Tom Price was sworn in to lead the Department of Health and Human Services after winning Senate confirmation early Friday morning, placing him in position to lead the way in dismantling Obamacare.
It was the Senate's fourth consecutive contested vote for a Trump Cabinet secretary. Partisan battles for Cabinet posts are usually rare, but the first weeks of Trump's presidency have seen little collegiality between the two sides.
Price is a veteran House member and orthopedic surgeon who Republicans call a knowledgeable pick for the job. Democrats say he's an ideologue whose policies would snatch care from many Americans.
“This is the first vote in the dismantling of the Affordable Care Act,” Sen. Maria Cantwell, D-Wash., said.
On his first day in office, Trump signed an executive order directing federal agencies to pare back elements of ObamaCare that do not require a congressional vote, The Wall Street Journal reported. Price is expected to follow through on the order.
Until recently chairman of the House Budget Committee, Price has proposed repealing Obama's health law and replacing it with tax credits, health savings accounts and high-risk pools for sick, costly consumers.
Democrats say those ideas are inadequate and would leave people unprotected against significant health expenses.Republicans have yet to produce a replacement plan and have differed over when they will do so.
Citing Price's long-time support for revamping the Medicare program for the elderly, Senate Minority Leader Chuck Schumer, D-N.Y., said that with Price's confirmation, "The Republicans launch their first assault in their war on seniors." Trump has said he won't cut Medicare.
Republicans see Price as a knowledgeable leader who will help scuttle Obama's health care overhaul, partly by issuing regulations weakening the law. Democrats describe an ideologue with a shady history of trading health care stocks and whose policies will snatch insurance coverage from Americans.
"He seems to have no higher priority than to terminate health coverage for millions of people," said Sen. Jeanne Shaheen, D-N.H. She said his preference for limiting women's access to free birth control was "not only wrong, it's arrogant."
Price's nomination is part of a larger clash in which Republicans want to quickly enact priorities long blocked by Obama. Democrats, with few tools as Congress' minority, are making a show of resistance, stretching some floor debates to the maximum 30 hours Senate rules allow.
The high stakes plus Trump's belligerent style have fed the combativeness. They've also produced remarkable scenes, including Democratic boycotts of hearings, Republicans suspending committee rules to approve nominees and GOP senators voting to bar Sen. Elizabeth Warren, D-Mass., from joining a debate.
Price has supported ending federal payments to Planned Parenthood, and paring Medicaid and giving states more power to shape the health care program for the poor. He'd reshape Medicare's guaranteed health coverage for the elderly into a program offering subsidies for people to buy policies.
Democrats have accused Price of lying about his acquisition of discounted shares of an Australian biotech company and benefiting from insider information. They've also asserted he pushed legislation to help a medical implant maker whose stock he'd purchased.
Price has said he's done nothing wrong. It's illegal for members of Congress to engage in insider trading.
The Senate has approved the previous three consecutive Cabinet nominees along mostly party lines.
Sen. Jeff Sessions, R-Ala., became attorney general by 52-47 after Warren was punished for reading a 1986 letter by Coretta Scott King criticizing him. Betsy DeVos was approved as education secretary, rescued by Vice President Mike Pence's tie breaker in a 51-50 vote, and Rex Tillerson won approval 56-43 as secretary of state.
That contrasts with the past four decades, when Senate records show most Cabinet selections have been approved overwhelmingly.
During that period, no secretary of state nominee received fewer than 85 votes. The closest tally for health secretary was the 65-31 roll call for Obama's 2009 pick, Kathleen Sibelius.
Just four of 31 votes for Obama Cabinet vacancies drew at least 40 "no" votes, as did only two of 34 votes for Cabinet positions under President George W. Bush.
The Associated Press contributed to this report