Kathleen Sebelius, the Governor of Kansas, has been asked by Barack Obama to take what is likely to be the most difficult job in his administration – delivering universal healthcare in a short space of time.
Producing even modest healthcare reform is a task that has broken the back of many an ambitious Democratic politician in the past. As the enormously popular Democratic Governor of a state where Republicans outnumber Democrats two to one, Ms Sebelius, 60, is well used to operating in treacherous political waters.
It should help that she gets on famously with President Obama, whose relatives on his mother's side still live in rural Kansas, and that she was one of Mr Obama's earliest supporters in his run for the White House. She also has strong environmentalist credentials: two years ago she blocked plans for a coal-fired power station.
As well as opposing the death penalty, and the "conceal carry" laws that allow Kansans to carry hidden handguns, the Governor is fiercely pro-choice, in one of the most anti-abortion states in the US; one doctor who performed early terminations of pregnancies has even been murdered. And the Archbishop of Kansas City has forbidden priests from giving the Catholic-born Governor communion.
But her nomination fills at least part of the gap left by the withdrawal of the former Senate majority leader Tom Daschle, who was Mr Obama's first pick for the job.
More than 40 million Americans have no health insurance, which will rise as unemployment shoots up. Healthcare reform almost destroyed Bill Clinton's presidency as the health insurance lobby ganged up on Hillary Clinton's secretive attempts at reform. This time the attempt is being carried out in public with Congress in the driving seat.
Governor Sebelius has little experience in national politics, but she comes from a highly political family and her father was governor of Ohio, making them the only father-daughter governors in US history.