The U.S. Senate finally came through with a vote for Marilyn Tavenner to take the helm at the Centers for Medicare & Medicaid Services, ending a series of administrators who have never won a Senate vote for the job. Tavenner's ascension gives CMS a more distinct voice in policy circles than she would have enjoyed as an interim administrator, but it also ensures she will be on the hot seat in any congressional hearings related to the Affordable Care Act.