Meet Sylvia Mathews Burwell -- the next secretary of health and human services. Here's everything you need about her career. in less than a minute. (Jackie Kucinich, Theresa Poulson and Jeff Simon/The Washington Post)

The Senate confirmed Sylvia Mathews Burwell, the White House’s budget director for the past year, on Thursday as the 22nd secretary of the Department of Health and Human Services.

On a bipartisan vote of 78 to 17, senators approved Burwell to lead the government’s largest domestic department, ending a quick confirmation process that was devoid of the bitter partisanship surrounding the 2010 Affordable Care Act and the changes it is bringing to the U.S. health-care system.

Senate Finance Committee Chairman Ron Wyden (D-Ore.), whose committee had recommended Burwell to the full Senate, said that she attracted what he called “a choir of bipartisan support” because “she is really that good, she is really that capable, and she is really that qualified.”

In her new role, the 48-year-old veteran of the Clinton administration’s economic team will oversee 11 far-flung agencies that make up HHS, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration and the enormous public insurance programs, Medicare and Medicaid.

But Burwell’s early focus is almost certain to center on the work that absorbed her predecessor, Kathleen Sebelius, during much of her five-year tenure at HHS: implementing the Affordable Care Act in a climate that remains politically polarized and could become more so, depending on the outcome of congressional elections this fall.

According to an HHS aide, Burwell is scheduled to take over once she is sworn in Monday.

The White House and federal health officials are pleased that the first six-month sign-up period in new insurance market­places overcame a troubled start to enroll 8 million people by early this spring — more than predicted.

Health-policy specialists point out, however, that substantial work remains to put the sprawling law into practice. For example, federal health officials need to merge into the federal insurance exchange three states — and possibly more — whose attempts to run their own insurance marketplaces have failed.

Officials also continue to wrestle with, the computer system for the federal health insurance exchange. Some aspects are not yet working or built, including parts designed to handle enrollment records, enable the direct enrollment of people poor enough to qualify for Medicaid, and allow the online enrollment of small businesses.

HHS also will need to decide how to handle a requirement under the law that many employers offer health benefits to their workers — a provision that the Obama administration has delayed twice.

President Obama nominated Burwell on April 11, the same day that Sebelius announced her resignation. Last fall, Sebelius became a public face of what the president called a “disastrous” launch of new insurance marketplaces, but she remained in place until after the first enrollment period ended.

During confirmation hearings last month before two Senate committees, Republicans reiterated their objections to the health-care law. But critics did not challenge Burwell’s competence.



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Several Senate Republicans clung to that distinction on the Senate floor Wednesday and Thursday before the vote.

Sen. Johnny Isakson (R-Ga.) said that he plans to support Burwell, adding that he finds her “articulate, forthright, straightforward and candid — something we really haven’t had from the secretary of HHS for the last year or so.”

But Isakson was quick to add: “No one should confuse that vote, however, for being a vote in support of the Affordable Care Act or what it’s doing to health care in the United States today.”

Senate Minority Leader Mitch McConnell (R-Ky.) said Thursday morning that he would vote “no.” “Her embrace of this disastrous law is reason enough to oppose her confirmation . . . In my view, the Senate shouldn’t be focusing on a new captain for the Titanic. It should focus on steering away from the iceberg.”

Democrats countered with a recitation of benefits from the law, from widening access to health coverage to helping to stabilize the financial underpinnings of Medicare, the federal health insurance program for older Americans.

“This bill is making a huge difference,” said Sen. Benjamin L. Cardin (D-Md.). “We have the best health care in the world. We are now on the path of having the best health-care system in the world, and the Affordable Care Act helped us get there.”

In the end, 24 Republicans joined all voting members of the Senate’s Democratic caucus in supporting Burwell. Still, the vote was more divided than the Senate’s unanimous vote 14 months ago confirming her to lead the Office of Management and Budget.

Before returning to Washington last year, Burwell spent more than a decade in the world of philanthropy — with the Bill and Melinda Gates Foundation and then as president of the Walmart Foundation.

During the Clinton administration, Burwell held several economic roles — as staff director of the White House National Economic Council, as chief of staff under then-Treasury Secretary Robert Rubin, and then at the Office of Management and Budget, where she eventually became the deputy director.

After becoming budget director, Burwell was mired at first in fiscal conflicts with congressional Republicans and, by October, had to manage the 16-day partial shutdown of the government.

Despite her Washington experience, she is not well known in health-policy circles, and, during her confirmation hearings, she gave little concrete sense of the direction in which she will take the complex department she will inherit.

Ed O’Keefe contributed to this report.