(Bloomberg) — The U.S. Senate confirmed Tom Price, a congressman and physician, to head the Department of Health and Human Services, a post where he’ll have a leading role in Republican efforts to dismantle Obamacare and implement its replacement, and oversee a budget of more than $1 trillion.

The vote was 52-47, making Price the most contentious nominee for the position since at least President Jimmy Carter’s administration. Democrats opposed him because of his free-market, limited-government views on how the American health-care system should operate, and his past efforts to privatize Medicare by turning it into a voucher system. They also strongly criticized him for leaving questions unanswered about stock purchases in medical companies he made while handling health-care legislation.

“President Trump is setting up his cabinet to run our country in a way that benefits those at the top and their allies, but really hurts the workers and families we all serve.” Senator Patty Murray, a Washington Democrat, said on the Senate floor during Thursday’s debate on Price. “It’s hard to imagine who in America would be better off under Congressman Price’s leadership at HHS.”

Senator Orrin Hatch, a Republican from Utah, backed the nominee, who was an orthopedic surgeon before being elected to Congress.

“Dr. Price has extensive insight into our nation’s health-care system, having practiced medicine for two decades in a variety of settings,” Hatch said. He “will put this vast experience to good use and be decisive not only in working with Congress to find solutions but implementing them.”

HHS Secretary Tom Price
Bloomberg/file photo

The biggest piece of HHS’s budget goes to Medicare, the U.S. program for the elderly and disabled, with another large chunk devoted to Medicaid. Seema Verma, Trump’s pick to lead the Centers for Medicare and Medicaid Services, an HHS agency, will face a confirmation hearing next Thursday at the Senate Finance Committee, which is chaired by Hatch. Other HHS agencies include the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health.

Price has served in the U.S. House representing Georgia since 2004. In 2015, he introduced legislation to replace Obamacare that featured tax credits to help people buy insurance on the private market, expanded use of health savings accounts, and federal funds for states to create high-risk pools to cover the very sick and those with pre-existing conditions. Democrats argue Americans’ uninsured rate will rise after it reached a record low under Obamacare if the health law is changed based on Price’s plan. Republicans say Price’s experience makes him ideally suited to help replace the law.

“Our health-care system has undergone some serious turmoil as of late, and this was undoubtedly caused at least in part by the rolling calamity of Obamacare,” Arkansas Republican Senator Tom Cotton said during the debate. “If we need someone who will focus on the needs of patients, why not pick a doctor.”

While Price’s plan generally espouses the principles Republicans embrace surrounding health coverage, GOP members of Congress have yet to unite around a specific proposal or even whether they will make wholesale changes to Obamacare or repair what they consider flawed pieces. The timing is also uncertain. While Trump said last month he’d put forward his plans for replacing the law once Price is confirmed, he told Fox News’ Bill O’Reilly in an interview that aired Sunday that the process could stretch into 2018.

For now, Price’s duties will include overseeing the Affordable Care Act on an ongoing basis. Trump’s administration so far has a mixed record of shoring up the law and working to undermine it. Trump signed an executive order on his first day in office calling for his agencies to work to reduce the law’s burdens, and Price will be among administration officials charged with that task.

Late last month, HHS halted some ACA outreach in the final days of the sign-up period before resuming it, a move that some have blamed for lower-than-expected sign-ups for insurance plans under the health law. References to the ACA and its benefits have since been removed from the government’s HealthCare.gov sign-up website, according to a review of internet records. The changes first appeared on Feb. 1, the Washington Examiner reported.

Trump has said he wants “insurance for everybody” though Price repeatedly said during a Senate hearing in January that he wants to ensure “every single American has access to affordable health coverage that will provide the highest-quality health care that the world can provide.”

“We should all be cautious about being promised access without any pathway towards the ability to actually afford quality health care,” said Senator Christopher Coons, a Democrat from Delaware.

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