The April 11 resignation of U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius shows both the importance of President Barack Obama’s landmark healthcare legislation, passed in 2009, and the extreme partisan divisions which obtain in the U.S. Congress. Ms. Sebelius has ostensibly resigned over the problems faced by those Americans who tried to enrol online for health insurance under the Patient Protection and Affordable Care Act (ACA) when the scheme opened in October 2013. The enrolment was fraught with crashes and glitches, and the scheme’s opponents redoubled their attacks. Despite Mr. Obama’s statement that none who had given up pre-existing insurance would lose coverage, some did, and the political fallout threatened the entire scheme. Most of the software issues were, however, solved, and the scheme has now exceeded expectations: over 7.5 million persons have signed up in the open enrolment period, which ended on April 15. Even redneck Republican Arizona saw nearly 60,000 sign-ups with over a month left. When the Act was passed, nearly 50 million Americans had no health insurance. Ms. Sebelius’s successor, subject to Senate ratification, will be Sylvia Mathews Burwell, director of the White House Office of Management and Budget (OMB).

Mr. Obama may have felt he had no option over Ms. Sebelius, in view of what happened to President George W. Bush’s Defense Secretary Donald Rumsfeld, who received a vote of presidential confidence before the 2006 midterm elections but had his resignation accepted immediately after the poll showed heavy Republican losses. Yet, Ms. Sebelius’s departure will reopen a debate which was being damped down by the continuing high enrolment, and opponents will probably target any continuing difficulties and any Congressional or other questioning which Ms. Sebelius resisted. Her putative successor, Ms. Burwell, who won a 96-0 Senate confirmation of her OMB nomination in April 2013, will face a tough time in her HHS hearing, for example over how many have actually paid their first month’s health insurance premiums. Key facts, for example that the Act means subscribers will no longer be tied by job-related health insurance, will probably disappear from the debate. So will the fact that the online enrolment contract went to a Canada-based company, CGI Federal, without competition, and that private insurers and drug companies remain the main treatment providers. The controversy has less to do with the Act than with ideological opposition to it among almost all Republican politicians, some Democrats, and insurance companies that see the ACA as a threat to profits.