Fall 2020 - Brookings Institute: Women’s Importance in Enacting, Implementing, and Defending the Affordable Care Act

Women’s roles in ACA implementation and defense

Of course, the story of the ACA did not end with its passage. Implementation was similarly fraught and also largely led by women; Secretary Sebelius and Marilyn Tavenner, the confirmed administrator of the Centers for Medicare and Medicaid Services (CMS) after the ACA’s passage. After the rough roll-out of HealthCare.gov, two new women stepped up: Sylvia Burwell as secretary of HHS and Kristie Canegallo as the first White House deputy chief of staff for Implementation. They helped forge systems, processes, and default policies and practices—many of which continue today. Women were leaders and drivers of the ACA legislative teams (e.g., Dana Singiser, Amy Rosenbaum), and communications teams (e.g., Anita Dunn, Linda Douglass, Stephanie Cutter, Tara McGuinness). And from the first to last day in the White House, Valerie Jarrett and Cecilia Munoz, through the Office of Public Engagement and Domestic Policy Council, contributed in numerous ways, not least by supporting women in this unusually demanding workplace.

The ACA drama continued beyond the Obama administration. In 2017, when Senator John McCain (R-Ariz.) cast his “thumbs down” vote against repeal, he followed women stalwarts Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska). (Notably, the only Republican Senator to vote for a version of the ACA in 2009 was Olympia Snowe from Maine.)