The Senate on Monday confirmed President Donald Trump’s nominee to run Medicare and Medicaid, Indiana health care consultant Seema Verma.

Verma was confirmed 55-43 in the Senate Monday evening.

Verma will head the Centers for Medicare & Medicaid Services, an agency that oversees health insurance programs covering more than 130 million Americans. Known as CMS, it’s also responsible for administering the Obama-era health care law that Trump has vowed to repeal and replace.

She’s a protégé of Vice President Mike Pence, after designing a Medicaid expansion along conservative lines for Indiana when he was governor. Her consulting business has about a dozen staffers, and if confirmed, she would run an agency with nearly 6,500 employees.