Sylvia Mathews Burwell

Mathews began her career in 1990 as an associate at the New York consulting firm McKinsey & Company.[12][14][15][16] In 1992, Mathews joined the Bill Clinton 1992 presidential campaign and led the economic team for the president-elect. Following Clinton's inauguration, Mathews, with Robert Rubin, helped establish the National Economic Council (NEC). She served as staff director of the NEC from 1993 to 1995.[12][14] While Mathews was at NEC, the White House pushed for healthcare reform. Mathews was among those in the administration who advocated for finding ways, apart from legislation, to curb healthcare costs.[17]

When Rubin became secretary of the treasury in 1995, Mathews became his chief of staff.[12][14] She testified before a Senate committee during the Whitewater investigations regarding her search of Vince Foster's garbage and the fate of the documents she discovered.[18] Mathews told the committee she had been looking for an indication as to why Foster had committed suicide and denied ordering any documents destroyed.[19][20]

In 1997 Chief of Staff Erskine Bowles recruited Mathews for deputy chief of staff after being impressed with her intelligence during an Oval Office meeting.[21][22] Mathews became one of two deputy chiefs of staff, serving alongside John Podesta.[14] She was deputy chief of staff for policy, charged with the task of keeping the White House focused on its agenda amid the impeachment of Clinton.[9]

Bowles later praised her as smart, hardworking, and skilled at getting people to work together, saying, "I've never known one person who does all those things as well."[7] Bowles resigned in 1998, at which point Podesta was named chief of staff, and Mathews moved to the Office of Management and Budget (OMB), where she took the role of deputy director under Jack Lew. Mathews remained at OMB for the remainder of Clinton's presidency during a time of three budget surpluses.[12][14]

In 2001 Mathews relocated to Seattle, Washington, to work for the Bill and Melinda Gates Foundation, the largest philanthropic organization in the United States, as an executive vice president.[1][12][14] The following year, she became chief operating officer of the Foundation.[14] The Foundation reorganized in 2006, naming Mathews president of the foundation's Global Development Program.[14][23] Mathews was involved in awarding grants to improve health outcomes in the developing world, including stopping the spread of HIV and other diseases and making contraception more readily available.[17]

She served on the board of the University of Washington Medical Center from 2002 to 2005. During that time, the board oversaw an upgrade to the medical center's electronic medical records and system for tracking patient outcomes. The board was also tasked with setting up a compliance program to fix a Medicare billing irregularity that had resulted in a settlement with federal investigators.[17] She was a Director of MetLife and Metropolitan Life Insurance Company from January 2004 to April 2013.[24] Mathews also served on the boards of the Council on Foreign Relations and the Nike Foundation Advisory Group.[15][25][26]

In 2005 Mathews was chosen by the Wall Street Journal as one of The 50 Women to Watch – 2005 worldwide for her work with the Gates Foundation.[4][27] In 2008, known as Sylvia Mathews Burwell following her 2007 marriage, she was named Obama/Biden Transition Agency Review Lead for the Federal Deposit Insurance Corporation.[1][28] Burwell remained with the Gates Foundation until 2011. She officially joined the Wal-Mart Foundation, which focuses on ending hunger in the United States, as the organization's president in January 2012.[lower-alpha 1][12][30] Burwell relocated to Bentonville, Arkansas, for the position.[1]

Kathryn Ruemmler, Jack Lew, Sylvia Mathews Burwell, and Alyssa Mastromonaco update President Barack Obama and Vice President Joe Biden on the government shutdown, October 1, 2013.

On March 3, 2013, President Barack Obama nominated Burwell to be the director of the White House Office of Management and Budget.[31] A confirmation hearing was held on April 10.[32][33] Burwell's nomination received bipartisan support, culminating in the U.S. Senate confirming Burwell as Director by a 96–0 vote.[34] With her confirmation, Burwell became only the second woman to serve as OMB Director, the first being Alice Rivlin, who held the position from 1994 to 1996.[12]

Burwell entered the job at a time when conservatives wanted to decrease spending and defund Obama's signature healthcare legislation, the Affordable Care Act, also known as Obamacare.[7] Although Congress tried to negotiate a continuing resolution to fund the government pending negotiation of the larger budget, it became clear on September 30, 2013, that no temporary agreement would be reached.[35] Without an agreed-upon budget from Congress, Burwell as Director was tasked with initiating a federal government shutdown, the first U.S. federal government shutdown in 17 years.[36] Burwell sent a memo advising agencies and executive departments to shut down, including the closing of national parks, visitors' centers, and even the "panda-cam" at the National Zoo.[36] The shutdown lasted 16 days.[16] Once the government reopened, Burwell helped negotiate a two-year budget deal to avoid future shutdowns.[16]

