A health care system overhaul, weak finances in Medicare, lapses in food safety. Those challenges and more await Kathleen Sebelius as President Barack Obama's health secretary.
Gaining confirmation from the Senate would be the Kansas governor's first hurdle. She has clashed with abortion opponents in the state, and they may try to carry the fight to Washington.
Obama planned to introduce Sebelius on Monday as his nominee to lead the Health and Human Services Department. Later this week he is to host lawmakers and representatives of major interest groups at a White House summit on health care reform.
On Sunday, Sebelius won praise from several Republican governors and from the chairman of the Senate panel that will handle her nomination.
Finance Committee Chairman Max Baucus, D-Mont., said Sebelius would make a "strong partner" in revamping the health care system and that she "really gets what needs to be done."
Viewed as a steady hand, experienced
Republican Govs. Arnold Schwarzenegger of California, Sonny Perdue of Georgia and Jon Huntsman of Utah also applauded her nomination.
Sebelius, 60, is seen as a steady hand, an experienced public official who knows how to work across political lines. As a former state insurance commissioner, she is unfazed by the complexities of health care and insurance issues.
But she represents Obama's backup plan.
Originally, the president had counted on former Senate Majority Leader Tom Daschle to shepherd his health overhaul agenda through Congress.
Daschle would have worn two hats: health secretary and head of a White House health reform office. He was on a first-name basis with most senators, where health care legislation faces its stiffest test. Yet he dropped out of consideration after his failure to pay taxes on all his earnings came to light.
Sebelius knows some of the key players, but she will have to establish a working relationship with others. Obama plans to name a different person for the White House health care job, raising the prospect of tensions between that office and the health secretary's.
Kansas' two senators, both Republicans, offered words of praise.
"Obviously we will have different viewpoints than the administration on many issues including health care reform, especially given the huge price tag," said Sens. Pat Roberts and Sam Brownback. But despite "real concerns" about Obama's direction, they said they looked forward to being able to pick up the phone and talk directly with Sebelius about health care issues.
Brownback and Roberts could be allies in defusing any opposition to her nomination.
Favorable response from industry groups
The health insurance industry and consumer groups have responded favorably to Sebelius' nomination.
Obama made his opening move on a health care overhaul last week with a speech to Congress and a budget that set aside $634 billion over 10 years as a down payment on coverage for all, a goal that could ultimately cost $1 trillion or more.
Obama outlined some general policies, such as putting the country on a path to cover all its citizens and preserving the employer role in providing health insurance. His budget also showed it will take tough choices on spending cuts and tax increases to pay for health care.
It will be up to Congress to turn those ideas into workable legislation. Baucus and Sen. Edward M. Kennedy of Massachusetts, who leads the Health, Education, Labor and Pensions Committee, say they want to present legislation by the summer.
Obama wants to expand coverage while slowing the rate of increase in costs. Administration officials say they are hoping that in the end that will lead to a more affordable system, without the coverage gaps that leave an estimated 48 million people uninsured.
But Republicans are concerned about the costs, and about giving government an even larger role in health care. White House chief of staff Rahm Emanuel signaled that the debate could get contentious.
Offer alternatives, not just criticism
Appearing on the CBS program "Face the Nation," Emanuel challenged Republicans to propose alternatives to Obama's health care plan, not just criticize it.
Health care "is a particular example where America's economic competitiveness, its strength around the world is sapped because we have a health care system that doesn't allow American workers and business to compete," Emanuel said. "And the Republicans will have an opportunity not just to criticize, but to propose."
Before health care legislation gets moving, Sebelius' attention may well be diverted by problems at the department. The administration will have to move quickly to name an FDA commissioner, a decision delayed by the difficulty in filling the health secretary's job.
A trustees' report due in the spring is expected to highlight the worsening condition of Medicare's finances, hammered by a drop in tax revenues because of the recession.