroad. NIH also conducts its own research at its 27 institutes and centers. Some of NIH’s researchers have been criticized for accepting money from pharmaceutical companies, while its leader has publicly criticized the policies of President George W. Bush.
 
Centers for Disease Control and Prevention CDC leads public health efforts to prevent and control infectious and chronic disease, injuries, workplace hazards, disabilities and environmental health threats. It is also responsible for producing and distributing health information internationally. While the CDC is globally recognized for its scientific research and epidemiologic investigations, newly-emerging issues such as terrorism, environmental threats and a rapidly aging population continue to challenge its capabilities. Although the CDC is supposed to prevent and control infectious disease, it has been accused of blatantly withholding information regarding such diseases as syphilis, autism and Guillain-Barré Syndrome.
 
Agency for Healthcare Research and Quality AHRQ sponsors research to improve the quality of health care in the United States. The agency works to elevate health care quality, reduce medical-related costs and expand healthcare access for more Americans. Almost 80% of AHRQ’s budget is awarded as grants and contracts to researchers at universities and other research institutions across the country. Early in its history, the agency became heavily involved in a controversial healthcare reform plan that almost led to AHRQ being eliminated. Since then, the agency has maintained a low profile, void of controversy.
 
National Toxicology Program NTP is an interagency program that provides data addressing a wide variety of issues important to public health. NTP works to safeguard public health by identifying the effects of chemicals used in everyday items and at what level of exposure they have the potential of becoming hazardous to humans. NTP has attracted controversy because of its policy of allowing some industries to self regulate their own products and because of its extensive use of animals for testing. 
 
Agency for Toxic Substances and Disease Registry ATSDR is a federal public health agency under the umbrella of the Centers for Disease Control (CDC) based in Atlanta, Georgia. The agency’s mission is to prevent harm to human health and diminished quality of life from exposure to hazardous substances found at waste sites, in unplanned releases and in other sources of pollution present in the environment. ATSDR identifies communities where people might be exposed to hazardous substances in the environment. But as far as investigations go, ATSDR cannot enforce any regulations by closing down a plant or other business. It can only make recommendations to the Environmental Protection Agency. The ATSDR has worked on a variety of different cases and projects, including aiding New York City in establishing a registry to assess short and long term health effects from the World Trade Center collapse, sampling the dust and air after the collapse of the World Trade Center, testing the water and soil at Camp Pendleton for lead, copper and other chemicals, as well as monitoring the effects of asbestos and identifying sites that have high concentrations of it.
 
Regulation

Food and Drug Administration

FDA regulates a wide range of medical and food products. From reviewing new medicines to inspecting food processing centers, the FDA plays a role in approximately $1 trillion worth of products each year. The FDA is comprised of chemists, pharmacologists, physicians, microbiologists, veterinarians, pharmacists, lawyers and other professionals. Despite all of the expertise employed by the agency, the FDA has struggled to carry out its mission to protect Americans from harmful drugs and foods. In recent years, the agency’s reputation has plummeted amid controversies involving the approval of certain pharmaceutical drugs and allowing tainted foods to reach consumers.

 

 

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Where Does the Money Go

According to USAspending.gov, the Health and Human Services Department has spent $67.4 billion so far this decade on contractors totaling 50,858. The biggest expenditures were for drugs and biologicals ($4.8 billion), computer and telecommunications services ($3.8 billion), biomedical basic research ($3.7 billion) and laboratory equipment and supplies ($3.1 billion).

 
The biggest spenders among HHS departments were the National Institutes of Health ($26.2 billion), the Centers for Disease Control and Prevention ($14.6 billion) and the Centers for Medicare & Medicaid Services ($7.95 billion).
 
The top 10 recipients of HHS dollars include major pharmaceutical companies and defense contractors:
 
SAIC, Inc.       
 $2,863,414,838
Merck & Co.   
$2,384,650,585
Westat, Inc
$2,117,195,587
Sanofi Pasteur MSD SNC Sigle SPMSD
$1,681,527,521
GlaxoSmithKline
$1,392,443,263
Wyeth
$1,170,849,726
Research Triangle Institute Inc
$1,156,129,714
Lockheed Martin
$1,045,138,008
Northrop Grumman
$966,528,985
Veritas Capital Fund II, LP
$809,789,386
 
Other contractors include High Performance Technologies, which received a $50 million contract in 2006 to provide information technology services to the Food and Drug Administration. Kaiser Permanente, United Health Group Inc., Vanderbilt University and Harvard Pilgrim Health Care won first-of-their-kind contracts from the FDA to help research the effects of pharmaceuticals on large patient populations after drugs go on the market. Each contractor will get $1.3 million over the next five years to provide data to the FDA from their databases.
 
Some HHS funding is distributed in the form of research grants. The NIH is a prime distributor of such moneys to higher education, hospitals, medical schools, research institutions and non-profits. (XLS) (Warning: Large Files)
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

According to USAspending.gov, the Health and Human Services Department has spent $67.4 billion so far this decade on contractors totaling 50,858. The biggest expenditures were for drugs and biologicals ($4.8 billion), computer and telecommunications services ($3.8 billion), biomedical basic research ($3.7 billion) and laboratory equipment and supplies ($3.1 billion).

 
The biggest spenders among HHS departments were the National Institutes of Health ($26.2 billion), the Centers for Disease Control and Prevention ($14.6 billion) and the Centers for Medicare & Medicaid Services ($7.95 billion).
 
The top 10 recipients of HHS dollars include major pharmaceutical companies and defense contractors:
 
SAIC, Inc.       
 $2,863,414,838
Merck & Co.    
$2,384,650,585
Westat, Inc
$2,117,195,587
Sanofi Pasteur MSD SNC Sigle SPMSD
$1,681,527,521
GlaxoSmithKline
$1,392,443,263
Wyeth
$1,170,849,726
Research Triangle Institute Inc
$1,156,129,714
Lockheed Martin
$1,045,138,008
Northrop Grumman
$966,528,985
Veritas Capital Fund II, LP
$809,789,386
 
Other contractors include High Performance Technologies, which received a $50 million contract in 2006 to provide information technology services to the Food and Drug Administration. Kaiser Permanente, United Health Group Inc., Vanderbilt University and Harvard Pilgrim Health Care won first-of-their-kind contracts from the FDA to help research the effects of pharmaceuticals on large patient populations after drugs go on the market. Each contractor will get $1.3 million over the next five years to provide data to the FDA from their databases.
 

Some HHS funding is distributed in the form of research grants. The NIH is a prime distributor of such moneys to

higher education

,

hospitals

,

medical schools

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research institutions

and

non-profits

. (XLS) (Warning: Large Files)

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Controversies:

Health Officials and FEMA Trailers

When the federal government failed to respond adequately to the destruction leveled on New Orleans by Hurricane Katrina, the Federal Emergency Management Agency (FEMA) took the brunt of the criticism. However, FEMA was not the only department to be dressed down by Congress. After FEMA decided to distribute thousands of mobile home trailers to those left homeless by the disaster, health officials at the Agency for Toxic Substances and Disease Registry (ATSDR) failed to alert officials about the presence of formaldehyde in the trailers.
 
The chemical, used in interior glue, was detected in many of the 143,000 trailers sent to the Gulf Coast in 2006. Residents of the FEMA trailers reported breathing difficulties, persistent flu-like symptoms, eye irritation, and nosebleeds. Tests on a number of FEMA trailers by the Sierra Club showed that 83% had levels of formaldehyde in the indoor air at levels above the Environmental Protection Agency recommended limit.
 
In April 2008, the House Committee on Science and Technology’s Subcommittee on Investigations and Oversight held hearings into how and why ATSDR failed to protect public health when those trailers were found to be emitting dangerous levels of formaldehyde. At the hearing, it was revealed that Dr. Christopher De Rosa, a leading government expert on formaldehyde, had tried to alert his superiors about the toxicity levels of the government trailers in New Orleans but was repeatedly ignored. Ultimately, he was demoted. His superiors later admitted that they should have followed his advice, but they did not address why they “reassigned” him to a new position.
Disease Registry’s Questioable Approaches (by Suemedha Sood, Washington Independent)
Kids in Katrina trailers may face lifelong ailments (by By John Moreno Gonzales, Associated Press)
 
Bush SCHIP Guidelines
In April 2008 the GAO challenged new guidelines handed down by the Bush administration regarding the State Children’s Health Insurance Plan (SCHIP). In a letter issued directly to states, the new rules prohibited states from using federal funds to cover children in families 250% or more above the poverty line ($53,000 for a family of four) until almost all children under 200% of poverty ($43,000) were covered.
 
