Kelly Kennedy, USA TODAY
TAMPA (USA TODAY) - Relaxed, joking with her staff and laughing with the people she'd been talking with for years, Kathleen Sebelius seems ready to enjoy the 45-day stretch run to the opening of health care exchanges on Oct. 1.
"It is exciting," said the secretary of Health and Human Services, the woman who has guided the Affordable Care Act since long before it was a 2,000-page political battle space. "We have been talking about this moment not just with this president. This is an incredible moment, and it has taken approximately 70 years of discussion."
As she met with health care providers, call-center operators, business leaders and local officials in Tampa on Thursday, Sebelius looked back at what the law has endured since it was first passed in 2010. The Supreme Court ruled last year in favor the law, and while the Republican-led House has voted 40 times to either repeal or strip funding from the law, the Senate has failed to consider their bills. Finally, President Obama won re-election last year, which defused another attempt to kill the law.
That doesn't mean the final push will be easy. Advertisements from the law's opponents in September will encourage people not to participate in the exchanges. Some Republicans, such as Sen. Mike Lee, R-Utah, have vowed to try to shut down the government in order to kill the law.
But so far, government health spending has gone down for the first time in 50 years. State premiums for the exchanges have come in lower than even the government expected. And more people are taking their medications, getting preventive exams and taking advantage of programs geared to help them become healthier.
"Even in 2010 when it was signed, 2013 seem so far away," Sebelius said. "I guess I've talked about it and thought about it and planned it, and I'm ready."
In Tampa, Sebelius seemed to enjoy herself as she touched base with the staff of call-center representatives who have answered an average of 60,000 calls a month since June. "What happens if I speak Cambodian?" she asked a staffer, who responded that an expert could read down a list of foreign words until the caller recognized the language, and then the expert could hook in a translator for that, or any of 150 languages. "That's really interesting," Sebelius said.
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She spoke to a group of trainees, seeming to enjoy the opportunity to give a pep talk.
"This is a huge deal, so don't forget that," she told them after a quick personal story of a family in need. "Just know that behind each of those voices is a real human and a real family, and you're making a difference."
Then, reminding them they had 45 days until the launch of open enrollment, she slammed her fist into her palm, grinned and said, "Now get to work!"
At a meeting of health care providers and others with a stake in the operations of the law, Sebelius heard concerns that enough people did not know about the exchanges.
"They want to know what's coming next - will there be TV?" Sebelius said. They asked about how to improve their chances for Medicaid expansion, and offered a possible political solution: Indigent populations are covered through property taxes. "Medicaid expansion could cause property taxes to go down."
While the law allows states to expand Medicaid, the state-federal program for low-income health care, Florida has not. The state's Republican governor, Rick Scott, supports expansion, but he has not persuaded the state legislature, also controlled by Republicans, to follow suit.
Mayors and county officials all want to see their uninsured populations helped, Sebelius said, adding that insurance commissioners deal daily with rate increases and people who can't get insured because of pre-existing conditions.
Sebelius, a Democrat, is a former Kansas insurance commissioner and governor.
She acknowledged the way forward won't be problem-free.
"I think that there will be glitches; there will be bumps," she said. "We just need to lean into this and recognize if there is a problem and fix it."