The Senate confirms Chiquita Brooks-LaSure, the first Black woman to lead Medicare and Medicaid.

The Senate on Tuesday confirmed Chiquita Brooks-LaSure, a former Obama administration health official, to lead the Centers for Medicare and Medicaid Services, one of the most powerful posts at the Department of Health and Human Services. The vote was 55 to 44, with five Republicans joining Democrats to support her confirmation.

As the official charged with overseeing providing services to poor and older Americans in Medicare and Medicaid, Ms. Brooks-LaSure will manage roughly $1 trillion of the federal budget in addition to the Affordable Care Act’s health insurance marketplaces and regulations.

Ms. Brooks-LaSure, the first Black woman to lead the agency, comes to the job with extensive experience in federal health policy. She was a senior official at the agency under President Barack Obama in the years after the health care law passed, working to expand coverage. She also worked on health issues as a congressional staffer and member of the White House’s budget office. She was a managing director at the health consulting firm Manatt before President Biden nominated her as Medicare chief.

The agency is key to fulfilling Mr. Biden’s health care agenda. His administration and a Democratic-controlled Congress are aiming to engineer the first substantial reforms and expansion of the Affordable Care Act since its passage, in part through billions of dollars in the American Rescue Plan. The administration opened a highly publicized special enrollment period in February that allowed the uninsured to sign up for coverage right away, drawing in over a million Americans.

Her nomination was challenged by Senator John Cornyn, Republican of Texas, who opposed a recent Medicaid policy decision affecting his home state. Biden administration Medicaid officials withdrew the approval of a waiver that would have given hospitals more than $100 billion in federal dollars over a decade for treating patients without insurance. The officials said the waiver’s approval, which was granted in the closing days of the Trump administration, had been rushed. The agency has also begun rolling back state Medicaid work requirements approved in some states during the Trump administration.

Ms. Brooks-LaSure’s predecessor, Seema Verma, feuded bitterly during the Trump administration with the H.H.S. secretary, Alex M. Azar II, and she attracted inspector general and congressional investigations into her agency’s lavish spending on outside consultants who worked to polish her personal brand.

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