The GAO said the administration illegally bypassed Congress to issue the rules, which constituted a policy change. The Bush administration refuted the GAO opinion and planned to ignore its recommendations. The conflict sprang from a long-standing debate between an administration that wants to cut federal healthcare spending and push towards privatization, and a Democratic Congress seeking to increase spending in response to rising medical costs and diminishing benefits coverage.
 
White House Suppresses CDC Data on Global Warming
In October 2007, officials with the Centers for Disease Control and Prevention (CDC) testified before Congress on the effects of global warming - only what they said was first edited by the White House. Portions were deleted that mentioned diseases that could prosper due to global warming. Altogether six pages were removed from the original twelve-page draft including mention of specific health concerns caused by climate changes.
 
The edited version stated that “climate change is anticipated to have a broad range of impacts on health of Americans and the nation’s public health infrastructure.” However the original statement said that “the public health effects of climate change remain largely unaddressed” was removed, and the testimony mainly focused on the preparedness of health agencies with general problems.
 
Medicare, Medicaid Funds Misspent
In 2007 the Government Accountability Office (GAO) reported that 9%, or about $90 million of the $1 billion that Congress appropriated to the Centers for Medicare And Medicaid Services during implementation of the 2003 Medicare Modernization Act was spent on “numerous questionable payments.” The GAO raised questions regarding contractor oversight, wasteful contracting practices, contract terms, internal control deficiencies and backlogs.
 
Medicare Prescription Drug Reform
In 2003, the Republican-controlled Congress and the Bush administration pushed through one of the most important and controversial changes to Medicare in the history of the program. Supporters and opponents of Medicare were not happy with the final product.
Critics decried the “huge costs” of the new law that called for privatizing the Medicare system. Medicare advocacy groups disparaged the legislation, calling it the “beginning of a battle over the soul of the Medicare program.”
 
Adding to the firestorm was a report by Public Citizen (based on analysis of federal lobbying disclosure records) that uncovered massive special interest lobbying from pharmaceutical and managed care industries, including a combined expenditure of $141 million and 952 individual lobbyists in 2003 - or nearly 10 lobbyists for each US Senator. Nearly half of these hires had “revolving door” connections to Congress, the White House or the executive branch.
 
The centerpiece of the 2003 legislation was a voluntary entitlement program for prescription drugs under “Program D,” funded by tax breaks and subsidies. The overhaul provided for issuance of discount prescription drug cards in 2004, preventative benefits in 2005 and implementation of the prescription drug plan in 2006.
 
The bill also forbade the federal government from negotiating with manufacturers over drug prices for beneficiaries. (In 2007, a newly Democratic-led House passed legislation requiring HHS to negotiate drug prices: The Medicare Prescription Drug Price Negotiation Act of 2007).
 
A month after the 2003 bill was signed, its 10-year cost estimate rose to $534 billion - more than $100 billion more than the figure presented to lawmakers by the Bush administration during deliberations. The lower figure helped garner unlikely support from Republicans who had promised to vote against the bill if costs were over $400 billion. A Salon.com article reported that the Administration had intentionally withheld the higher estimate - and that an official threatened to fire Medicare Chief Actuary Richard Foster if he revealed the real figure. By early 2005 the budget had risen to a 10-year estimate of $1.2 trillion.
Medicare Act of 2003 - Timeline (Center for Medicare Advocacy)
Mysterious Fax Adds to Intrigue Over the Medicare Bill's Cost (by Sheryl Gay Stolberg and Robert Pear, New York Times)
Time to Rethink the Disastrous Medicare Legislation (by Stuart M. Butler and Robert E. Moffit, Heritage Foundation)
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Debate:

Morning-After Pill

For three years HHS officials found themselves in the middle of a hotly-debated issue over allowing pharmaceutical companies to sell so-called “morning after” pills without a prescription. The debate began when Barr Pharmaceuticals filed for permission to sell its Plan B pill over the counter to women of all ages. The pill had been available as a prescription-only drug since 1999. Plan B prevents pregnancy by stopping the ovary from releasing an egg and may also prevent fertilization, if taken within 72 hours after having sex.
 
When the Food and Drug Administration first balked at approving Plan B, the decision came as a surprise because a panel of independent experts assembled by the FDA voted to recommend that the drug be sold over the counter. The majority concluded that the drug was not only effective, but that women could be trusted to use it correctly without a doctor. The FDA normally followed the recommendations of its advisory panels.
 
Barr Pharmaceuticals then revised its application to sell Plan B to consumers 16 and older. The FDA countered by saying 17 and older was okay, then rescinded that plan and raised the age restriction to 18 and up. At one point, a top FDA scientist resigned in protest over what she claimed was political interference in the approval process. Susan F. Wood, assistant FDA commissioner for women’s health and director of the Office of Women’s Health, said she left because then-Commissioner Lester M. Crawford acted on instructions from within the administration to stall Plan B’s approval. Crawford himself wound up leaving the FDA before the controversy was resolved, which led to a delay in a replacement taking over because Plan B supporters in Congress held the nomination hostage as leverage to force the Bush administration to grant FDA approval.
 
Those involved in the Plan B debate mirrored many of the same groups involved in the debate over abortion.
 
For
Supporters of the effort to allow over-the-counter sales of “morning after” pills included many Democrats in Congress, including US Senators Hillary Rodham Clinton and Patty Murray. Other supporters included pro-choice advocates, liberal women’s organizations and even some FDA scientists. They claimed there was no harm in removing the prescription requirement for Plan B and other pills like it, since the FDA had already vetted the medication when it was first approved for sale in the late 1990s. Allowing the pills sales without a prescription would help reduce unwanted pregnancies and, thus, abortions, argued proponents.
 
Against
Opponents of allowing non-prescription sales of morning-after pills included Concerned Women for America, a conservative women’s organization, American Association of Physicians and Surgeons, Family Research Council, Safe Drugs for Women, religious organizations and many Republicans. President Bush never publicly opposed FDA approval of Plan B, but some suspected that the President may have exerted pressure on the agency to delay its decision. Many opponents were opposed entirely to morning-after pills, with or without a prescription, because of their belief that pregnancy begins with the fertilizing of the egg - thus, Plan B represented just another form of abortion. Opponents also claimed that non-prescription use of Plan B would create a public health hazard by causing an increase in sexually transmitted disease.
 
Background
U.S. Rules Morning-After Pill Can't Be Sold Over the Counter (by Gardiner Harris and Robin Toner, New York Times)
Morning-After Pill: Politics and the F.D.A. (by Gardiner Harris, New York Times)
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Suggested Reforms:

No Shortage of Suggestions for Medicaid Reform

Seemingly everyone who’s anyone has an idea for what the federal government should do about the Medicaid program, which continues to consume more money and not produce satisfactory results. The Congressional Budget Office suggested that health officials do the following to change Medicaid:
  • Reduce the rate at which the federal government reimburses states
  • Reduce eligibility and the number of mandatory services
  • Force beneficiaries to assume more costs
  • Promote lower-cost services, such as alternatives to nursing home care
 
Some conservative analysts have made their own suggestions that range from dismantling the program entirely to opening it up to competition to create more choice for Medicaid recipients. Examples of conservative opinions include the National Center for Policy Analysis, The Heritage Foundation, the Heartland Institute and the Cato Institute.
 
