by Brad Forenza, MSW, Ph.D.
When President Obama enacted the Affordable Care Act (ACA), it was the most significant contribution to social welfare policy since President Johnson’s Great Society initiatives. However, the fate of the ACA has been political fodder ever since. The person initially tasked with ACA implementation was the Honorable Kathleen Sebelius, Secretary of Health and Human Services from 2009-2014. In this exclusive interview, Secretary Sebelius offers advice to aspiring human service professionals, as well as her insights on modern social welfare.
“I grew up in the world of social welfare policy,” Sebelius begins. “You might even say it was in my DNA.” This predisposition to policy likely refers to Sebelius’ father’s tenure as Governor of Ohio, 32 years before her own tenure as Governor of Kansas. “I was part of a family where the civil rights era was very much a part of my growing up. Segregation was going on then, and so was the Vietnam War.... So when I got out of school, I got involved in areas where I thought I could make a difference in people’s lives.” Those post-school involvements (Sebelius studied political science) refer to practice with survivors of domestic abuse, as well as practice with those who were criminal justice-involved. “If you are in a practice area, you can clearly have a significant impact on the clients that you see,” Sebelius notes. After spending time in these practice-oriented capacities, however, Sebelius says, “I realized that changing the law and...offering a different kind of platform for people was the best way for me to make change.”
Sebelius won her first elective office in 1987, representing Topeka in the Kansas House of Representatives. In 1995, she was elected as that state’s insurance commissioner, where she was responsible for reviewing and regulating insurance practices. In discussing the link between policy and practice, Sebelius notes that, through policy, “What an individual can do with a client can be amplified by putting together a set of circumstances or possibilities, so that a lot of people can reach their full potential simultaneously.” As Governor of Kansas (2003-2009), Sebelius helped individuals reach their full potential by making unprecedented investments in public education, reproductive health, and prescription drug affordability, among much else. “People don't always know who does the work or what the work really is [in policy], but the work itself can have a lot of impact.”
In reflecting on her time as Secretary of Health and Human Services, Sebelius recalls that, “[Since the enactment of the ACA], people no longer fear being bankrupted by their healthcare bills, or getting kicked off their parents’ plans, or being denied coverage because of a pre-existing condition.” She continues, “Social work students should know that...there is a framework now, where health is one of the most essential rights that Americans have...health enables us to live more productive lives, personally and professionally.”
Sebelius goes on to say that, while healthcare is a universal concern, the task of defending core components of the ACA will likely fall on social workers and allied professionals. “In most developed nations, the right to things like healthcare and education are part of the framework,” she says. “But that’s not the contract our framers made.... We wouldn’t have a ‘floor’ if it weren’t for social welfare policies.” The “floor” that Sebelius refers to is the American social safety net, of which the ACA is part. “The ‘floor’ makes sure that individuals can survive in this country, even when the free market may not have treated them so kindly. Absent the safety net, we would have a lot of citizens falling through the cracks and ending up in dismal straights... [as it is] we have too many people going to bed hungry at night in a nation that produces more food than it needs, and—in spite of medical advances—a nation that still has way too many people going to bed without healthcare.”
With every transition comes uncertainty. The fate of the ACA is presently unknown. However, since the Act was first implemented by Secretary Sebelius, it has insured approximately 20 million people. Sebelius reminds us that, “When people talk about cutting programs, they are talking about eliminating a lifeline for neighbors and friends they might interact with every single day.”
On behalf of our 20 million neighbors and friends who benefit from the ACA, and on behalf of a profession that emphasizes equality and justice, it is fitting to salute Secretary Kathleen Sebelius for the role that she played in helping to make a historical contribution to American social welfare policy. As social workers, we must hope that the ACA, and the legacy of its enabling administration, will survive for generations to come.
Brad Forenza, MSW, Ph.D., is an assistant professor at Montclair State University. His research foci include child welfare, youth development, and civil society. His academic career is accentuated by direct practice at youth and family development agencies, as well as public policy analysis and advocacy.