WASHINGTON — In naming a new team to run health policy for his administration, President Obama has recruited a formidable array of talent, but has not clarified the lines of authority, leaving various appointees to jockey for primacy.
Mr. Obama announced his intention on Monday to nominate Gov. Kathleen Sebelius of Kansas to be secretary of health and human services.
He also named Nancy-Ann DeParle to coordinate health policy for the administration. Her position, counselor to the president and director of the White House Office for Health Reform, is not subject to Senate confirmation.
In separating the roles of health czar and health secretary, Mr. Obama is adding to an already large stable of experts who will help him in his effort to overhaul the health care system, one of his priorities. It was not immediately clear who would dominate, or who would corral members of the ever-growing team, with their varying viewpoints.
Mr. Obama’s first choice for secretary of health and human services, former Senator Tom Daschle of South Dakota, was also to have been chief of the White House health office and was widely viewed as likely to be first among equals on health issues. Mr. Daschle withdrew early last month after belatedly paying more than $140,000 in back taxes and interest. In searching for a replacement, Mr. Obama decided to split the duties between two people.
At the White House news briefing on Monday, Robert Gibbs, the president’s press secretary, struggled to say who specifically would lead negotiations with Congress on health care.
Ms. DeParle will “head health care reform here in the White House,” Mr. Gibbs said, but he emphasized that “a lot of people who work in this building and in different agencies will be involved.”
“This isn’t something that’s just going to lie with one or two people,” Mr. Gibbs said, adding that that “the entire economic team” would be involved.
Administration officials said Ms. DeParle’s office would not be in the West Wing of the White House, a symbolically important location, with proximity to the president. Rather, it will be next door in the Eisenhower Executive Office Building. Mr. Daschle was to have had offices in the West Wing and at the Department of Health and Human Services.
Robert D. Reischauer, president of the Urban Institute and a former director of the Congressional Budget Office, said: “President Obama’s health team is talented and has considerable experience, but there will obviously be competing power centers. That raises several questions. Will one of these people be dominant? To what extent will the others coordinate their activities with that individual?”
In introducing them on Monday, Mr. Obama said Ms. DeParle would provide Ms. Sebelius with “an excellent partner at the White House.” But the enterprise has many partners.
Peter R. Orszag, director of the White House Office of Management and Budget, has stepped into the vacuum caused by the vacancy at the top of the health department and has become a dominant voice on health policy within the administration.
As budget director, Mr. Orszag would have leverage in any event because the cost of legislation to achieve universal coverage is a crucial factor. But Mr. Orszag commands additional respect because, as director of the Congressional Budget Office in 2007-8, he became an expert on health policy and health economics. He prepared two book-length studies analyzing the issue and more than 100 options for cutting costs and expanding coverage.
Another influential voice at the White House is that of Dr. Ezekiel J. Emanuel, an oncologist and medical ethicist. Dr. Emanuel, a brother of Rahm Emanuel, the White House chief of staff, is working for Mr. Orszag and is sometimes described as the kibitzer-in-chief on health policy.
While all the players agree with Mr. Obama on the goal — providing affordable health insurance to all— they have expressed different ideas about how to get there.
In a book published last year, for example, Dr. Emanuel proposed “a guaranteed health care access plan,” under which all Americans would receive vouchers to enroll in health plans offering a standard package of benefits like those available to members of Congress. The program would be administered by a National Health Board, modeled on the Federal Reserve Board.
As a House member, Rahm Emanuel showed strong interest in health care. As White House chief of staff, he led negotiations with Congress on the recent economic recovery bill. His top health policy adviser in Congress, Lauren Aronson, has joined him at the White House.
Others with influence on the issue include Melody C. Barnes, the director of the Domestic Policy Council at the White House, and Lawrence H. Summers, the director of the National Economic Council. Ms. DeParle will not be a member of either council, the White House said.
Ms. Sebelius, a former president of the National Association of Insurance Commissioners, is an expert on insurance regulation, which is likely to be a major component of any comprehensive health legislation.
Ms. DeParle was commissioner of the Tennessee Department of Human Services from 1987 to 1989. Under President Bill Clinton, from 1997 to 2000, she was administrator of the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services.
Since then, she has gained extensive experience in the business world. That experience, though seen as an asset by many, prompted questions from some of the people vetting personnel for Mr. Obama, supporters of Ms. DeParle said.
Ms. DeParle has been a director of large health care companies including Medco Health Solutions, a pharmacy benefit manager; Cerner, a supplier of health information technology, including electronic medical records; Boston Scientific, a medical device company; DaVita, which runs kidney dialysis centers; and Triad Hospitals.
Senator Robert C. Byrd, Democrat of West Virginia, expressed concern about the proliferation of White House policy czars for health care, urban affairs and climate change.
“Too often,” Mr. Byrd said in a letter to Mr. Obama, “I have seen these lines of authority and responsibility become tangled and blurred, sometimes purposely, to shield information and to obscure the decision-making process.”