The U.S. Senate has confirmed President Donald Trump’s selection for CMS administrator, Seema Verma, MPH, by a 55-43 vote, with Democrats largely opposing her nomination while the healthcare industry pledged to work with her.

Verma has helped several Republican-led states craft their own versions of expanding Medicaid. She worked with Vice President Mike Pence while he was governor of Indiana in creating the Healthy Indiana Plan 2.0, which required beneficiaries to pay into health savings accounts and didn’t provide retroactive benefits.

“With Senate confirmation of Seema Verma as CMS Administrator, both CMS and HHS can truly work in harmony,” House Energy and Commerce Committee Chairman Greg Walden, R-Oregon, and Health Subcommittee Chairman Michael C. Burgess, MD, R-Texas, said in a statement. “There’s no shortage of work ahead, and the administration has built a well-equipped team to clean up the mess that Obamacare has made. Rebuilding our health care system with patient-centered reforms is a top priority for this Congress and we look forward to working together to deliver results for patients and families all across the country.”

During her confirmation hearing, Verma expressed skepticism about some recent moves by CMS, such as making bundled payment models mandatory for providers. She was largely supportive of the Medicare Access and CHIP Reauthorization Act (MACRA), calling it a “step forward,” but said small and rural providers may not be able to take on risk-based arrangements.

America’s Essential Hospitals, a coalition of public hospitals, said Verma’s experience with their facilities gives her an important perspective as the Trump Administration weighs major changes to Medicaid.

“We look forward to working with Ms. Verma to ensure access to comprehensive coverage for all people and that Medicaid changes occur in an equitable, stable, and sustainable way across states, and to protect the financial stability of essential hospitals so they can continue to meet their commitment to patients and communities,” said the group’s president and CEO, Bruce Siegel, MD, MPH.

The Healthcare Information and Management Systems Society (HIMSS) offered similar comments, hoping Verma will “ensure health IT remains a key tool in supporting healthcare transformation.”

“As we prepare for next steps in healthcare transformation, we anticipate having discussions with Administrator Verma on  a number of topics of mutual interest, including  continuing the shift to value-based care delivery, sustaining the Quality Payment Program, reinforcing the importance of electronic clinical quality reporting, and expanding CMS recognition of telehealth capabilities across the agency,” HIMSS said in a statement.

Her confirmation did draw some negative reaction. Sen. Maria Cantwell, D-Washington, told the New York Times that Verma’s Indiana work “made millions of dollars in consulting fees by kicking poor, working people off Medicaid for failure to pay monthly contributions similar to premiums.”