Liberals, who want to keep Medicaid going, have their own set of ideas for improving the system. These are offered by The Century Foundation and the Center on Budget and Policy Priorities.
Reforming Medicaid (by Michael Bond, John C. Goodman, Ronald Lindsey and Richard Teske, National Center for Policy Analysis)
The Future of Medicaid (by James Frogue, Heritage Foundation)
Pressure for Market-Based Medicaid Reform Rises (by Christie Raniszewski Herrera, Heartland Institute)
Medicaid’s Unseen Costs (by Michael F. Cannon, Cato Institute)
Out-of-Pocket Expenses for Medicaid Beneficiaries are Substantial and Growing (by Leighton Ku and Matthew Broaddus, Center on Budget and Policy Priorities)
Medicaid Budget Proposals Would Shift Costs to States and Be Likely to Cause Reductions in Health Coverage (by Victoria Wachino, Andy Schneider and Leighton Ku, Center on Budget and Policy Priorities)
 
GAO: Extend Deadline on Medicare Drug Reform
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) significantly reformed contracting for the administration of claims for Part A, Medicare’s hospital insurance, and Part B, which covers outpatient services such as physicians’ care.
The MMA required the Centers for Medicare & Medicaid Services (CMS) - the agency within the Department of Health and Human Services (HHS) that administers Medicare - to conduct full and open competition for all of its claims administration contracts and to transfer the work to Medicare administrative contractors (MAC) by October 2011.
 
The MMA required the Secretary of HHS to submit a report to the Congress and GAO on the plan for implementing Medicare contracting reform and for GAO to evaluate the plan. GAO did just that and recommended that CMS extend its implementation schedule from 2009 to 2011 to be better prepared to manage contracting reform.
 
CMS did not concur with the recommendation, but GAO believed that extending the time frame was the most prudent approach to manage contracting reform risks.
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Former Directors:

Former Secretaries of Health and Human Services

 
Tommy G. Thompson (February 2001 - January 2005)
 
A native of Elroy, Wisconsin, Tommy Thompson received his bachelor’s in 1963 and his JD in 1966 from the University of Wisconsin-Madison.
 
Thompson began his career in public service in 1966 as a representative in Wisconsin’s state Assembly. He was elected assistant Assembly minority leader in 1973 and Assembly minority leader in 1981. He was first elected governor of Wisconsin in 1987 and wound up being re-elected three times, a state record.
 
During his 14 years as governor, Thompson gained national attention for his welfare reform plan, Wisconsin Works or “W-2,” which served as a national model for welfare reform. The program required participants to work while at the same time providing the services and support to make the transition to work feasible. Thompson also worked to extend health insurance to many low-income children and families.
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Comments

Leo D. Frey 21 hours ago
Is this the proper agency to file a complaint against Del Sol MC in El Paso TX for losing a patient?

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Founded: 1980
Annual Budget: $707 billion
Employees: 64,750
Official Website: http://www.hhs.gov/

Department of Health and Human Services

Burwell, Sylvia Mathews
Secretary

President Barack Obama has nominated Sylvia Mathews Burwell, who is currently director of the Office of Management and Budget (OMB), to be Secretary of Health and Human Services (HHS), replacing Kathleen Sebelius. She was confirmed by the Senate on June 5, 2014.

 

Born in 1965 and raised in the small town of Hinton, West Virginia, Burwell is the daughter of optometrist Dr. William Mathews and Hinton Mayor Cleo Mathews. Valedictorian of her class at Hinton High School in 1983, Burwell earned a B.A. in Government from Harvard University in 1987 and a bachelor’s degree in philosophy, politics and economics from Oxford University, where she was a Rhodes Scholar.

 

Burwell began her career during college, serving as an intern for her Congressman, Rep. Nick Rahall (D-West Virginia) and as an aide to Gov. Michael Dukakis (D-Massachusetts). From 1990 to 1992, she was an associate at McKinsey & Company, a consulting firm based in New York.

 

After working on the Michael Dukakis presidential campaign of 1988 and the Bill Clinton campaign of 1992, Burwell served the Clinton Administration in various posts, starting as manager of Clinton’s economic transition team from 1992 to 1993 and staff director of the National Economic Council from 1993 to 1995. She served as chief of staff to Treasury Secretary Robert Rubin from 1995 to 1997, deputy chief of staff to President Clinton from 1997 to 1998, and OMB deputy director from 1998 to 2001.

 

Leaving government after the 2000 election, Burwell was immediately hired by the Bill and Melinda Gates Foundation to work as its chief operating officer and executive director, posts she held from January 2001 until a reorganization in 2006, when she became president of Global Development. In 2008-2009, Burwell served as Obama-Biden transition agency review lead for the Federal Deposit Insurance Corporation. Passed over for the Gates Foundation CEO position when it became available in 2008, Burwell left in late 2011 to become president of the Wal-Mart Foundation, which she led from January 2012 until her OMB nomination.

 

Burwell was at OMB only about a year, being confirmed by the Senate on April 24, 2013. Her time there was busy, however, and included a government shutdown in October 2013. She also dealt with health policy issues during her tenure, including Medicare and Medicaid, which should help her navigate her new challenge at HHS.

 

Burwell is a member of the Pacific Council on International Policy, the Aspen Strategy Group and the Nike Foundation Advisory Group. She has been a director of MetLife and Metropolitan Life Insurance Company since January 2004.

 

Burwell is married to attorney Stephen Burwell, with whom she has one child. A lifelong Democrat, she has donated $15,850 to Democratic candidates and causes, including $2,500 to the Democratic National Committee; $3,000 to Sen. John Kerry’s 2004 presidential campaign; $2,600 to President Obama’s 2008 run; $250 to Hillary Clinton’s 2006 U.S. Senate campaign; and $2,900 to Alan Khazei’s two primary campaigns for U.S. Senate from Massachusetts.

-Matt Bewig, Steve Straehley

 

To Learn More:

Meet The Nominee To Lead HHS (by Jason Millman, Washington Post)

Walmart Biography

Hinton Native Tapped: Obama Picks Foundation Chief Sylvia Mathews Burwell, Former Clinton Administration Economics Team Member to Head OMB (by David M. Kinchen, Huntington News)

Burwell as Obama's Budget Director: Walmart Wins, Working Families Lose (by Bertha Lewis, The Guardian)

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Sebelius, Kathleen
Previous Secretary

Kathleen Sebelius, President Barack Obama’s second choice for Secretary of Health and Human Services, was sworn in on April 28, 2009. As governor of Kansas, she earned a reputation as a political moderate who worked well with Republicans and possessed wonkish understanding of health policy. But she did little during her time as governor to bring about substantial change in the state’s health coverage or costs—which might explain Obama’s decision not to give Sebelius the dual assignment of running the new White House Office of Health Care Reform, which the previous nominee, Tom Daschle, would have had, had he not pulled out.

 
Born May 15, 1948, into a Roman Catholic family in Cincinnati, OH, Sebelius was exposed to politics from an early age. Her father, Democrat John Gilligan, served as governor of Ohio from 1971-1975. She attended the Summit Country Day School in Cincinnati, followed by Trinity Washington University in Washington, DC, where she met her future husband, Gary Sebelius, whose father, Keith, was a Republican congressman from Kansas.
 
After graduating with a BA in political science in 1970, Kathleen married Gary in 1974, and the two settled in Topeka, Kansas, where she worked as a special assistant to the state’s secretary of corrections from 1975 to 1977. She later attended graduate school at the University of Kansas, earning her Master of Public Administration in 1977, before becoming executive director of the Kansas Trial Lawyers Association (1977-1987).
 
In 1984, Sebelius served as Gary Hart’s campaign coordinator in Kansas during the Democratic primary for president. Her own political career began in 1986, with her election to the Kansas House of Representatives. She served eight years in the state legislature.
 
In 1994 Sebelius ran for state insurance commissioner and won a surprising victory, becoming the first Democrat to hold the post. She was credited with bringing the agency out from under the influence of the insurance industry. She refused to take campaign contributions from insurers and blocked the proposed buyout of Blue Cross Blue Shield of Kansas, the state’s largest health insurer, by Indiana-based Anthem Insurance. Her decision marked the first time the corporation had been rebuffed in its acquisition attempts. Her work as insurance commissioner resulted in being named one of Governing magazine’s Public Officials of the Year in 2001.
 
