By David Morgan and Julia Edwards
WASHINGTON (Reuters) - Sylvia Mathews Burwell, President Barack Obama's nominee for U.S. health secretary, moved closer to confirmation on Wednesday with a final Senate hearing that was marked more by bipartisan accolades than tough questions about Obamacare.
Burwell, Obama's widely respected budget director, discussed the Patient Protection and Affordable Care Act in terms that sometimes seemed calculated to appeal to Republicans. At one point she defined healthcare "affordability" in terms of its cost to taxpayers and the economy, as well as the law's intended beneficiaries, many of them low-income Americans.
"We don't always agree. But if we can have conversations and those conversations can be specific, I think we can work to figure most things out," she told the Senate Finance Committee that will decide whether to send her nomination on for a final vote in the Senate.
Republicans have made Obamacare their leading campaign issue in November's election battle for control of the Senate. Analysts and congressional aides say Burwell's immediate task, if she is confirmed as secretary of health and human services, will be to prevent problems with the law that could reverberate on the campaign trail.
Burwell, who received a cordial reception at her first hearing before a different Senate panel last week, got another bipartisan introduction from her home state Democratic Senator Jay Rockefeller of West Virginia and Senator Tom Coburn of Oklahoma, a prominent Republican voice on healthcare issues who praised her competence and character.
"My favorite quote is: 'There's a-thimble-and-a-half-full of common sense in Washington.' And she's the half," Coburn said.
Republicans again expressed concerns about what they see as the 2010 law's shortcomings: reduced Medicare payments for insurers, insurance policy cancellations, the inability of some enrollees to keep their doctors and an uneven implementation schedule that has delayed penalties for employers but kept them in place for individuals who fail to obtain healthcare.
"We can be very cordial today. But if you want to change the relationship your department has with Congress, you're going to have to be willing to break the by-any-means-necessary mindset that we have seen for the past five years," said Senator Charles Grassley, an Iowa Republican.
Some analysts say the muted Republican questioning at the two hearings stems from party divisions on how to proceed with opposition to Obamacare, which up to now has focused largely on repealing the law.
"The GOP isn't backing off. But once you get past the public's overall opposition to ACA, their views are nuanced: they want it fixed. And Republicans are struggling mightily on the ground to come up with a fix," said Bill Pierce, a healthcare official under former President George W. Bush.
Another reason for the conciliatory Republican tone appears to be Burwell herself. She has met privately with individual senators, Republican and Democratic, and those meetings have led to praise from lawmakers of both parties.
On Wednesday, lawmakers appeared to accept Burwell's reassurances that she would pursue a transparent, common-sense approach to health reform implementation and place a high priority on responding to their questions.
"You're going to need all the luck you can get," said Senator Orrin Hatch of Utah, the committee's senior Republican. "But I'm grateful for people willing to take on these tough responsibilities and lend their best expertise to it. I'm grateful that you are willing to serve," he said.
Finance Committee Chairman Ron Wyden, an Oregon Democrat, said the panel would move quickly on deciding whether to forward Burwell's nomination to the Senate floor.
(Additional reporting by David Lawder; Editing by Caren Bohan, Bernard Orr and Mohammad Zargham)