U.S. Health and Human Services Director Kathleen Sebelius is stepping down, news broke last night. Hours earlier, Sebelius told members of Congress that an estimated 7.5 million Americans had signed up for health insurance through the state and federal exchanges created under 2010 health care reform law. A statement from the HHS department hailed her “work on Head Start, to expanding mental health coverage, to advancing cutting-edge health care research and, of course, her unwavering leadership in implementing the Affordable Care Act.”

Naturally, instant commentaries on Sebelius’ departure have highlighted the disastrous rollout of the Healthcare.gov website. I thought she should have resigned last fall. Even though the technical failure wasn’t entirely her fault, someone should have been held accountable. Igor Volsky took a more generous view, praising Sebelius’ work with Republican governors on alternatives to Medicaid expansion. She also convinced some of them, including Iowa’s Terry Branstad, to “form partnership health care exchanges in which the federal government and the state would share responsibilities in running the marketplaces.”

All in all, I think Sebelius could have done the country more good by staying in Kansas. As governor, she could have continued to block new coal-fired power plants and veto lunatic bills coming out of the state legislature. Plenty of people could have done at least as well, if not a better job, running HHS and implementing the Affordable Care Act.

What do you think, Bleeding Heartland readers?

President Barack Obama will appoint Office of Management and Budget Director Sylvia Mathews Burwell to replace Sebelius. Juliet Eilperin and Amy Goldstein reported, “Although Burwell does not have an extensive background in health-care policy, she is known for her strong management skills and has experience in issues of poverty and global health issues from her time at the Bill and Melinda Gates Foundation. Moreover, she is popular on Capitol Hill. The Senate confirmed her as OMB director 96 to 0 almost exactly a year ago.” Some Republicans are already praising her, and in any event, the 60-vote threshold for confirming presidential appointees no longer applies in the Senate.

The U.S. Department of Health and Human Services has granted a waiver for Iowa’s alternative to the Medicaid expansion foreseen under the 2010 health care reform law. Governor Terry Branstad signed the Iowa Health and Wellness Plan compromise into law in June, and state officials submitted a formal request for a waiver in August. Iowa elected officials from both parties as well as many non-profit organizations with a stake in the outcome had urged Health and Human Services to approve the plan.

However, Governor Terry Branstad may appeal today’s decision, because federal officials rejected a provision he insisted on during negotiations with Democrats in the Iowa legislature.

Three weeks into the launch of exchanges where millions of Americans are supposed to shop for private health insurance, the federal Healthcare.gov website is still a disaster. At a White House press conference today, President Barack Obama promised a massive effort to fix the problems and highlighted other benefits of the 2010 Affordable Care Act.

After the jump I’ve posted news and analysis related to the botched rollout of the health insurance exchanges. Any comments related to the 2010 health care reform law are welcome in this thread. It’s worth noting that Democrats in the Iowa legislature favored creating a state-run exchange, which would have eliminated the need for Iowans to purchase insurance through the screwed-up federal website. But Governor Terry Branstad insisted on a state-federal partnership, under which the federal government would administer the website for finding health insurance.

When news broke last week of a tax compromise skewed toward business, I wondered why Senate Democrats would agree to pass that bill without progress toward Medicaid expansion, one of their top priorities. Governor Terry Branstad was saying legislators should adjourn after approving a budget, education reform and the tax deal, returning later this year for a special session on health insurance coverage for low-income Iowans. In my opinion, Democrats would be insane to give Republicans what they want on taxes now, hoping for Medicaid expansion later.

Today several signs point toward a possible deal on Medicaid coverage before the end of the legislative session.

Expanding Medicaid in Iowa would add nearly $2.2 billion to the state’s economy, create an estimated 2,362 jobs, and save state government about $1.6 billion, according to a new study. For now, Governor Terry Branstad is sticking to his alternative plan for covering some low-income Iowans, but Senator Tom Harkin predicted last week that federal officials will not approve a waiver for Branstad’s approach.

Follow me after the jump for details on those stories and more about Medicaid in Iowa. I’ve also enclosed a moving personal statement State Senator Mary Jo Wilhelm delivered today about Iowans who can’t afford health insurance.

Five years ago this week, I was hospitalized with an infection that might have become life-threatening or permanently debilitating had I not had health insurance coverage, which allowed me to receive a relatively early diagnosis. Every day in this country, uninsured people hunker down, hoping their health problem will go away without an expensive doctor’s visit. That’s one of many reasons studies have shown that expanding Medicaid saves lives.

Governor Terry Branstad sounds determined not to expand Medicaid, but none of his arguments can withstand scrutiny.

UPDATE: Branstad confirmed on February 23 that he will not agree to expand Medicaid. Added details and other related news below.