On April 11, 2014, Obama nominated Burwell to be the next secretary of health and human services, succeeding Kathleen Sebelius, who had announced her resignation the day before.[37] At the time of her nomination, Obama praised Burwell as a "proven manager and she knows how to deliver results."[38] The Senate confirmed Burwell as Secretary on June 5, 2014, by a vote of 78–17.[38][39][40] She was sworn into office on June 9, 2014.[25] As of 2014, the secretary oversaw the Department of Health and Human Services (HHS), which included the equivalent of 77,000 full-time employees and the management of several agencies and programs including Medicare and Medicaid, the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention.[37] At the end of her tenure, Burwell received praise from Democratic and Republican senators.[41]

With an Ebola epidemic devastating West Africa, Burwell began holding daily meetings on July 28, 2014, as part of the efforts of the United States government, including the Department of HHS, to prevent the further spread of the disease.[42][43][44] Starting on September 30, other Obama administration officials began giving daily public briefings while Burwell took less of a public role, although she did take part in a number of public meetings.[42] In the fall of 2014, the first known death from Ebola in the United States occurred.[43] The Obama administration proposed devoting $6 billion to fight the spread of Ebola, including $2 billion for the State Department and USAID.[45] The plan included provisions to help U.S. hospitals become better prepared and to support global health initiatives aimed at containing the disease in Africa.[45] Congress allocated $5.4 billion to fight Ebola in response to the Obama administration request.[46] Burwell and other Obama administration officials sought to assure the public that the American health system was prepared to deal with Ebola cases and that the chances of a full outbreak in the United States were low.[47]

In February 2016, in response to the spread of the Zika virus, the Obama administration requested that Congress appropriate $1.9 billion to fight the spread of the disease.[48] Congress did not initially take action, leaving Burwell to direct the Department of Health and Human Services to reprogram $589 million in funds previously designated as part of the response to Ebola, to fight the spread of the Zika virus.[48][49]

Of the initial Zika funding, the Centers for Disease Control (CDC) received $222 million to lead the domestic fight against the virus with the National Institutes of Health and the Biomedical Advanced Research and Development Authority splitting $152 million for the domestic effort. In response to Congressional complaints that the money was not being spent fast enough, Burwell informed Congress that without further funding, the CDC would deplete its budget to fight Zika by September 30, 2016.[49] After Burwell moved funding from other HHS programs, Congress finally appropriated $1.1 billion to fight the spread of Zika in the United States.[48] By the end of September 2016, the United States reported 23,000 cases in the territory of Puerto Rico, 3,000 cases in the states, and 21 babies born in the United States with microcephaly testing positive for Zika.[48]

Rural Council meeting in the Eisenhower Executive Office Building of the White House, February 3, 2016. From left to right: Agriculture Secretary Tom Vilsack, President Barack Obama, and Burwell.

Burwell's tenure as HHS secretary began ahead of the Affordable Care Act's second open-enrollment period for healthcare insurance in November 2014.[50] In preparation for the enrollment period, Burwell hired additional staff to coordinate operations.[50] The first open-enrollment period, which had occurred during Secretary Sebelius' tenure, was marred by technical difficulties with the Healthcare.gov website.[51] In preparation for the second enrollment period, the HealthCare.gov website underwent various testing actions.[51][52] The Secretary noted the website had been reconfigured, reducing the number of screens from over seventy to just over a dozen website pages to make the application process smoother.[51][52]

Because of her position as Secretary of HHS, Burwell was the named party in multiple lawsuits related to the Affordable Care Act.[53][54] One month into her tenure, the Supreme Court decided Burwell vs. Hobby Lobby, where the court struck down the implementation of the Affordable Care Act's contraception mandate as violating Hobby Lobby's religious freedom.[55] The Supreme Court also decided King v. Burwell, a case in which the Court upheld the Affordable Care Act's subsidies for healthcare plans purchased on federal exchanges.[53][54]

In July 2016, ahead of the 2016 elections, Burwell began touring, giving speeches on the success of the Affordable Care Act and its potential for the future.[54] The election resulted in Republicans winning control of the Presidency and Congress, having campaigned to repeal the law.[56] Burwell continued to advocate for the Affordable Care Act, arguing it was "woven into the fabric of our nation".[56] Since its inception, the law had led to coverage for 20 million more people, and Burwell argued the complexity of the law meant that repealing any part would have effects throughout the healthcare system.[56][57] Burwell and the Department of HHS devised the "Coverage Matters" campaign to increase public support for the law and to boost enrollment.[57][58]

Less than a week after leaving her position as HHS secretary, American University announced Burwell would serve as the university's next president, its school's highest leadership position despite not having earned a masters or doctoral degree.[41][59] Burwell began her tenure on June 1, 2017,[60] becoming American's 15th president and the first woman to assume the role.[59]

In 2020, Burwell was appointed by the Council on Foreign Relations to co-chair (alongside Frances Townsend) the Independent Task Force on Improving Pandemic Preparedness.[61]