He served as Chief of Staff for the Secretary of Health and Human Services in the administration of President Bill Clinton and as Deputy Secretary of the United States Department of Health and Human Services in the administration of President Barack Obama from 2009 to 2015.

He earned a Bachelor of Arts in economics from the University of Virginia and Juris Doctor from the Vanderbilt School of Law.

He later served as chief counsel and staff director for the Subcommittee on Antitrust, Monopolies and Business Rights of the Senate Committee on the Judiciary from 1989 to 1993.

He served as chief counsel and policy director for former Senate majority leader, Tom Daschle (D-South Dakota) from 1998 to 2000.

His appointment as Deputy Secretary was criticized by conservative publications because he worked as an anti-tobacco lobbyist as recently as September 2008, having been the executive director of the Campaign for Tobacco-Free Kids.