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The first Congressional hearing on President Barack Obama’s new nominee for Health and Human Services Secretary started out with a predictable attack on health reform on Thursday.

But Democrats countered with their own attacks against Republican governors who have held out against expanding Medicaid, even as senators from both parties praised Sylvia Mathews Burwell and promised her a speedy approval.

“We want to repair the damage that Obamacare has done and prevent future damage,” Tennessee Sen. Lamar Alexander, a Republican, told Burwell at the opening of the hearing on her nomination. Calling Obamacare “a huge mistake,” Alexander told Burwell: “Ms. Burwell, you have a reputation for competence and I say with respect that you are going to need it."

Burwell deflected Alexander's question about extending exemptions to some requirements under the 2010 Affordable Care Act. "I think flexibility is important. I think principles are important," she said.

Arizona Sen. John McCain, a Republican, said he advised Burwell against taking the HHS job. "Who would recommend to a friend to take over as captain of the Titanic after it hit the iceberg?" he asked.

Obama nominated Burwell to replace Kathleen Sebelius last month when Sebelius resigned April 10, after months of criticism as the face of the Affordable Care Act.

The disastrous rollout last year of the health insurance exchanges has dominated the headlines and been the main thrust of Republican campaigning since then.

Burwell is widely expected to pass through the Senate confirmation process smoothly. Burwell, who has a long history in the White House dating back to the Clinton administration, is currently director of the Office of Management and Budget, but takes on a $1 trillion-a-year department that includes Medicare and Medicaid, the Food and Drug Administration, Centers for Disease Control and Prevention and the National Institutes of Health.

“I believe Ms. Burwell has the qualifications to run HHS,” McCain said at the hearing of the Senate Help, Education, Labor and Pensions Committee.

Several Republican senators attacked the 2010 Affordable Care Act, widely known as Obamacare, and asked Burwell to help them change it. But Democrats had planned their own countermeasures.

"We have states like Connecticut that have worked so hard to implement (the law), said Connecticut's Christopher Murphy. Then you have states that are at best not implementing the law, trying at times to undermine the law."

"Who would recommend to a friend to take over as captain of the Titanic after it hit the iceberg?"

Burwell said she hoped to win more states over to the idea of expanding Medicaid. "Both the results and the willingness for conversation are the two ways that will make progress on that front," she said.

Burwell fumbled one softball tossed her way. North Carolina Sen. Kay Hagan asked her several times to compare states that had expanded Medicaid to states that hadn't. "In my state we have 500,000 that are still without coverage," Hagan, also a Democrat, said. "There's nowhere for them to turn."

Then came the easy pitch, as Hagan asked Burwell how much each state would have to pay for the Medicaid expansion. At first Burwell said she'd have to study the figures, but then corrected herself after an aide whispered in her ear.

"That would be zero," she said. "The state doesn't pay anything. The federal government will pay."

North Carolina's other senator, Republican Richard Burr, gave Burwell mostly a pass. "I support her nomination," he said. "She comes with a portfolio of experience."

Burwell, who has also worked for the Bill & Melinda Gates Foundation and Wal-Mart Foundation, gets praise from the health insurance industry, also.

"She has a strong track record as an effective manager who works with leaders across the political aisle,” said Karen Ignani of America’s Health Insurance Plans.

“As health plans prepare for the next open enrollment period, we look forward to working with her."

Burwell, who was born in the tiny West Virginia town of Hinton, was deputy chief of staff to former president Bill Clinton, chief of staff to the Secretary of the Treasury and as staff director of the National Economic Council. She was at OMB twice, under Clinton and again under Obama for the past year.

It was Burwell who closed down the federal government last year when Congress failed to come to a budget agreement.