In 2002, Sebelius ran for governor of Kansas and defeated Republican Tim Shallenburger, 53%-45%. In doing so, she became the first daughter of a governor in U.S. history to also be elected governor.
 
Her gubernatorial victory—in a state where registered Republicans outnumber Democrats 2-to-1—elevated Sebelius to national prominence among Democrats in Washington.
 
In November 2005, Time named Sebelius as one of the five best governors in America, praising her for eliminating the $1.1 billion debt she inherited, ferreting out waste in state government, and strongly supporting public education – all without raising taxes, although she did proposed raising sales, property, and income taxes. She was also credited for her bipartisan approach to governing, which was critical since Republicans dominate the Kansas State Legislature.
 
Sebelius was easily re-elected governor in 2006, beating GOP State Senator Jim Barnett by 17 percentage points. During her two terms as governor, Sebelius enjoyed some victories on the issue of health care reform. She got Kansas to join a multi-state consortium that allowed Kansans to order prescription drugs from Canada, Great Britain and Ireland, often at a lower price than they cost in the United States. She also pushed through changes that added tens of thousands of children from low-income households to state health programs.
 
But more substantial health care reforms did not materialize under her watch, including two attempts to raise Kansas’ cigarette tax to expand medical coverage. Both times she was thwarted by Republican legislators, who objected to the tax increases and wanted a more market-based solution. In her 2007 State of the State address, she called for universal health care for Kansans, but declined to detail how she would pay for it. Republicans dubbed the idea “Hillarycare” in reference to former First Lady Hillary Clinton’s failed 1993 reform effort. Sebelius later condemned President George W. Bush for vetoing an expansion of the State Children’s Health Insurance Program, and called offering health care to children a “moral obligation.”
 
She vetoed anti-abortion legislation in Kansas in 2003, 2005, 2006, and in 2008, including a bill in April 2008 that sought to strengthen the state’s late-term abortion law. Kansas City Archbishop Joseph Naumann asked that Sebelius no longer receive Holy Communion because of her position on abortion. He also criticized her for vetoing the late-term abortion bill. Meanwhile, the governor’s office claimed that abortions declined 8.5% while Sebelius was in office, thanks to health care reforms she initiated, including adoption incentives, extended health services for pregnant women, and sex education. Planned Parenthood has been a strong supporter of Sebelius.
 
On other policy issues, Sebelius pushed for more widespread recycling efforts across the state, and she vetoed bills authorizing the construction of coal-fired power plants on three separate occasions. She also vetoed a concealed weapons law that would have allowed citizens to carry handguns after obtaining a state permit and passing an FBI background check. She vetoed a similar bill in 2006, but this time her veto was overturned by both the House and Senate.
 
Sebelius did not support an April 2005 amendment to the Kansas Constitution that outlawed same-sex marriage, saying she supported existing state law banning such unions. The constitutional amendment passed with 70% voter approval.
 
In 2008 Sebelius endorsed Barack Obama early in his primary battle against Hilary Clinton, and campaigned fiercely on his behalf, often acting as a surrogate to women’s groups.
 
After the November 2008 election, Sebelius was considered a prime candidate for a post in Obama’s cabinet. But she officially withdrew her name from consideration on December 6. Shortly thereafter, US Senator Sam Brownback (R-KS) announced his retirement from the Senate and his plan to run for governor. Some analysts speculated that Sebelius (who was prevented from running for a third time as governor due to term limits) would, in turn, run for Brownback’s Senate seat.
 
Sebelius has served on the Governor’s Blue Ribbon Panel on Prison Overcrowding, the Kansas Children’s Commission, and the Kansas Natural Resource Council. She also has served as chair of the National Governors Association (NGA), the NGA’s Executive Committee, and its initiative, “Securing a Clean Energy Future.” She also has been chair of the Education Commission of the States.
 
Sebelius’s husband, Gary, has been a federal judge for 34 years. The couple has two sons. One is a graduate of the Rhode Island School of Design and the other is a law student.
 
Sebelius's Political Skills, Experience Win Plaudits (by Michael Fletcher, Washington Post)
Kathleen Sebelius: Two decades in politics (Lawrence Journal-World & News)
Kansas Governor Kathleen Sebelius (by Alex Altman, Time)
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Overview

One of the largest civilian departments in the federal government, the Department of Health and Human Services (HHS) oversees the implementation of numerous health and welfare-related programs. HHS’ budget accounts for almost one out of every four federal dollars, and it administers more grant dollars than all other federal agencies combined. HHS’ Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare and Medicaid together provide health care insurance for 25% of Americans. Many HHS-funded services are provided at the local level by state or county agencies or through private sector grantees. With its large size also has come a large number of troubles and controversies involving birth control, prescription drugs, food safety and more.

 

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History:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Before the federal government established a cabinet-level department to address health issues, lawmakers took a number of steps to create programs and agencies that focused on health-related research and regulation. The earliest effort came in 1798 with the passage of an act to help sick and disabled seamen. This led to the establishment of a federal network of hospitals for the care of merchant seamen, forerunner of today’s Public Health Service.

 
During the administration of President Abraham Lincoln, the Bureau of Chemistry was created within the Department of Agriculture. This move represented the earliest attempt to address food-related issues, and it helped lead to the founding of the Food and Drug Administration several decades later.
 
The post-Civil War era would see the appointment of the first Supervising Surgeon (later called Surgeon General) in 1871 for the Marine Hospital Service; the opening of a one-room laboratory on Staten Island for research on disease (the forerunner to the National Institutes of Health); and passage in 1891 of legislation that made the Marine Hospital Service responsible for medical examination of arriving immigrants.
 
Shortly after the turn of the 20th Century, the Public Health Service was officially established in 1902, and four years later, Congress passed the Pure Food and Drugs Act authorizing the government to monitor the purity of foods and the safety of medicines (another key step that led to the founding of the FDA).
 
The era following World War I witnessed the creation of two important offices that would later become part of the health and human services department: the Bureau of Indian Affairs Health Division in 1921 (later to become the Indian Health Service); and the National Institute (later Institutes) of Health in 1930.
 
In response to the economic downturn of the Great Depression, President Franklin Roosevelt’s New Deal brought about several important policy decisions that had long-term impacts on government health programs. The first was the passage of the Social Security Act in 1935, without which future programs like Medicare and Medicaid would not have been possible. In 1938, Roosevelt and Congress adopted the Federal Food, Drug and Cosmetic Act of 1938, which led to the establishment of the FDA. And in 1939, Roosevelt pushed for the formation of the Federal Security Agency, which brought together federal activities in the fields of health, education and social insurance under a single cabinet-level authority.
 
Although the Federal Security Agency did not last, its founding demonstrated a need to make health matters a top priority for federal policymakers. Subsequently, the Eisenhower administration established a successor - the Department of Health, Education and Welfare in 1953. The 1950s and 1960s would constitute a time of important health policy decisions by federal officials. In 1955, the polio vaccine created by Jonas Salk was licensed, helping lead to the elimination of the crippling disease.
 
In 1961, the Kennedy administration conducted the first White House Conference on Aging. The following year, Congress adopted the Migrant Health Act that provided support for clinics serving agricultural workers. In 1964, the Surgeon General released the first report on smoking and health, which launched a new debate on the dangers of a previously unquestioned habit enjoyed by millions of Americans. Even more dramatic was the decision in 1965 to create the Medicare and Medicaid programs, which for the first time made comprehensive health care available to millions of Americans. That same year, the Older Americans Act created the nutritional and social programs administered by today’s Administration on Aging. The Head Start program was also created. In 1966, the Public Health Service launched the International Smallpox Eradication program that would lead to the complete elimination of the disease by 1977.
 
The late seventies saw the Carter administration remove education from the Department of Health, Education and Welfare (creating the Department of Education) and form the Department of Health and Human Services.

 

Historical Highlights of Health and Human Services

 

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What it Does:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Department of Health and Human Services (HHS) is a cabinet-level agency that manages a wide array of health and welfare programs. HHS is responsible for regulating food products and new pharmaceutical drugs (Food and Drug Administration), implementing the nation’s biggest health care programs (Medicare and Medicaid), preventing the outbreak and spread of diseases (Centers for Disease Control and Prevention) and funding some of the most important medical research in the world (National Institutes of Health), among other programs.

