WASHINGTON (AP) — The Senate on Tuesday confirmed President Joe Biden’s pick to run U.S. health insurance programs, putting in place a key player who’ll carry out his strategy for expanding affordable coverage and reining in prescription drug costs.

Obama-era policy adviser Chiquita Brooks-LaSure will be the first Black person to head the Centers for Medicare and Medicaid Services, or CMS, which also administers children’s health insurance and the Affordable Care Act. Together, the programs cover more than 130 million people, from newborns to nursing home residents, and play a central role in the nation’s health care system.

The Senate vote was 55-44, with five Republicans joining Democrats in approving her nomination. Brooks-LaSure had been expected to win stronger bipartisan support, but a controversy over a CMS action affecting the Medicaid program in Republican-led Texas appears to have spoiled those chances.

During her confirmation hearing before the Senate Finance Committee, Brooks-LaSure paid homage to generations of Black women and men in public service who came before her. “Too often, they weren’t given the opportunity to live up to their full God-given potential,” she said. “But their selfless, often silent, sacrifice paved the way for me and so many other women of color.”

Brooks-LaSure, 46, has spent most of her career in government, under administrations of both parties. She served in the White House budget office during the Republican administration of George W. Bush, and worked in Congress and at CMS in senior policy roles during the Barack Obama years.

Under Biden, she’ll be charged with moving toward his goal of health insurance for all Americans by building on existing programs, particularly the Obama health law. Biden’s COVID-19 relief bill has greatly expanded subsidies for private plans offered through HealthCare.gov, a feature that the administration wants to make permanent.

Biden is also keenly eager to help more than 2 million low-income people essentially trapped in a coverage gap because the states they live in have not expanded Medicaid. Throughout her career, Brooks-LaSure has worked on Medicaid policy, and that program has now grown to become a mainstay of coverage for many low-income working people.

Part of her portfolio will include reviewing __ and amending or rolling back __ a series of Trump administration changes to health insurance rules. Under Trump, CMS tried to promote the sale of cheaper private insurance that offered less coverage than plans sold under the Affordable Care Act. Many Democrats want restrictions on “short-term” plans that don’t cover pre-existing conditions.

Prescription drug costs are likely to be the biggest challenge for Brooks-LaSure, and there she will be in the role of a supporting player.

With Biden’s backing, Democrats in Congress want to pass legislation this year that would authorize Medicare to negotiate prices with drug companies and bring down the high costs Americans face. The Trump administration tangled with the powerful pharmaceutical industry for four years but ultimately was unable to secure legislation to curb prices.

Now it’s Biden’s turn, and the path forward for legislation remains uncertain, particularly in the Senate. If that route hits a dead end, Brooks-LaSure will be tasked with finding ways to use the rule-making powers of her agency to rein in prices.

CMS also plays a central role in the nation’s $4 trillion health care economy. It sets Medicare payment rates for hospitals, doctors, labs and other service providers. Government payments become the foundation for private insurers. The agency also sets standards that govern how health care providers operate.

In between her stints in government service, Brooks-LaSure was a managing director at the Manatt Health consultancy.

Sen. Ron Wyden, D-Ore., who shepherded her nomination through the Senate said Brooks-LaSure has done just about everything in health care “short of scrubbing into the operating room herself.”

She’s “committed to working with both sides here in the Senate,” he added.

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