President Obama picked Sylvia Mathews Burwell to be the new face of health care because she has dealt with the complexities of the federal budget and has managed large organizations.
One other thing: Burwell is a good bet for Senate confirmation.
Just a year ago, the Senate voted by a 96-0 margin to confirm Burwell to her current job, director of the Office of Management and Budget.
"I'm assuming not that much has changed since that time," Obama joked Friday as he nominated Burwell to replace Kathleen Sebelius as secretary of Health and Human Services.
Burwell, 48, does face the prospect of tough new Senate confirmation hearings featuring Republicans' attacks on Obama's health care law. But at this point, at least, Burwell has much better relations with Congress than the embattled Sebelius.
"Sylvia Burwell is an excellent choice to be the next #HHS Secretary," tweeted one prominent Republican, Sen. John McCain of Arizona.
Praising his new nominee during a White House ceremony, Obama cited a Burwell résumé that included high-ranking jobs with the Clinton administration, Wal-Mart and the Gates Foundation.
"Sylvia is a proven manager, and she knows how to deliver results," Obama said, adding that she will need those skills managing the health care law and other HHS responsibilities: "These are tough tasks — big challenges."
The president praised Burwell's performance as budget director in negotiations that ended the partial government shutdown in October and led to a two-year budget agreement with Congress. He called her "a rock" and "a steady hand" during tense times.
As OMB director, Burwell was technically the official who ordered the shutdown after Congress could not agree on a new spending plan.
During brief comments in the White House Rose Garden, Burwell told Obama she is "humbled, honored and excited" by the new assignment.
Burwell and Obama also pointed out that the Department of Health and Human Services has responsibilities beyond health care, including food and drug safety, disease outbreak prevention, and medical research.
A staff member throughout her government career, Burwell figures to be a lower-key Cabinet secretary than the higher-profile Sebelius, a politician who once served as governor of Kansas. Sebelius faced heavy criticism over the rollout of the new health care law, particularly the website problems that blocked early sign-ups for policies.
If confirmed by the Senate, Burwell faces a number of health care challenges. Provisions that have been delayed are scheduled to go into effect, including the requirement that employers provide health insurance to their workers.
The administration hit its goal of more than 7 million sign-ups when this year's enrollment period ended March 31. A new enrollment period begins later this year, and Republicans are saying that premiums will rise as financial pressures burden the new system.
Senate Minority Leader Mitch McConnell, R-Ky., said he hopes Burwell's nomination — "to lead one of the most important jobs in government" — will be "the start of a candid conversation about Obamacare's shortcomings and the need to protect Medicare for today's seniors, their children and their grandchildren."
While she has spent much of her career as a government staffer, Burwell does have something of a political background. Her mother served as the mayor of Hinton, W.Va., where she was born in 1965.
A Harvard graduate and Rhodes Scholar, Burwell had several jobs during Bill Clinton's presidency. She served as chief of staff to Treasury Secretary Robert Rubin and deputy chief of staff to Clinton himself. She was deputy OMB director to then-budget director Jack Lew, now Obama's Treasury secretary.
Burwell also has experience in the private sector. She worked at the Bill & Melinda Gates Foundation, which develops global health and anti-poverty programs. Burwell has also been president of the Walmart Foundation, the charity arm of the retail giant, and a board member for MetLife — a major player in the health insurance business.