           
HHS’ primary offices are as follows:
Services
Centers for Medicare and Medicaid Services CMS is the federal body responsible for administering Medicare and Medicaid programs. CMS also runs the State Children’s Health Insurance Program (SCHIP), which is jointly financed by the federal and state governments and administered by individual states.
 
Medicare is a federal social insurance program established in 1965 to provide healthcare coverage for people over 65. The program was expanded in 1972 to include people under 65 with permanent disabilities. Most Americans are entitled to basic coverage under Medicare if they or their spouse have contributed payroll taxes for more than 10 years. Medicare is financed by payroll taxes, FICA and the Self-Employment Contributions Act of 1954. Medicare currently covers more than 40 million people, but with significant coverage gaps—in vision, dental and long-term care. Accounting for a current 14% of the federal budget, Medicare is a highly debated system that draws bipartisan criticism. The gradual privatization of the system—including recently reformed prescription drug coverage—is also highly contested among advocates, lawmakers and lobbyists.
 
Medicaid is a complex entitlement program for many people who can’t afford adequate health care, including single parents and their children, the disabled and the elderly (some of whom also receive Medicare benefits as so-called “dual eligibles”). It is funded as a joint venture by states and the federal government, with each state determining the exact scope of its program, payment rates and specific eligibility standards. The federal government, meanwhile, establishes general guidelines for the programs and monitors their enforcement through the Centers for Medicare and Medicaid Services (CMS). Participation is voluntary; however, every state has been signed up since the last holdout, Arizona, created its Medicaid variant in 1982. The major sticking point for Medicaid can be summed up in one word: money. Many people view with alarm the gradually escalating costs associated with the program, and some states have had to devote as much as one-fifth of their budgets to sustaining it. Fraud is also a major issue. Medicaid reform of some kind or another is therefore a perennial item on the political agenda.
 
Administration for Children and Families ACF is a key division within the Department of Health and Human Services.ACF oversees and finances social and economic programs for vulnerable children and families designed to help them develop more independent, self-reliant lives. Targeted groups include Native Americans, persons with developmental disabilities, refugees and legalized aliens. Programs are carried out by state, county, city and tribal governments, as well as public and private local agencies. Critics argue that ACF, a relatively new administration, has been deployed as a forum to push the Bush administration’s more conservative initiatives—funneling money to (discredited) abstinence-only programs and marriage promotion grants.
 
Health Resources and Services Administration HRSA is responsible for improving access to healthcare for those who are uninsured or otherwise marginalized and/or medically vulnerable. The agency identifies areas of the country that have a shortage of primary and dental care and medical professionals. HRSA administers about 90% of its funding in the form of grants directly to states and public and private healthcare providers, including health professions training programs and a network of 1,000 health clinics.
 
Indian Health Service IHS provides preventive, curative and community health care to approximately 1.9 million of the nation’s 3.3 million American Indians and Alaska Natives. IHS currently provides health services to approximately 1.5 million of these American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units. According to US Census data, American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher).
 
Substance Abuse & Mental Health Services Administration SAMHSA makes grants to various agencies to prevent and treat addictive and mental disorders and furthers its work through public campaigns, system reform, policy and program analysis. SAMHSA seeks to improve the quality and availability of prevention, treatment and rehabilitation services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. At times the agency has taken public stances on controversial issues, such as treatment of heroin addiction and homosexuality and transgender identity.
 
Administration for Community Living ACL is the official federal agency responsible for home and community-based services and programs related to aging. It also focuses on helping empower Americans before and during their later years to make informed decisions about health care options; ensuring the rights of the elderly to prevent their abuse, neglect and exploitation; and facilitating society to prepare for an aging population. ACL, funded by the Older Americans Act, is part of a federal, state, tribal and local partnership called the National Network on Aging, which currently helps about seven million older people and their caregivers, via 29,000 service providers and thousands of volunteers.
 
Research
National Institutes of Health NIH produces some of the most important medical and scientific research in the United States. Eighty three percent of NIH’s funding is distributed to scientists, medical researchers and university professors both in the US and abroad. NIH also conducts its own research at its 27 institutes and centers. Some of NIH’s researchers have been criticized for accepting money from pharmaceutical companies, while its leader has publicly criticized the policies of President George W. Bush.
 
Centers for Disease Control and Prevention CDC leads public health efforts to prevent and control infectious and chronic disease, injuries, workplace hazards, disabilities and environmental health threats. It is also responsible for producing and distributing health information internationally. While the CDC is globally recognized for its scientific research and epidemiologic investigations, newly-emerging issues such as terrorism, environmental threats and a rapidly aging population continue to challenge its capabilities. Although the CDC is supposed to prevent and control infectious disease, it has been accused of blatantly withholding information regarding such diseases as syphilis, autism and Guillain-Barré Syndrome.
 
Agency for Healthcare Research and Quality AHRQ sponsors research to improve the quality of health care in the United States. The agency works to elevate health care quality, reduce medical-related costs and expand healthcare access for more Americans. Almost 80% of AHRQ’s budget is awarded as grants and contracts to researchers at universities and other research institutions across the country. Early in its history, the agency became heavily involved in a controversial healthcare reform plan that almost led to AHRQ being eliminated. Since then, the agency has maintained a low profile, void of controversy.
 
National Toxicology Program NTP is an interagency program that provides data addressing a wide variety of issues important to public health. NTP works to safeguard public health by identifying the effects of chemicals used in everyday items and at what level of exposure they have the potential of becoming hazardous to humans. NTP has attracted controversy because of its policy of allowing some industries to self regulate their own products and because of its extensive use of animals for testing. 
 
Agency for Toxic Substances and Disease Registry ATSDR is a federal public health agency under the umbrella of the Centers for Disease Control (CDC) based in Atlanta, Georgia. The agency’s mission is to prevent harm to human health and diminished quality of life from exposure to hazardous substances found at waste sites, in unplanned releases and in other sources of pollution present in the environment. ATSDR identifies communities where people might be exposed to hazardous substances in the environment. But as far as investigations go, ATSDR cannot enforce any regulations by closing down a plant or other business. It can only make recommendations to the Environmental Protection Agency. The ATSDR has worked on a variety of different cases and projects, including aiding New York City in establishing a registry to assess short and long term health effects from the World Trade Center collapse, sampling the dust and air after the collapse of the World Trade Center, testing the water and soil at Camp Pendleton for lead, copper and other chemicals, as well as monitoring the effects of asbestos and identifying sites that have high concentrations of it.
 
Regulation

Food and Drug Administration

FDA regulates a wide range of medical and food products. From reviewing new medicines to inspecting food processing centers, the FDA plays a role in approximately $1 trillion worth of products each year. The FDA is comprised of chemists, pharmacologists, physicians, microbiologists, veterinarians, pharmacists, lawyers and other professionals. Despite all of the expertise employed by the agency, the FDA has struggled to carry out its mission to protect Americans from harmful drugs and foods. In recent years, the agency’s reputation has plummeted amid controversies involving the approval of certain pharmaceutical drugs and allowing tainted foods to reach consumers.

 

 

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Where Does the Money Go

According to USAspending.gov, the Health and Human Services Department has spent $67.4 billion so far this decade on contractors totaling 50,858. The biggest expenditures were for drugs and biologicals ($4.8 billion), computer and telecommunications services ($3.8 billion), biomedical basic research ($3.7 billion) and laboratory equipment and supplies ($3.1 billion).

 
The biggest spenders among HHS departments were the National Institutes of Health ($26.2 billion), the Centers for Disease Control and Prevention ($14.6 billion) and the Centers for Medicare & Medicaid Services ($7.95 billion).
 
