In 1993, Leavitt was elected governor of Utah, serving three terms (1993-2003). In 2003, he joined the Cabinet of President George W. Bush, first as leader of the Environmental Protection Agency (2003-2005) and then as secretary of Health and Human Services (2005-2009). At HHS, Leavitt administered a $750 billion budget—nearly 25 percent of the entire federal budget—and oversaw 67,000 employees.
He led the implementation of the Medicare Part D Prescription Drug Program. The task required the design, systematization and implementation of a plan to provide 43 million seniors with a new prescription drug benefit. By the end of the first year, enrollments exceeded projections, prices were lower than projected and seniors expressed high levels of satisfaction.
A pattern of innovation runs throughout Leavitt's career. When he was elected governor, Utah's major freeway system was dangerously inadequate. Taking what some thought was a significant political and financial risk, Leavitt instigated a design-build system, creating cost and quality incentives between the state and its contractors.
Collaborator is a word that comes up repeatedly when one examines Leavitt's background. His skill led his colleague governors to elect him as chairman of the National Governors Association, the Republican Governors Association and Western Governors' Association.