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MELISSA BLOCK, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

With Congress out of town for its July 4th break, President Obama sidestepped the Senate confirmation process to make several recess appointments today, including one that is very controversial.

Pediatrician Donald Berwick is the new head of the Centers for Medicare and Medicaid Services.

As NPR's Julie Rovner reports, that has left Senate Republicans fuming.

JULIE ROVNER: White House Press Secretary Robert Gibbs was blunt in defending the appointment at his daily briefing this afternoon. He said Republicans in the Senate have been holding up too many nominations and this post, heading up an agency that oversees hundreds of billions of dollars of federal spending each year, is too important to be left vacant.

Mr. ROBERT GIBBS (Press Secretary, White House): The president is going to install people that need to be installed for this government to run effective and efficiently. In this case, because the appointments process is clearly broken, he did so through a recess appointment.

ROVNER: Besides, said Gibbs, there is little doubt that Berwick, a Harvard professor and founder of a health quality think-tank, has broad base support for the job.

Mr. GIBBS: This is somebody who all involved say is uniquely qualified. The last two people that had run CMS from the Bush administration both strongly supported Dr. Berwick's appointment.

ROVNER: That's true. Berwick also has broad support from every corner of the health care industry, including doctors, nurses, consumers, hospitals and even health insurers.

Karen Ignagni is president and CEO of America's Health Insurance Plans.

Ms. KAREN IGNAGNI (President and CEO, America's Health Insurance Plans): We've had a long relationship with Don Berwick. We have nothing but the utmost respect for his qualifications.

ROVNER: But there's one key group that's not so sure about Berwick's qualifications. Senate Republicans, including Wyoming's John Barrasso, have serious doubts about some of the things Berwick has written during his long career in academia. And Barrasso is among those senators who are furious the president has evaded their opposition by using his recess appointment authority. The senator was on his cell phone between meetings in rural Wyoming.

Senator JOHN BARRASSO (Republican, Wyoming): I think it is arrogant and irresponsible to go ahead and appoint someone as controversial as Dr. Berwick without ever having a single congressional hearing.

ROVNER: During Senate floor speeches, since Berwick's nomination was announced in April, Barrasso and his Republican colleagues have repeatedly cited Berwick's praise for Britain's national health system and suggested he'd like to impose a similar system here.

Sen. BARRASSO: Dr. Berwick has a long history with the British health care system, and it's a system that saves money by denying care to people in need of care.

ROVNER: But Chris Jennings, a senior health policy adviser to President Clinton, says what Republicans really want has less to do with Berwick and more to do with whoever President Obama might have nominated for the key Medicare/Medicaid post.

Mr. CHRIS JENNINGS (Former Senior Health Policy Adviser, Clinton Administration): The desire of many, perhaps not all Republicans, is to continue the debate that has already been settled. They wish to relitigate the legislative battle that took place last year and the beginning of this year.

ROVNER: In other words, they want to keep the battle over the health care law alive, and whoever heads the Medicare/Medicaid agency will have a significant say over how that law is implemented.

With the recess appointment, Berwick can now lead the agency until the end of 2011.

Julie Rovner, NPR News, Washington.

BLOCK: In addition to Dr. Berwick, President Obama made two other recess appointments today.

Former Assistant Secretary of Defense Philip Coyle is now associate director for National Security and International Affairs; that's in the White House Office of Science and Technology Policy.

And former Assistant Secretary of the Treasury Joshua Gotbaum can start work as the new director of the Pension Benefit Guarantee Corporation; that's the agency that protects pensions for more than 44 million workers and retirees.

A year and half into his term, Mr. Obama has more than 180 nominees still pending before the Senate.

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