WASHINGTON -- The Senate on Wednesday confirmed former hospital executive, Virginia government official and nurse Marilyn Tavenner to be administrator of the Centers for Medicare and Medicaid Services, a vast agency responsible for those named programs and major parts of President Barack Obama's health care overhaul.


On a 91-7 vote, the Senate ended a more-than-six-year stretch, dating back to the George W. Bush administration, during which the agency lacked a confirmed leader. The Senate had declined to vote on Tavenner's nomination during Obama's first term and failed to vote on Obama's prior nominee, Donald Berwick, or Bush's nominee Kerry Weems.


The Centers for Medicare and Medicaid Services already provide health care benefits to more than 100 million Americans and have a budget rivaling the Pentagon's. The agency's role is growing as the Obama administration implements the health care reform law, which will reduce the number of uninsured Americans by an estimated 25 million by 2023. As head of the agency, Tavenner is charged with carrying out key elements of Obamacare, including its expansion of Medicaid.


Tavenner has helmed the Medicare and Medicaid agency in an acting capacity since December 2011, when Obama first nominated her for the job. The president renominated her this February. Berwick left the post in 2011 because stiff resistance from Republican senators blocked his path to confirmation after he had served in an acting capacity for more than a year. Likewise, Weems was acting administrator for almost a year and a half.


The last confirmed administrator of the Centers for Medicare and Medicaid Services was Mark McClellan, who resigned in October 2006. Since then, partisan politics and Senate obstruction through filibuster threats have been to blame for the absence of a fully empowered chief -- a departure from the experience of previous administrations.


Tavenner's nomination languished for nearly a year and a half despite her qualifications. Berwick is a pediatrician and the founder of the Institute for Healthcare Improvement, a nonprofit that advises medical providers on improving quality and reducing costs, but he came under Republican fire over his support for the United Kingdom's government-run health system, among other issues. Weems was a budget expert and an employee of the Department of Health and Human Services for more than 20 years.


The Senate Finance Committee advanced Tavenner's nomination last month. She cleared her final hurdle when Sen. Tom Harkin (D-Iowa) lifted a hold on her confirmation tied to his objections to the White House diverting funds for preventive medicine to implementation of Obamacare.


All seven votes against Tavenner came from Republicans, including Senate Minority Leader Mitch McConnell (Ky.).


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