|Centers for Medicare and Medicaid Services
The administrator of the Centers for Medicare and Medicaid Services effectively runs Medicare and Medicaid. The previous administrator, Donald Berwick, was nominated by the president to head the CMS in April 2010. When the Senate failed to hold a nomination hearing, the president went ahead and appointed Berwick as a recess appointment in July 2010. In order to be reappointed in 2012, he needed to be confirmed by the Senate — but when 42 Republicans pledged to block his reappointment, Berwick resigned a month before the end of his term.
Obama’s next nominee, Marilyn B. Tavenner, was considered relatively uncontroversial compared to Berwick, who for years had advocated for health care reform and raised Tea Party hackles when he said the U.K.’s health care system could be an “example” for the U.S. But Tavenner never received a confirmation vote and since Berwick’s departure has served as an acting administrator.