President Barack Obama's choice to lead the Health and Human Services Department has a history of bucking the insurance industry, which faces the biggest hit under Obama's initial health care reform plan.
Kansas Gov. Kathleen Sebelius gets her introduction to the reform debate at a White House summit Obama will call to order on Thursday.
Obama introduced Sebelius on Monday as his choice to run HHS, including overseeing Medicare and Medicaid, the twin government health programs for the elderly and the poor. Their spiraling costs threaten to bankrupt the country.
The 60-year-old, second-term governor has cultivated an image as someone who stands up to insurers.
She was state insurance commissioner in 2001 when Indianapolis-based Anthem Insurance Cos. Inc. offered to buy Blue Cross-Blue Shield of Kansas for $190 million as it sought to expand its holdings nationwide. It promised to maintain coverage levels.
Sebelius blocked the deal in February 2002 after concluding that premiums would rise under Anthem's ownership. She prevailed when the state's highest court overturned a lower court ruling that she had exceeded her authority by rejecting the offer.
Later that year, Sebelius made her decision against the merger a central component of her campaign for governor, using it to help craft her image as a staunch consumer advocate who would stand up to powerful special interests.
As the nation's health secretary, Sebelius likely will have a similar, but bigger fight on her hands: pushing through the changes Obama outlined in the 2010 budget he released last week. Among other things, it calls for setting aside $634 billion over 10 years as a down payment on health care overhaul.
About half the sum would come from spending cuts in government health programs, such as Medicare and Medicaid.
But the biggest cut of all — nearly $177 billion — would come from reducing payments to private insurance plans now serving about 10 million Medicare recipients, about one-fourth of the seniors and disabled people enrolled in the programs.
"Health care reform that reduces costs while expanding coverage is no longer just a dream we hope to achieve. It's a necessity we have to achieve," Obama said in the East Room of the White House as he introduced Sebelius.
Obama also announced that he had chosen Nancy-Ann DeParle to run the White House Office for Health Reform. DeParle was a health policy figure during the Clinton administration.
Sebelius is subject to Senate confirmation; DeParle is not.
Both posts were to be filled by former the longtime senator from South Dakota, Tom Daschle, but Obama was left searching for replacements after Daschle withdrew from consideration about a month ago after disclosing he failed to pay $140,000 in taxes and interest.
Sebelius told Obama that she shares his belief "that we can't fix the economy without fixing health care."
As insurance commissioner, Sebelius also sought to require insurance companies to cover birth control for women. Insurance lobbyists and anti-abortion groups opposed the proposal, and it died in the state Legislature.
She also cut state workers' compensation rates by more than 11 percent, when the industry wanted a more than 4 percent increase. And she has argued that patients should be allowed to sue insurance companies over their decisions.
A Roman Catholic who supports abortion rights, Sebelius' nomination prompted angry reactions from anti-abortion groups outraged by her ties to Dr. George Tiller, a late-term abortion provider in Wichita, Kan. Groups including Operation Rescue and Concerned Women for America vowed to mobilize against her nomination. The American Life League said it was rolling out a "STOP Sebelius" petition and asking other anti-abortion groups to join.
Labor unions, the American Medical Association and the Hispanic advocacy group National Council of La Raza applauded the nomination.
As a state lawmaker, Sebelius worked to codify into state law the U.S. Supreme Court's Roe v. Wade decision that legalized abortion. She voted to allow state-financed abortions and against restricting late-term abortions, adding an eight-hour waiting period and requiring parental notification for minors.
As governor, she vetoed a bill putting new restrictions on abortion and allowing lawsuits to block the procedure on fetuses 22 weeks or older.
"There is nobody in America in my mind that is more radically sold out to the abortion lobby than Kathleen Sebelius," said Troy Newman, president of Kansas-based Operation Rescue.
But such criticism did not appear to be translating, at least immediately, into opposition among senators who will vote on her nomination.
Sen. Sam Brownback, R-Kan., one of the Senate's leading social conservatives, issued a joint statement with Roberts that seemed to accept Sebelius' nomination as a done deal.
Sen. Tom Coburn, R-Okla., a medical doctor and another conservative whom anti-abortion groups were looking to for help, signaled through a spokesman that he was concerned about Sebelius' abortion position, but stopped short of threatening to block her nomination.
Sebelius has been criticized for holding a reception at the governor's mansion in April 2007 with Tiller, who was under investigation into whether he illegally performed late-term abortions. She held the reception as part of a fundraising auction for the Greater Kansas City Women's Political Caucus. Tiller was the highest bidder.
Tiller is scheduled to go on trial later this month on 19 misdemeanor charges alleging he failed to get a second opinion from an independent physician before performing some late-term abortions, as Kansas law requires.