WASHINGTON -- Kathleen Sebelius and Nancy-Ann DeParle first met at the White House mess in 1997, during the battle for a patients' bill of rights to combat the constraints of managed care. The friendship they forged then could pay big dividends for President Obama now.
Sebelius and DeParle are the tag team for Obama's most ambitious domestic policy goal: an overhaul of the nation's health care system, which eluded President Clinton in 1994. The two "working moms," in Sebelius' words, are charged with chaperoning a measure through Congress that's likely to cost more than $1 trillion.
"There's a natural alliance," Sebelius says of their relationship, built over a dozen years on topics ranging from the children's health insurance program to raising their own children. She came to Washington in late April after serving as Kansas' governor and insurance commissioner.
DeParle has run Medicare and Medicaid, the mammoth government health programs for seniors, low- and middle-income families and people with disabilities.
With Sebelius as secretary of Health and Human Services and DeParle as director of the White House Office of Health Reform, Obama has two field generals where he originally envisioned one: former Senate majority leader Tom Daschle, whose nomination was withdrawn because of unpaid taxes.
"They have two people who not only are thoughtful emissaries but also are policy experts on health care," says Andy Stern, president of the Service Employees International Union.
No secret bill on hand
The president also has two pragmatists whose goal, like his, is to work with Congress rather than dictate to it, as the Clinton administration did. Given leeway, Congress is forging ahead with a goal of passing comprehensive legislation this year. "Nancy-Ann and the secretary are going to be pushing the ball up the hill, but they haven't designed the ball," says Chip Kahn, president of the Federation of American Hospitals.
That means Sebelius and DeParle will be spending more time consulting with lawmakers in June and July as the bill gets written and pushed through as many as five committees. Their goal is to get something passed that includes Obama's principles: expanded coverage, reduced costs, wider choice. Says former Health and Human Services secretary Donna Shalala, who introduced the pair over lunch in 1997: "They know where the tripwires are."
On the most controversial points, the two are willing to negotiate. They want a public insurance plan to compete with private insurers but say it doesn't need to be a rigid, Medicare-like model. They want more employers to offer health insurance but have not insisted on a mandate. They want to cover more uninsured but have not dictated how many. They want to pay for the expansion but aren't saying what taxes to raise or spending to cut.
"People still believe that either Nancy-Ann or I have the 1,000-page bill," Sebelius says in a joint interview in her office, during which the two occasionally finish each other's sentences.
"People comment on my handbag being so big," DeParle quips, as if the secret health care plan is inside. Instead, she says, Congress will write it by consensus. "It becomes retail politics now. It's member by member."
So far, many members are pleased with the tag team's light touch. Rep. Pete Stark, D-Calif., who chairs a key health subcommittee, calls DeParle "a quick study."
Sen. Bill Nelson, D-Fla., who was elected his state's insurance commissioner the same year as Sebelius, says she "knows the insurance industry backwards and forwards."
Other Democrats want the White House to take a firmer stand on behalf of a government insurance plan and other options favored by liberals. "It's about time for the Obama administration to begin to get more specific and begin to push," says Sen. Sherrod Brown, D-Ohio.
Republicans, including Senate Minority Leader Mitch McConnell, R-Ky., are concerned about the health care plan's likely cost and inclusion of a government insurance option. That will make it difficult for the administration to win their support.
"They're doing considerable outreach to members like me who want to help the administration shape a health care reform effort that could actually pass with significant support," says Sen. Susan Collins, R-Maine, one of three moderate Republicans who backed the administration's $787 billion economic stimulus plan in February.
Obama and his health care team also have cultivated relationships with doctors, hospitals, drug companies, insurers, businesses, labor unions and consumer groups, all of whom have embraced change -- at least until the bill is unveiled. Some health care leaders have even promised to reduce health costs by $2 trillion over the next decade; details to come.
"They have a knowledge of the issue, they have political experience, and they know the data," says Karen Ignagni, president of America's Health Insurance Plans. "They're 24/7 workers."
Ron Pollack, head of the health care consumers group Families USA, says Sebelius and DeParle are not ideologues. "You can't find two people who are nicer to work with," he says. "So much of Washington depends on human contact."
'Close to home'
Sebelius, 61, and DeParle, 52, know the business of health care from personal experience. Each has two sons. Sebelius' are grown; DeParle's are in grade school.
Sebelius helped her sons navigate the individual insurance market when their first jobs after college offered no coverage. DeParle advised her brother after he lost a job and couldn't afford to keep family coverage under the COBRA law, which gives workers and their families who lose employer-paid health benefits the right to stay covered temporarily if they pay the premiums.
Sebelius, the last member of Obama's Cabinet to be confirmed, says those experiences make both women keenly aware of the problems facing 46 million people in the USA without insurance and those who are in and out of coverage.
"It's something that a lot of families are struggling to try and figure out," she says. "If your child doesn't have a job, can you luck it out for a while or not? Can you take that risk or not? That's a difficult situation."
"It hits very close to home," DeParle says. "It's part of what makes this work so important and wonderful, I think, for both of us -- being able to be involved in something that could really make a difference in people's lives."
To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com
Copyright 2009 USA TODAY, a division of Gannett Co. Inc.