Marilyn Tavenner, acting CMS administrator (CMS photo)

WASHINGTON (AP) — Marilyn Tavenner  won bipartisan Senate approval Wednesday to become the permanent director of the Centers for Medicare & Medicaid Services (CMS).

Tavenner, who has been the acting CMS director since December 2011, has been playing a key role in overseeing federal efforts to implement the Patient Protection and Affordable Care Act (PPACA), overhaul Medicare’s finances, improve long-term care (LTC) services, and improve programs for people with disabilities.

The Senate confirmed Tavenner by an overwhelming 91-7 vote.

CMS is part of the U.S. Department of Health and Human Services (HHS).

Together, the programs Tavenner oversees at CMS cover about 100 million Americans, ranging from newborns in low-income families, to people with severe physical and mental disabilities, to patients under hospice care in their last days of life.

CMS has annual budget of about $850 billion — a figure that easily eclipses spending on national defense.

PPACA is supposed to broaden the reach of Tavenner’s agency, by helping many of the millions of people who are now uninsured get health coverage.

Tavenner, 61, started out as a nurse at Johnston-Willis Hospital in Richmond, Va., working in demanding situations that called for a mix of strong clinical knowledge, steady nerves, and the ability to plan and execute in real time. From ICU nurse, she rose to emergency room supervisor.

Then her career took a turn as she decided to go into administration. She worked her way up to become the hospital’s CEO, and eventually a top executive of its parent company, Hospital Corporation of America. She voluntarily removes herself from all decisions about the big hospital chain.

Tavenner switched tracks again, to government service this time, becoming Virginia’s health secretary under former Democratic Gov. Tim Kaine. She joined the Obama administration early in 2010 as the health care law neared final passage in Congress following months of heated debate.

Her confirmation marks the first time in more than six years that the Medicare agency will have a Senate-approved leader. Senate confirmation is an important distinction for department heads and major agency chiefs in Washington, conferring a degree of status and permanence on the individual, but also signifying accountability to lawmakers of both parties.

Tavenner became acting administrator in December 2011 after Senate Republicans blocked the confirmation of her predecessor, Don Berwick. A pediatrician and nationally recognized health care innovator, Berwick ran into political trouble after Republicans said some of his statements as an academic smacked of support for socialized medicine and rationing, charges he repeatedly denied.

Such controversies have been absent from Tavenner’s tenure. Early on, she won the public endorsement of Rep. Eric Cantor, R-Va., the second-ranking GOP lawmaker in the House and an influential conservative. Avoiding ideological battles, Tavenner has promised to focus on problem-solving in her management of the giant health care programs.

“This is a critical time to have someone with Ms. Tavenner’s experience confirmed and in charge,” Senate Finance Committee Chairman Max Baucus, D-Mont., said.

Her honeymoon may not last for long, however. Tavenner’s main focus these days is to ensure a successful rollout of Obama’s health care law. Senate Republican leader Mitch McConnell of Kentucky said he voted against the nomination for that very reason.

Republicans haven’t stopped trying to sink what they deride as “Obamacare.” The next repeal vote in the House could come Thursday.

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