As I wrote back in a June 2010 story for the American Spectator, “There are more than 2,500 references to the secretary of HHS in the health care law (in most cases she’s simply mentioned as ‘the Secretary’). A further breakdown finds that there are more than 700 instances in which the Secretary is instructed that she ‘shall’ do something, and more than 200 cases in which she ‘may’ take some form of regulatory action if she chooses. On 139 occasions, the law mentions decisions that the ‘Secretary determines.’ At times, the frequency of these mentions reaches comic heights. For instance, one section of the law reads: ‘Each person to whom the Secretary provided information under subsection (d) shall report to the Secretary in such manner as the Secretary determines appropriate.'”

The new secretary of HHS will have the ability to determine when the open enrollment period for the exchanges can begin or end; what type of insurance every American must have; and what constitutes enough of a “hardship” to exempt individuals from the mandate to purchase coverage, among other powers. As HHS secretary, Sebelius has proven herself willing to push the boundaries of her discretion to delay or modify key parts of the law without seeking congressional authorization.