New Health Secretary Is Never Far From Her Roots

HINTON, W.Va. - When President Bill Clinton had thrashed out his first difficult budget with advisers, he turned to one of his younger aides for the final word, a seal of approval. 'Sylvia, are the folks in Hinton going to think we've done right by them?' he said.

To the man from Hope, Ark., the town of Hinton, W.V., was likewise a defining, all-American touchstone. And Mr. Clinton knew that Sylvia Mathews, now Sylvia Burwell, indeed had stayed in touch with neighbors and friends there long after she had left the Appalachian railroad depot on the New River as he had Hope - for the Ivy League, a Rhodes scholarship and ultimately the nation's capital.

Senators say Ms. Burwell will need that sensibility now that they have confirmed her as President Obama's secretary of the Department of Health and Human Services. The department has a work force of about 30 times the population of Hinton, and it is responsible for, among many other tasks, continuing to put the landmark but divisive Affordable Care Act into effect.

'Because she's from West Virginia - Hinton, a town of about 3,000 people - she comes to Washington with a lot of common sense,' Senator Tom Coburn, Republican of Oklahoma, said at Ms. Burwell's confirmation hearings, where the positive bipartisan reception she received belied the partisan vortex she enters. Mr. Obama said much the same in nominating her in April.

Rhapsodizing about the traditional values of America's struggling small towns is a timeworn exercise among politicians, and Ms. Burwell's well-known association with Hinton - years after she left there first for Washington, followed by more than a decade as an executive at the charitable foundations of Bill and Melinda Gates, in Seattle, and then of Walmart in Bentonville, Ark. - explains much about her bipartisan reception in the otherwise polarized Capitol.

While senators of the president's opposing party often vote against high-level nominees to register broader disapproval of policies, last year the Senate unanimously confirmed Ms. Burwell to be Mr. Obama's budget director. And during her confirmation hearings for health secretary last month, Ms. Burwell drew little opposition for what Senator John McCain of Arizona, another Republican fan of hers, called the toughest 'most thankless' job in Washington, even though Republicans have made 'Obamacare' their main election-year target.

Lawmakers attributed her bipartisan support to the relationships that Ms. Burwell, who carries Crane's stationery for dashing off personal notes, had quickly built with them.

'We are a product of our environment, all of us,' said Senator Joe Manchin III, Democrat of West Virginia. 'The social skills that you learn in those small towns for survival - particularly if you're an ethnic in a state that's the least diverse state in the nation - well, you learn to adjust, you learn to work within, you learn to bring people together.'

Ms. Burwell, 48, was unavailable for interviews pending confirmation. But here in Hinton, plenty of people testify to the ties she maintains to the place where her grandparents - Greek immigrants who spoke little English - are still remembered for their 'sweet shop,' and for visiting Greece to try to find a son-in-law.

Donna Pivont, a florist, said Ms. Burwell called often to order flowers for someone. Residents described souvenirs she had sent from her global travels, like ornamental mice for Anna Mae McNeer's collection. Terri Giles, a friend since kindergarten, pointed out a childhood haunt in Bellepoint Park where Ms. Burwell's husband, Stephen, a lawyer from Seattle, proposed - because the park meant so much to her.

The Burwells' children - Helene, 6, and Matthew, 4 - were baptized, like their mother, at Ascension Episcopal Church in Hinton, where Ms. Burwell's father, William Mathews, a retired optometrist, presided when there was no minister. Ms. Burwell was an acolyte and her sister, Stephanie, played the organ. The Burwells' children stay each summer with their godmothers, Ms. Giles and Kristi Scott, another childhood friend, to enjoy the same idylls their mother did - swimming at Pipestem Resort State Park, eating on the river at Kirk's or Dairy Queen, watching movies at the restored Ritz.

But also evident here, three decades after Ms. Burwell left for Harvard, is the impact of the economic dislocation, brain drain and drug use that have ravaged so many towns. Like elsewhere, some locals blame Walmart's arrival in nearby Beckley for the demise of downtown Hinton.

A shrunken, aging population has lately been restoring what it can of a once thriving community. Yet amid the quaint results, apparent drug sellers and users linger on Third Avenue.

Ms. Burwell's mother, Cleo Mathews, 78, a former teacher, was the mayor of Hinton from 2001 to 2009. 'She walked the entire town, knocked on every door, asking for votes - even from Republicans,' said Ms. Burwell's sister, Stephanie Mathews O'Keefe, an executive at the American Bankers Association in Washington.

Mrs. Mathews was defeated for a third term twice, most recently last year, because of what she and others said was resistance to her relentless push for changes to make Hinton a tourism and technology destination. She remains active, even as she cares for her ailing husband.

'The Hinton you see is not the Hinton that's in our hearts,' said Ms. Giles, 48, who returned after years away to be near her mother. 'The Hinton that's in our hearts and our minds is the bustling downtown, but more importantly to us, the people. They're like the steel thread that runs through our lives and knitted together to make us very strong, very self-confident.'

In a 2007 interview with The Seattle Times, Ms. Burwell was asked who had most inspired her. Before naming well-known bosses - former Treasury Secretary Robert E. Rubin, the former White House chief of staff Erskine B. Bowles, Mr. Clinton, the Gateses - she singled out Margie Hank, the Mathewses' neighbor for 50 years, citing her lifelong zeal for learning.

Mrs. Hank, 82, sat in her living room recently and reminisced. She said Ms. Burwell phoned on each birthday and anniversary, and she showed off a lacquered tray from Vietnam and baskets from Bhutan - both gifts from Ms. Burwell. Like others here, she expressed resignation that younger residents had moved away.

'If they wanted to find work, they had to leave town,' said Mrs. Hank, whose son lives in Massachusetts.

In a high school class of about 165, Ms. Burwell was the valedictorian and student body president, and she was chosen most likely to succeed, most studious, prettiest eyes, best personality, best dancer, most dependable, best dressed (her mother forbid jeans) and 'best all-around.' One caption says Sylvia Mathews 'enjoys working with people to solve the school's problems.'

She was Summers County Junior Miss, winning academic and spirit awards at the state pageant, as well as cash she needed that fall when she entered Harvard. Ms. Burwell followed her sister there; Stephanie, four years older, ended up at Harvard only because, as a National Merit Scholar semifinalist, she had been sent an application.

Both Mathews sisters struggled to adjust. Ms. Burwell's friends, Ms. Giles and Ms. Scott, recalled her telling them about people 'who weren't nice.'

'We had a saying,' Ms. Giles said. 'No matter what happens, we've got our families and we've got each other.'

From Harvard, Ms. Burwell went to Oxford University as a Rhodes scholar, and then worked at McKinsey & Co. in New York before joining Mr. Clinton's 1992 campaign and then his administration. After eight years at the White House, Treasury Department and Office of Management and Budget, mentors predicted that she would someday seek office in West Virginia.

Her mother said they had not talked about that. Mrs. Mathews would most likely know: She operates the local Democratic headquarters in what used to be Mr. Mathews' downtown office. On recent days it was empty except for his optometry equipment, a patient's chair and political paraphernalia. Since the Clinton years, West Virginia has turned from a Democratic stronghold to a Republican one.

'I'd love for her to think about being involved and coming home in West Virginia politics, if public service is still in her heart,' Senator Manchin said.

That, however, would have to come after Ms. Burwell works for a president and a program that are both vilified in her state.