WASHINGTON — Sylvia Mathews Burwell, President Obama's nominee to head the Department of Health and Human Services, appears on track for confirmation after a Thursday hearing in which she was praised by Democratic and Republicans senators.
Sen. John McCain, R-Ariz, called her a friend. Sen. Tom Harkin, D-Iowa, called her "dynamic." Sen. Lamar Alexander, R-Tenn., said she had a reputation for "competence," but continued, "You are going to need it."
Sen. Richard Burr, R-N.C., praised her, saying "I support her nomination and I will vote for her. She comes with a portfolio of experiences" that qualify her for the job.
Burwell, now director of the Office of Management and Budget, still faced criticism by Republicans for the Affordable Care Act, which she will have to administer as HHS secretary.
Sen. Tim Scott, R-S.C., called for the end of "Obamacare," and Alexander said he'd like to fix a "historic mistake."
In her opening statement, Burwell stuck to the middle ground, saying she hoped to lower costs and improve access to the health care system, and that she would focus on keeping people safe.
"The issues are fundamental to all of us — whether it is the chronic condition of a child we love, the safety of the food we eat every day, or improving quality, lowering the cost and expanding access in our health care system," she said. "So I respect the importance of the challenges before us."
Burwell also praised the law, saying health costs would be greatly reduced.
Burwell's hearing came a week after HHS announced that 8 million people had signed up for private health care through the exchanges — 1 million more than the Congressional Budget Office originally projected, and 2 million more than CBO's most recent projection.
That came under the leadership of HHS Secretary Kathleen Sebelius, who said 13 million people have gained insurance through Medicaid and the adults younger than 26 who gained coverage through their parents' plans. Sebelius announced her resignation last month on the same day she announced the administration had surpassed its goals.
Sen. Chris Murphy, D-Conn., called Sebelius' service "admirable," adding that "she carried out the law."
If confirmed, however, Burwell will inherit a federal exchange site that had a disastrous launch in October, before it was fixed in November. The site still has problems for insurers and payment processing, which insurance company representatives said at a Wednesday House hearing.
She may also face a Senate controlled by Republicans next year if their election-year assault on the law elects those determined to put more pressure on whoever leads HHS.
Senators expressed hope that Burwell's leadership at OMB, as well as her ability to work with both parties, would smooth the transition to a new secretary.
Sen. Elizabeth Warren, D-Mass., said that so far, Medicare spending has gone down under the ACA, and that it will be $500 billion less than originally projected from 2017 to 2026. She added that that's more than any of the budget cuts made recently.
Burwell said federal costs have been cut by $900 billion, according to the Congressional Budget Office.
"The implementation of the changes in the Affordable Care Act are reducing the deficit and providing great savings," Burwell said. She said the law would extend the life of the Medicare Trust Fund by five years.
Sen. Barbara Mikulski, D-Md., asked what experience Burwell has that could help her "wrap your arms around this huge bureaucracy."
Burwell said she needed to create a goal list, building strong teams and empowering them, and understanding when analysis versus emotion are leading the charge. While she served as president of global development at the Gates Foundation, she said she had to use those abilities to lead health programs worldwide.
Sen. Pat Roberts, R-Kan., asked if she understood there was a difference between implementing the law and pushing an agenda. Burwell said she looked forward, if confirmed, to expanding access.
Burwell told Roberts she hoped to avoid using the Independent Payment Advisory Board created for Medicare in the health care law. The board, which has no members yet, has the power to create recommendations for spending that could go into effect automatically unless Congress votes to stop them.
"I am confident that IPAB will never need to be used," she said, saying the board only goes into place if Medicare costs reach a certain limit, and Medicare costs have been remaining stable.
"I'm afraid I'm not as confident about that as you are," Roberts said.
Burwell told Sen. Michael Enzi, R-Wyo., that she would make improving the HealthCare.gov website a priority.
However, she could not answer Enzi's question about how many people have paid their premiums after buying insurance through HealthCare.gov.
"With regards to the specific data HHS has, I'm not privy to this knowledge in my current role," Burwell said. But she said insurers have not given final numbers to the administration, although insurers told the House panel Wednesday that between 80% and 90% of customers have paid their premiums.
Follow @KellySKennedy on Twitter.