Kathleen Sebelius won Senate confirmation Tuesday as the nation's health and human services secretary, thrusting her into the middle of a public health emergency with the swine flu sickening dozens of Americans.
The 65-31 confirmation vote came after Democrats urged quick action so that Sebelius could get to work leading the federal response to the flu outbreak.
"We find ourselves in the midst of a global crisis," said Democratic Sen. Chris Dodd. "What we've been missing in all of this is the head of the Health and Human Services Department."
Sixty votes in the 100-seat Senate were necessary for approval. Immediately after the vote, Sebelius resigned as governor of the midwestern state of Kansas and headed to Washington to be sworn into her new job.
Republican opponents cited Sebelius' position supporting women's rights to abortion and voiced misgivings about whether Obama administration plans to overhaul the nation's health system would cut out Republicans and lead to rationing of care.
"She is the wrong appointee for this particular assignment," said Republican Sen. Robert Bennett. "She has backed a partisan process for health care reform. She has refused to support patient safeguards."
With no HHS secretary in place, the White House has turned to Homeland Security Secretary Janet Napolitano to help lead its response to the encroaching swine flu, even while insisting that vacancies at the top of HHS were not a problem.
Sebelius, 60, was the first of 20 HHS officials who required Senate approval to win it, and she heads to work with many team members missing. The Senate has not acted on Obama's nominees for deputy HHS secretary or commissioner of the Food and Drug Administration, and Obama has not even nominated people for other crucial jobs, including surgeon general and assistant secretary for preparedness and response.
There also has not been an appointment for head of the Centers for Disease Control and Prevention, another component of the sprawling HHS, which has 65,000 employees and a $750 billion budget.
The whole process suffered a setback when Obama's first pick for HHS secretary, Democratic former Sen. Tom Daschle, withdrew in February over unpaid taxes.
Although swine flu will be an immediate focus, Sebelius also will be responsible for shepherding Obama's overhaul of the nation's $2.5 trillion health care system to reduce costs and cover some 50 million uninsured Americans.
Sebelius was the last of Obama's Cabinet nominees awaiting confirmation.