The HHS secretary is poised to become one of the most high-profile and political posts next year if a Republican wins the White House.
The job could catapult the career of a politician able to say he or she helped take down "Obamacare." But there's also a risk that whoever lands the position won't be able to meet such high expectations.
"There are so many ways that the secretary — if he or she wants to play hardball, and in this case, will play hardball with Obamacare — would be able to slow down" the law, said Tommy Thompson, who was former President George W. Bush's HHS secretary for four years and is now running for the Senate in Wisconsin.
The secretary likely would face a contentious confirmation process. And the focus on how the health care law will — or won't — be implemented will likely overshadow the many other HHS responsibilities and its jurisdiction over nearly one-quarter of the federal budget.
In the Senate, Republican views on a nominee "are going to be based on, 'What are you going to do as secretary to get rid of Obamacare?'" Thompson said.
Thompson refused to speculate on who might be placed in the job, but POLITICO spoke with some top conservative health policy thinkers about who might end up on any Republican presidential shortlist:
Gov. Bobby Jindal — The two-term governor's state, Louisiana, has taken one of the strongest positions against implementing the health care law, and Jindal also has some serious health care policy credentials that might dilute some of the likely Democratic opposition.
At the age of 25, he was appointed secretary of the Louisiana Department of Health and Hospitals where, according to his campaign website, he turned the state's Medicaid program from a $400 million deficit to a $220 million surplus in three years. He got national attention as staff director of the National Bipartisan Commission on the Future of Medicare, chaired by then- Rep. Bill Thomas and then- Sen. John Breaux. In 2001, he was confirmed as Bush's assistant secretary of HHS for planning and evaluation, the chief policy adviser.
Jindal has been a vocal opponent of the health care law, a credential that would please the right. He returned an exchange planning grant in March and Louisiana was the second state to announce it wouldn't create a state exchange. Louisiana is also part of the 26-state lawsuit against reform. But according to HHS, the state did accept a $1 million ACA grant to monitor insurance rates.
Jindal endorsed Texas Gov. Rick Perry, who called him "just a brilliant guy when it comes to policy issues dealing with health and human services." But the ties to Perry won't mean that other Republicans won't take a look. Given his leadership against the health law and his policy depth, he's likely to end up on any Republican president's HHS shortlist.
Mark McClellan — He's the first name that comes to mind for many Republican health policy folks. He led both the FDA and CMS under President George W. Bush and has friends all over Washington. While he has strong relationships on Capitol Hill to ease a confirmation process, he is also far from a firebrand against "Obamacare."
"I don't think there's anybody in health care who has more respect from both sides of the aisle than Mark," said Gary Karr, a former CMS spokesman who now works in the medical device industry.
McClellan, a medical doctor and an economist, also worked in Treasury during the Clinton administration early in his career. Now he's director of the Engelberg Center for Health Care Reform at Brookings, trying to figure out how to improve health care delivery, among other vexing health care problems.
"He's the pre-eminent active Republican thought leader when it comes to health care," said one former Bush administration HHS appointee who didn't want to be named. "That's a very obvious one."
While he has the policy creds and experience in the FDA and CMS, he's been supportive of the health care reform law, while issuing caveats that it could have done more to address costs. That alone could delete him from any Republican shortlist, especially if it belongs to Gov. Mitt Romney, whose Massachusetts health care law may put additional scrutiny on his HHS pick.
Tevi Troy — Troy has a résumé deep with health and domestic policy experience and has a record of opposition to the reform law. He's also advising the Romney campaign.
Troy has an extensive policy background, having led George W. Bush's Domestic Policy Council and serving as deputy secretary of HHS, where he was No. 2 to Secretary Mike Leavitt. He's now a senior fellow at the Hudson Institute.
But he doesn't appear to have the political chops that would likely be necessary to navigate the confirmation process on Capitol Hill.
"Certainly in terms of Republican intellectual health policy circles, he's very highly regarded," said one Republican health policy source who didn't want to publicly speculate on a shortlist. "Given what a huge deal this spot is going to be, are they going to want someone who's a political heavyweight?"
Gail Wilensky — The former head of Medicare and Medicaid is another Republican with sterling health policy expertise, but whose qualified embrace of the health care law could hurt her chances for the HHS job. She's also generally regarded as more of a moderate than most of the Republican presidential contenders.
Wilensky directed Medicare and Medicaid and was a senior health and welfare adviser for President George H.W. Bush in the early 1990s. She also was the chairwoman of the Medicare Payment Advisory Commission from 1997 to 2001.
"She's absolutely going to be mentioned," the former HHS appointee said. "How realistic it is, I have no idea. But in terms of the big thinkers who are out there who played in a previous administration and understand the nature of it, she's a name that's certainly going to be out there."
Wilensky has been supportive of the law, with caveats. In 2010, Wilensky wrote: "As important and sweeping as the legislation is, it represents no more than a first step on a path to reaching universal coverage and reform of the health care delivery system."
Mike Huckabee — The former Arkansas governor and one-time presidential hopeful has been out front on repealing the health care law, even leading an effort to petition the Senate to vote on repeal again. He also has been vocal about healthy living and wellness.
"In the case of a Romney administration, it would be the 'Cabinet of rivals' idea," the Republican health policy source said. "He has the personal story of losing weight and wrote a book about prevention and wellness. Plus, for someone like Romney, he brings strong social conservative credentials."
One of the Republican candidates — The presidential field is full of folks who say they want to repeal "Obamacare." Current or recent candidates including Tim Pawlenty, Michele Bachmann, Rick Santorum and Rick Perry have all spoken about the importance of repeal. Newt Gingrich, Ron Paul and Jon Huntsman have, too, but none of them — a former House speaker, a libertarian opponent of government agencies and a former ambassador to China — seem likely picks to lead HHS. One other guy unlikely to get the job if he's not the nominee: Mitt Romney, who has faced attacks from all the other presidential contenders about his real interest in repealing the law.