WASHINGTON -- The first, and perhaps most painful, call for Kathleen Sebelius to resign as President Barack Obama's health secretary came earlier this month from an old family friend: Sen. Pat Roberts, R-Kan., who once boasted of a "special relationship" with Sebelius, forged when he worked for her father-in-law.
Now Sebelius, the former Kansas governor and onetime insurance commissioner who is the public face of Obama's health care overhaul, is facing a barrage of criticism over the problem-plagued rollout of its online insurance exchange. For Republicans, still reeling from their failed "defund Obamacare" strategy and the resulting government shutdown, she has proved an easy target.
Republicans insist the buck stops with the secretary. But though Sebelius runs the Department of Health and Human Services, the agency responsible for the health care law, there are questions about how deeply she was involved in the development of the problem-plagued HealthCare.gov website and whether she saw the problems coming.
"Kathleen has the title, but she doesn't have the responsibility or in many respects the kind of wide authority and access to the president that she really needs to make a difference," said one person close to Sebelius and the White House, who asked to remain anonymous to discuss internal decision-making. "Everybody thinks that she's the driving force, but unfortunately she's not."
The White House kept close tabs on the creation of the online exchange, with particular attention to the website's design, but managing the details of the software development was left to the Centers for Medicare and Medicaid Services, which Sebelius oversees.
She testified on Capitol Hill this spring that the exchanges were "on track" to open Oct. 1, but those close to her say she has been far more immersed in developing policy related to the health care law, and in traveling the country to promote it, than in its technical aspects.
Sebelius' decision to leave Washington this week - she will speak at a gala at the John F. Kennedy Presidential Library and Museum in Boston on Wednesday night, then travel to promote the health care law in Phoenix; Austin, Texas; and San Antonio - caused an uproar among Republicans who said she had not explained why the website failed and how the government plans to fix it.
House Republicans, including leaders of the Energy and Commerce Committee, which planned a hearing Thursday to examine issues related to the technical failures of the website, have demanded that she testify. (She will appear next week.)
"We've got lots of questions," said Rep. Joe Pitts, R-Pa. and chairman of the panel's health subcommittee. "Why would she mislead us so shortly before the rollout, when they were obviously not prepared and are still not prepared, and it's going to take a long time to fix the problem? We want to know how long she thinks it is going to take."
On Tuesday, Sebelius tried to provide some answers, at least in writing. In a blog post on her agency's website, she provided details of the "technology surge" promised by the White House to correct the site's deficiencies, and she named Jeffrey D. Zients, a management consultant and administration veteran with a history of resolving government technology issues, as leader of the effort. She said the administration also was bringing in "veterans from top Silicon Valley companies" and other experts to consult on the technology overhaul.
Though Republicans are increasingly calling for her resignation, Sebelius has not addressed her future. Allies have said she has no intention of stepping down; the White House supports her.
"She has the president's confidence," Denis McDonough, the White House chief of staff, said in an interview Tuesday. "And she knows that."
But even her Democratic defenders agree that the secretary did not help herself with a fumbling appearance earlier this month on "The Daily Show With Jon Stewart." Stewart began the show by pulling out a laptop computer and declaring, "I'm going to try and download every movie ever made, and you're going to try and sign up for Obamacare, and we'll see which happens first."
For Sebelius, the interview went downhill from there; soon Republicans were gleefully circulating video clips to reporters. Rush Limbaugh, the conservative radio host, said she looked "ignorant, misleading and totally incompetent." Even McDonough did not defend the performance, saying only, "I thought it was tough."
The secretary, who declined to be interviewed, has kept a low television profile since then, prompting questions about whether the White House was keeping her under wraps, although she has taken questions at community events. Tuesday night, she sat for an interview with Dr. Sanjay Gupta of CNN, which promoted the appearance on Twitter, asking, "What went wrong w.Obamacare website? Will she resign?" She dodged the question twice.
The ruckus over Sebelius may have roots in Kansas politics, where she rose to prominence as a daughter of a governor (John Gilligan of Ohio) and the daughter-in-law of a congressman, Keith Sebelius, a conservative Kansas Republican.
Roberts, the Kansas senator, was Sebelius' longtime chief of staff, and succeeded him as his "handpicked replacement," said Todd Tiahrt, a former Kansas congressman. But Roberts is facing a primary challenge from a Tea Party activist, so his break with Sebelius is no surprise.
"If she was running a private company that had this kind of meltdown at the startup, she'd be replaced," said Tiahrt, who now runs an energy startup in Colorado Springs, Colo. "So I think he's justified in calling for her resignation, but it's also good politics in Kansas."
The 65-year-old Sebelius has been at Obama's side since 2007, when she was governor and he was challenging Hillary Rodham Clinton for the Democratic presidential nomination. Sebelius endorsed him in January 2008.
Obama admired Sebelius, said his former senior adviser David Axelrod, as "a very successful governor in a red state." As a former insurance commissioner, she was eager to be health secretary, he said.
"She anticipated that he would do health reform," Axelrod said. "That was the attraction to her."
Getting the website running was only one component, albeit a very public one, of Sebelius' work to carry out the Affordable Care Act. After the bill became law in 2010, she began holding weekly meetings on a range of thorny regulatory and policy issues, like how to define the "essential health benefits" provided by insurance plans or what to do about a possible shortage of primary care doctors.
She also set out to sell the public on the program; McDonough praised her as "tireless" in that effort. While he described the health secretary as the law's "chief implementer, with support from us," he would not discuss her work with respect to the website, saying that those were questions best directed to her.
It is not Sebelius' first brush with controversy. A federal judge once criticized her over the decision to restrict morning-after contraceptive pills to teenage girls, calling it "politically motivated," and she also faced scrutiny from Republicans for her fundraising work for Enroll America, a group promoting the health law.
Those close to her say she views the measure as part of her own legacy as well as Obama's. After helping to get it passed - a vote that ran along party lines - and seeing it through a Supreme Court challenge, she does not appear to be going anywhere.
"They ran it up the flagpole all the way to the Supreme Court," McDonough said Tuesday, "and the law is still standing, and so is she."
By SHERYL GAY STOLBERG
The New York Times