The top 10 recipients of HHS dollars include major pharmaceutical companies and defense contractors:
 
SAIC, Inc.       
 $2,863,414,838
Merck & Co.   
$2,384,650,585
Westat, Inc
$2,117,195,587
Sanofi Pasteur MSD SNC Sigle SPMSD
$1,681,527,521
GlaxoSmithKline
$1,392,443,263
Wyeth
$1,170,849,726
Research Triangle Institute Inc
$1,156,129,714
Lockheed Martin
$1,045,138,008
Northrop Grumman
$966,528,985
Veritas Capital Fund II, LP
$809,789,386
 
Other contractors include High Performance Technologies, which received a $50 million contract in 2006 to provide information technology services to the Food and Drug Administration. Kaiser Permanente, United Health Group Inc., Vanderbilt University and Harvard Pilgrim Health Care won first-of-their-kind contracts from the FDA to help research the effects of pharmaceuticals on large patient populations after drugs go on the market. Each contractor will get $1.3 million over the next five years to provide data to the FDA from their databases.
 
Some HHS funding is distributed in the form of research grants. The NIH is a prime distributor of such moneys to higher education, hospitals, medical schools, research institutions and non-profits. (XLS) (Warning: Large Files)
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

According to USAspending.gov, the Health and Human Services Department has spent $67.4 billion so far this decade on contractors totaling 50,858. The biggest expenditures were for drugs and biologicals ($4.8 billion), computer and telecommunications services ($3.8 billion), biomedical basic research ($3.7 billion) and laboratory equipment and supplies ($3.1 billion).

 
The biggest spenders among HHS departments were the National Institutes of Health ($26.2 billion), the Centers for Disease Control and Prevention ($14.6 billion) and the Centers for Medicare & Medicaid Services ($7.95 billion).
 
The top 10 recipients of HHS dollars include major pharmaceutical companies and defense contractors:
 
SAIC, Inc.       
 $2,863,414,838
Merck & Co.    
$2,384,650,585
Westat, Inc
$2,117,195,587
Sanofi Pasteur MSD SNC Sigle SPMSD
$1,681,527,521
GlaxoSmithKline
$1,392,443,263
Wyeth
$1,170,849,726
Research Triangle Institute Inc
$1,156,129,714
Lockheed Martin
$1,045,138,008
Northrop Grumman
$966,528,985
Veritas Capital Fund II, LP
$809,789,386
 
Other contractors include High Performance Technologies, which received a $50 million contract in 2006 to provide information technology services to the Food and Drug Administration. Kaiser Permanente, United Health Group Inc., Vanderbilt University and Harvard Pilgrim Health Care won first-of-their-kind contracts from the FDA to help research the effects of pharmaceuticals on large patient populations after drugs go on the market. Each contractor will get $1.3 million over the next five years to provide data to the FDA from their databases.
 

Some HHS funding is distributed in the form of research grants. The NIH is a prime distributor of such moneys to

higher education

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hospitals

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medical schools

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research institutions

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non-profits

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Controversies:

Health Officials and FEMA Trailers

When the federal government failed to respond adequately to the destruction leveled on New Orleans by Hurricane Katrina, the Federal Emergency Management Agency (FEMA) took the brunt of the criticism. However, FEMA was not the only department to be dressed down by Congress. After FEMA decided to distribute thousands of mobile home trailers to those left homeless by the disaster, health officials at the Agency for Toxic Substances and Disease Registry (ATSDR) failed to alert officials about the presence of formaldehyde in the trailers.
 
The chemical, used in interior glue, was detected in many of the 143,000 trailers sent to the Gulf Coast in 2006. Residents of the FEMA trailers reported breathing difficulties, persistent flu-like symptoms, eye irritation, and nosebleeds. Tests on a number of FEMA trailers by the Sierra Club showed that 83% had levels of formaldehyde in the indoor air at levels above the Environmental Protection Agency recommended limit.
 
In April 2008, the House Committee on Science and Technology’s Subcommittee on Investigations and Oversight held hearings into how and why ATSDR failed to protect public health when those trailers were found to be emitting dangerous levels of formaldehyde. At the hearing, it was revealed that Dr. Christopher De Rosa, a leading government expert on formaldehyde, had tried to alert his superiors about the toxicity levels of the government trailers in New Orleans but was repeatedly ignored. Ultimately, he was demoted. His superiors later admitted that they should have followed his advice, but they did not address why they “reassigned” him to a new position.
Disease Registry’s Questioable Approaches (by Suemedha Sood, Washington Independent)
Kids in Katrina trailers may face lifelong ailments (by By John Moreno Gonzales, Associated Press)
 
Bush SCHIP Guidelines
In April 2008 the GAO challenged new guidelines handed down by the Bush administration regarding the State Children’s Health Insurance Plan (SCHIP). In a letter issued directly to states, the new rules prohibited states from using federal funds to cover children in families 250% or more above the poverty line ($53,000 for a family of four) until almost all children under 200% of poverty ($43,000) were covered.
 
The GAO said the administration illegally bypassed Congress to issue the rules, which constituted a policy change. The Bush administration refuted the GAO opinion and planned to ignore its recommendations. The conflict sprang from a long-standing debate between an administration that wants to cut federal healthcare spending and push towards privatization, and a Democratic Congress seeking to increase spending in response to rising medical costs and diminishing benefits coverage.
 
White House Suppresses CDC Data on Global Warming
In October 2007, officials with the Centers for Disease Control and Prevention (CDC) testified before Congress on the effects of global warming - only what they said was first edited by the White House. Portions were deleted that mentioned diseases that could prosper due to global warming. Altogether six pages were removed from the original twelve-page draft including mention of specific health concerns caused by climate changes.
 
The edited version stated that “climate change is anticipated to have a broad range of impacts on health of Americans and the nation’s public health infrastructure.” However the original statement said that “the public health effects of climate change remain largely unaddressed” was removed, and the testimony mainly focused on the preparedness of health agencies with general problems.
 
Medicare, Medicaid Funds Misspent
In 2007 the Government Accountability Office (GAO) reported that 9%, or about $90 million of the $1 billion that Congress appropriated to the Centers for Medicare And Medicaid Services during implementation of the 2003 Medicare Modernization Act was spent on “numerous questionable payments.” The GAO raised questions regarding contractor oversight, wasteful contracting practices, contract terms, internal control deficiencies and backlogs.
 
Medicare Prescription Drug Reform
In 2003, the Republican-controlled Congress and the Bush administration pushed through one of the most important and controversial changes to Medicare in the history of the program. Supporters and opponents of Medicare were not happy with the final product.
Critics decried the “huge costs” of the new law that called for privatizing the Medicare system. Medicare advocacy groups disparaged the legislation, calling it the “beginning of a battle over the soul of the Medicare program.”
 
Adding to the firestorm was a report by Public Citizen (based on analysis of federal lobbying disclosure records) that uncovered massive special interest lobbying from pharmaceutical and managed care industries, including a combined expenditure of $141 million and 952 individual lobbyists in 2003 - or nearly 10 lobbyists for each US Senator. Nearly half of these hires had “revolving door” connections to Congress, the White House or the executive branch.
 
The centerpiece of the 2003 legislation was a voluntary entitlement program for prescription drugs under “Program D,” funded by tax breaks and subsidies. The overhaul provided for issuance of discount prescription drug cards in 2004, preventative benefits in 2005 and implementation of the prescription drug plan in 2006.
 
The bill also forbade the federal government from negotiating with manufacturers over drug prices for beneficiaries. (In 2007, a newly Democratic-led House passed legislation requiring HHS to negotiate drug prices: The Medicare Prescription Drug Price Negotiation Act of 2007).
 
A month after the 2003 bill was signed, its 10-year cost estimate rose to $534 billion - more than $100 billion more than the figure presented to lawmakers by the Bush administration during deliberations. The lower figure helped garner unlikely support from Republicans who had promised to vote against the bill if costs were over $400 billion. A Salon.com article reported that the Administration had intentionally withheld the higher estimate - and that an official threatened to fire Medicare Chief Actuary Richard Foster if he revealed the real figure. By early 2005 the budget had risen to a 10-year estimate of $1.2 trillion.
Medicare Act of 2003 - Timeline (Center for Medicare Advocacy)
Mysterious Fax Adds to Intrigue Over the Medicare Bill's Cost (by Sheryl Gay Stolberg and Robert Pear, New York Times)
Time to Rethink the Disastrous Medicare Legislation (by Stuart M. Butler and Robert E. Moffit, Heritage Foundation)
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Debate:

Morning-After Pill

For three years HHS officials found themselves in the middle of a hotly-debated issue over allowing pharmaceutical companies to sell so-called “morning after” pills without a prescription. The debate began when Barr Pharmaceuticals filed for permission to sell its Plan B pill over the counter to women of all ages. The pill had been available as a prescription-only drug since 1999. Plan B prevents pregnancy by stopping the ovary from releasing an egg and may also prevent fertilization, if taken within 72 hours after having sex.
 
