The resignation of Health and Human Services Secretary Kathleen Sebelius leaves her expected successor Sylvia Mathews Burwell with a lot on her plate, with the implementation of the Affordable Care Act still incomplete.

Kathleen Sebelius may have launched the Affordable Care Act, bungled its rollout and managed the subsequent repair effort, but she is leaving the Obama Administration long before the full effects of the law are known or felt by the vast majority of Americans. Sylvia Mathews Burwell, the director of the Office of Management and Budget, is expected to be nominated to replace Sebelius, who will officially resign on Friday.

If confirmed by the Senate, Burwell will be tasked with turning the page on the Administration’s embarrassing early implementation of the ACA while managing the critical next steps in the effort to reform the U.S. health care system.

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