Updated: March 7, 2022 at 12:50 p.m.

Former U.S. Secretary of Health and Human Services Kathleen Sebelius spoke about her role in passing the Affordable Care Act in the University Student Center Amphitheater Wednesday.

Sebelius, who served as HHS secretary during the administration of former President Barack Obama, the changes it could face under the next two administrations and the new challenges that the COVID-19 pandemic has created for health law. More than 50 students and faculty attended the event, which was moderated by GW Law Dean Dayna Matthew and hosted by the GW Health Law Initiative – a group of law school students and faculty focusing on health law.

Sebelius kicked off the event reflecting on her beginnings as the governor of Kansas in the early 2000s and how Obama urged her to step down from her position to join HHS in 2009 when he was stepping into office as president. She said the secretary position felt more urgent and intriguing for her because of the 2009 swine flu pandemic, which led to more than 60 million American infections, and Obama’s campaign promise to pass a health care reform bill in his first term.

Sebelius said she initially did not want to resign from her position as governor of Kansas until the U.S. Senate confirmed her nomination to the cabinet, but she had to leave office after needing to arrive in Washington sooner than first expected. Obama’s first nominee for HHS secretary, former Senate Majority Leader Tom Daschle, had withdrawn his name from consideration after reports circulated that he had failed to pay more than $100,000 in income tax.

“Our plan was to go through the debate, they hopefully will vote me in, I will resign, my lieutenant governor will be sworn in and I’ll come into Washington with my husband and get sworn in,” she said. “So this call comes in at nine o’clock in the morning in Kansas saying ‘There’s a plane in the air, it will land at noon and the president wants you on that plane.’ So well that’s really interesting, but I’m the governor, and I have a day job. And I’m really not interested in resigning that day job until I have another day job.”

Sebelius said she was involved in numerous Congressional hearings, committees sessions and draft writing sessions that led to the final Affordable Care Act legislation, which was federal lawmakers passed just 15 months after Obama’s inauguration. She said one of the most common pieces of feedback she got from critics of the legislation was that “nobody knew what was in the bill” and that it was too complicated.

Sebelius said lawmakers’ criticism of the bill was inaccurate and frustrating because of her cabinet’s extensive work drafting and communicating the contents of the legislation to them.

“There are a lot of things about this whole process that have driven me crazy, but one is this notion that nobody knew what was in the bill and it was too complicated,” she said. “Nobody read it. I have to say, unequivocally, that was bullshit.”

The final draft of the Affordable Care Act offered less-expensive government-sponsored options and outlined plans to expand Medicaid programs to include people who don’t have access to private insurance.

Sebelius said after months of negotiations between Congressional leaders – where she said lawmakers would regularly storm in and out of government meetings – President Obama signed the Affordable Care Act into law in March 2010. She said lawmakers had been reluctant to pass the bill for most of the legislative process, putting a lot of stress on her office.

“There had never been a piece of legislation that was this extensive, where the other party refused to ever pass a piece of legislation to actually put it together,” she said. “No administrative changes, no allocation of resources to administer this bill, no attempt to reconcile.”

When Congress finally passed the Affordable Care Act, Sebelius and her advisors had to implement the bill nationwide, which she said was difficult because of mixed opinions on expanding government-sponsored healthcare among state lawmakers. She said some of these state politicians constantly pushed conspiracy theories about how the legislation would lead to the collapse of the American free market or the rise of a “nanny state” – a term used to describe a government that interferes with personal freedom.

“It was impossible to say, ‘That’s not true, look at what’s happening,’ because nothing was happening – it was all he said, she said,” Sebelius said.

The Affordable Care Act faced some changes – like policies that would discourage undocumented immigrants from enrolling in Medicaid – during the administration of former President Donald Trump, who favored privatizing parts of the government health insurance plan. Sebelius said the legislation continues to provide health care to Americans, and its survival shows the relative resilience and popularity of the bill.

At the end of Obama’s presidency, 22 million Americans attained insurance they didn’t have before and health inflation was at the lowest level ever recorded in history.

“The good news is that it wasn’t repealed, even though Republicans controlled the House and the Senate and the presidency and promised that that would be act number one – get rid of it on day one,” she said.

Sebelius said the COVID-19 pandemic highlighted the “fractured” nature of the American health care industry because of the country’s lack of rampant politicization of a global health crisis. She said the response to the pandemic was too reliant on local leaders and policies instead of the federal government.

“We didn’t do a very good job mobilizing resources, and energy and providers into communities where they were desperately needed and to the folks on the front line,” she said.

This post has been updated to correct the following:
An earlier version of this post said the event took place in the University Student Center’s Dorothy Betts Marvin Theater. It took place in the University Student Center Amphitheater. We regret this error.