When the Food and Drug Administration first balked at approving Plan B, the decision came as a surprise because a panel of independent experts assembled by the FDA voted to recommend that the drug be sold over the counter. The majority concluded that the drug was not only effective, but that women could be trusted to use it correctly without a doctor. The FDA normally followed the recommendations of its advisory panels.
 
Barr Pharmaceuticals then revised its application to sell Plan B to consumers 16 and older. The FDA countered by saying 17 and older was okay, then rescinded that plan and raised the age restriction to 18 and up. At one point, a top FDA scientist resigned in protest over what she claimed was political interference in the approval process. Susan F. Wood, assistant FDA commissioner for women’s health and director of the Office of Women’s Health, said she left because then-Commissioner Lester M. Crawford acted on instructions from within the administration to stall Plan B’s approval. Crawford himself wound up leaving the FDA before the controversy was resolved, which led to a delay in a replacement taking over because Plan B supporters in Congress held the nomination hostage as leverage to force the Bush administration to grant FDA approval.
 
Those involved in the Plan B debate mirrored many of the same groups involved in the debate over abortion.
 
For
Supporters of the effort to allow over-the-counter sales of “morning after” pills included many Democrats in Congress, including US Senators Hillary Rodham Clinton and Patty Murray. Other supporters included pro-choice advocates, liberal women’s organizations and even some FDA scientists. They claimed there was no harm in removing the prescription requirement for Plan B and other pills like it, since the FDA had already vetted the medication when it was first approved for sale in the late 1990s. Allowing the pills sales without a prescription would help reduce unwanted pregnancies and, thus, abortions, argued proponents.
 
Against
Opponents of allowing non-prescription sales of morning-after pills included Concerned Women for America, a conservative women’s organization, American Association of Physicians and Surgeons, Family Research Council, Safe Drugs for Women, religious organizations and many Republicans. President Bush never publicly opposed FDA approval of Plan B, but some suspected that the President may have exerted pressure on the agency to delay its decision. Many opponents were opposed entirely to morning-after pills, with or without a prescription, because of their belief that pregnancy begins with the fertilizing of the egg - thus, Plan B represented just another form of abortion. Opponents also claimed that non-prescription use of Plan B would create a public health hazard by causing an increase in sexually transmitted disease.
 
Background
U.S. Rules Morning-After Pill Can't Be Sold Over the Counter (by Gardiner Harris and Robin Toner, New York Times)
Morning-After Pill: Politics and the F.D.A. (by Gardiner Harris, New York Times)
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Suggested Reforms:

No Shortage of Suggestions for Medicaid Reform

Seemingly everyone who’s anyone has an idea for what the federal government should do about the Medicaid program, which continues to consume more money and not produce satisfactory results. The Congressional Budget Office suggested that health officials do the following to change Medicaid:
  • Reduce the rate at which the federal government reimburses states
  • Reduce eligibility and the number of mandatory services
  • Force beneficiaries to assume more costs
  • Promote lower-cost services, such as alternatives to nursing home care
 
Some conservative analysts have made their own suggestions that range from dismantling the program entirely to opening it up to competition to create more choice for Medicaid recipients. Examples of conservative opinions include the National Center for Policy Analysis, The Heritage Foundation, the Heartland Institute and the Cato Institute.
 
Liberals, who want to keep Medicaid going, have their own set of ideas for improving the system. These are offered by The Century Foundation and the Center on Budget and Policy Priorities.
Reforming Medicaid (by Michael Bond, John C. Goodman, Ronald Lindsey and Richard Teske, National Center for Policy Analysis)
The Future of Medicaid (by James Frogue, Heritage Foundation)
Pressure for Market-Based Medicaid Reform Rises (by Christie Raniszewski Herrera, Heartland Institute)
Medicaid’s Unseen Costs (by Michael F. Cannon, Cato Institute)
Out-of-Pocket Expenses for Medicaid Beneficiaries are Substantial and Growing (by Leighton Ku and Matthew Broaddus, Center on Budget and Policy Priorities)
Medicaid Budget Proposals Would Shift Costs to States and Be Likely to Cause Reductions in Health Coverage (by Victoria Wachino, Andy Schneider and Leighton Ku, Center on Budget and Policy Priorities)
 
GAO: Extend Deadline on Medicare Drug Reform
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) significantly reformed contracting for the administration of claims for Part A, Medicare’s hospital insurance, and Part B, which covers outpatient services such as physicians’ care.
The MMA required the Centers for Medicare & Medicaid Services (CMS) - the agency within the Department of Health and Human Services (HHS) that administers Medicare - to conduct full and open competition for all of its claims administration contracts and to transfer the work to Medicare administrative contractors (MAC) by October 2011.
 
The MMA required the Secretary of HHS to submit a report to the Congress and GAO on the plan for implementing Medicare contracting reform and for GAO to evaluate the plan. GAO did just that and recommended that CMS extend its implementation schedule from 2009 to 2011 to be better prepared to manage contracting reform.
 
CMS did not concur with the recommendation, but GAO believed that extending the time frame was the most prudent approach to manage contracting reform risks.
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Former Directors:

Former Secretaries of Health and Human Services

 
Tommy G. Thompson (February 2001 - January 2005)
 
A native of Elroy, Wisconsin, Tommy Thompson received his bachelor’s in 1963 and his JD in 1966 from the University of Wisconsin-Madison.
 
Thompson began his career in public service in 1966 as a representative in Wisconsin’s state Assembly. He was elected assistant Assembly minority leader in 1973 and Assembly minority leader in 1981. He was first elected governor of Wisconsin in 1987 and wound up being re-elected three times, a state record.
 
During his 14 years as governor, Thompson gained national attention for his welfare reform plan, Wisconsin Works or “W-2,” which served as a national model for welfare reform. The program required participants to work while at the same time providing the services and support to make the transition to work feasible. Thompson also worked to extend health insurance to many low-income children and families.
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Leo D. Frey 21 hours ago
Is this the proper agency to file a complaint against Del Sol MC in El Paso TX for losing a patient?

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Founded: 1980
Annual Budget: $707 billion
Employees: 64,750
Official Website: http://www.hhs.gov/

Department of Health and Human Services

Burwell, Sylvia Mathews
Secretary

President Barack Obama has nominated Sylvia Mathews Burwell, who is currently director of the Office of Management and Budget (OMB), to be Secretary of Health and Human Services (HHS), replacing Kathleen Sebelius. She was confirmed by the Senate on June 5, 2014.

 

Born in 1965 and raised in the small town of Hinton, West Virginia, Burwell is the daughter of optometrist Dr. William Mathews and Hinton Mayor Cleo Mathews. Valedictorian of her class at Hinton High School in 1983, Burwell earned a B.A. in Government from Harvard University in 1987 and a bachelor’s degree in philosophy, politics and economics from Oxford University, where she was a Rhodes Scholar.

 

Burwell began her career during college, serving as an intern for her Congressman, Rep. Nick Rahall (D-West Virginia) and as an aide to Gov. Michael Dukakis (D-Massachusetts). From 1990 to 1992, she was an associate at McKinsey & Company, a consulting firm based in New York.

 

After working on the Michael Dukakis presidential campaign of 1988 and the Bill Clinton campaign of 1992, Burwell served the Clinton Administration in various posts, starting as manager of Clinton’s economic transition team from 1992 to 1993 and staff director of the National Economic Council from 1993 to 1995. She served as chief of staff to Treasury Secretary Robert Rubin from 1995 to 1997, deputy chief of staff to President Clinton from 1997 to 1998, and OMB deputy director from 1998 to 2001.

 

Leaving government after the 2000 election, Burwell was immediately hired by the Bill and Melinda Gates Foundation to work as its chief operating officer and executive director, posts she held from January 2001 until a reorganization in 2006, when she became president of Global Development. In 2008-2009, Burwell served as Obama-Biden transition agency review lead for the Federal Deposit Insurance Corporation. Passed over for the Gates Foundation CEO position when it became available in 2008, Burwell left in late 2011 to become president of the Wal-Mart Foundation, which she led from January 2012 until her OMB nomination.

 

Burwell was at OMB only about a year, being confirmed by the Senate on April 24, 2013. Her time there was busy, however, and included a government shutdown in October 2013. She also dealt with health policy issues during her tenure, including Medicare and Medicaid, which should help her navigate her new challenge at HHS.

 

Burwell is a member of the Pacific Council on International Policy, the Aspen Strategy Group and the Nike Foundation Advisory Group. She has been a director of MetLife and Metropolitan Life Insurance Company since January 2004.

 

Burwell is married to attorney Stephen Burwell, with whom she has one child. A lifelong Democrat, she has donated $15,850 to Democratic candidates and causes, including $2,500 to the Democratic National Committee; $3,000 to Sen. John Kerry’s 2004 presidential campaign; $2,600 to President Obama’s 2008 run; $250 to Hillary Clinton’s 2006 U.S. Senate campaign; and $2,900 to Alan Khazei’s two primary campaigns for U.S. Senate from Massachusetts.

-Matt Bewig, Steve Straehley

 

To Learn More:

Meet The Nominee To Lead HHS (by Jason Millman, Washington Post)

Walmart Biography

Hinton Native Tapped: Obama Picks Foundation Chief Sylvia Mathews Burwell, Former Clinton Administration Economics Team Member to Head OMB (by David M. Kinchen, Huntington News)

Burwell as Obama's Budget Director: Walmart Wins, Working Families Lose (by Bertha Lewis, The Guardian)

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Sebelius, Kathleen
Previous Secretary

Kathleen Sebelius, President Barack Obama’s second choice for Secretary of Health and Human Services, was sworn in on April 28, 2009. As governor of Kansas, she earned a reputation as a political moderate who worked well with Republicans and possessed wonkish understanding of health policy. But she did little during her time as governor to bring about substantial change in the state’s health coverage or costs—which might explain Obama’s decision not to give Sebelius the dual assignment of running the new White House Office of Health Care Reform, which the previous nominee, Tom Daschle, would have had, had he not pulled out.

 
Born May 15, 1948, into a Roman Catholic family in Cincinnati, OH, Sebelius was exposed to politics from an early age. Her father, Democrat John Gilligan, served as governor of Ohio from 1971-1975. She attended the Summit Country Day School in Cincinnati, followed by Trinity Washington University in Washington, DC, where she met her future husband, Gary Sebelius, whose father, Keith, was a Republican congressman from Kansas.
 
After graduating with a BA in political science in 1970, Kathleen married Gary in 1974, and the two settled in Topeka, Kansas, where she worked as a special assistant to the state’s secretary of corrections from 1975 to 1977. She later attended graduate school at the University of Kansas, earning her Master of Public Administration in 1977, before becoming executive director of the Kansas Trial Lawyers Association (1977-1987).
 
In 1984, Sebelius served as Gary Hart’s campaign coordinator in Kansas during the Democratic primary for president. Her own political career began in 1986, with her election to the Kansas House of Representatives. She served eight years in the state legislature.
 
In 1994 Sebelius ran for state insurance commissioner and won a surprising victory, becoming the first Democrat to hold the post. She was credited with bringing the agency out from under the influence of the insurance industry. She refused to take campaign contributions from insurers and blocked the proposed buyout of Blue Cross Blue Shield of Kansas, the state’s largest health insurer, by Indiana-based Anthem Insurance. Her decision marked the first time the corporation had been rebuffed in its acquisition attempts. Her work as insurance commissioner resulted in being named one of Governing magazine’s Public Officials of the Year in 2001.
 
In 2002, Sebelius ran for governor of Kansas and defeated Republican Tim Shallenburger, 53%-45%. In doing so, she became the first daughter of a governor in U.S. history to also be elected governor.
 
Her gubernatorial victory—in a state where registered Republicans outnumber Democrats 2-to-1—elevated Sebelius to national prominence among Democrats in Washington.
 
In November 2005, Time named Sebelius as one of the five best governors in America, praising her for eliminating the $1.1 billion debt she inherited, ferreting out waste in state government, and strongly supporting public education – all without raising taxes, although she did proposed raising sales, property, and income taxes. She was also credited for her bipartisan approach to governing, which was critical since Republicans dominate the Kansas State Legislature.
 
Sebelius was easily re-elected governor in 2006, beating GOP State Senator Jim Barnett by 17 percentage points. During her two terms as governor, Sebelius enjoyed some victories on the issue of health care reform. She got Kansas to join a multi-state consortium that allowed Kansans to order prescription drugs from Canada, Great Britain and Ireland, often at a lower price than they cost in the United States. She also pushed through changes that added tens of thousands of children from low-income households to state health programs.
 
But more substantial health care reforms did not materialize under her watch, including two attempts to raise Kansas’ cigarette tax to expand medical coverage. Both times she was thwarted by Republican legislators, who objected to the tax increases and wanted a more market-based solution. In her 2007 State of the State address, she called for universal health care for Kansans, but declined to detail how she would pay for it. Republicans dubbed the idea “Hillarycare” in reference to former First Lady Hillary Clinton’s failed 1993 reform effort. Sebelius later condemned President George W. Bush for vetoing an expansion of the State Children’s Health Insurance Program, and called offering health care to children a “moral obligation.”
 
She vetoed anti-abortion legislation in Kansas in 2003, 2005, 2006, and in 2008, including a bill in April 2008 that sought to strengthen the state’s late-term abortion law. Kansas City Archbishop Joseph Naumann asked that Sebelius no longer receive Holy Communion because of her position on abortion. He also criticized her for vetoing the late-term abortion bill. Meanwhile, the governor’s office claimed that abortions declined 8.5% while Sebelius was in office, thanks to health care reforms she initiated, including adoption incentives, extended health services for pregnant women, and sex education. Planned Parenthood has been a strong supporter of Sebelius.
 
On other policy issues, Sebelius pushed for more widespread recycling efforts across the state, and she vetoed bills authorizing the construction of coal-fired power plants on three separate occasions. She also vetoed a concealed weapons law that would have allowed citizens to carry handguns after obtaining a state permit and passing an FBI background check. She vetoed a similar bill in 2006, but this time her veto was overturned by both the House and Senate.
 
Sebelius did not support an April 2005 amendment to the Kansas Constitution that outlawed same-sex marriage, saying she supported existing state law banning such unions. The constitutional amendment passed with 70% voter approval.
 
In 2008 Sebelius endorsed Barack Obama early in his primary battle against Hilary Clinton, and campaigned fiercely on his behalf, often acting as a surrogate to women’s groups.
 
After the November 2008 election, Sebelius was considered a prime candidate for a post in Obama’s cabinet. But she officially withdrew her name from consideration on December 6. Shortly thereafter, US Senator Sam Brownback (R-KS) announced his retirement from the Senate and his plan to run for governor. Some analysts speculated that Sebelius (who was prevented from running for a third time as governor due to term limits) would, in turn, run for Brownback’s Senate seat.
 
Sebelius has served on the Governor’s Blue Ribbon Panel on Prison Overcrowding, the Kansas Children’s Commission, and the Kansas Natural Resource Council. She also has served as chair of the National Governors Association (NGA), the NGA’s Executive Committee, and its initiative, “Securing a Clean Energy Future.” She also has been chair of the Education Commission of the States.
 
Sebelius’s husband, Gary, has been a federal judge for 34 years. The couple has two sons. One is a graduate of the Rhode Island School of Design and the other is a law student.
 
Sebelius's Political Skills, Experience Win Plaudits (by Michael Fletcher, Washington Post)
Kathleen Sebelius: Two decades in politics (Lawrence Journal-World & News)
Kansas Governor Kathleen Sebelius (by Alex Altman, Time)
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