WASHINGTON – President Joe Biden has selected Chiquita Brooks-LaSure to lead the Centers for Medicare and Medicaid Services, filling a major role in his health care leadership team, according to four people who spoke on the condition of anonymity because they were not authorized to discuss the decision.

Brooks-LaSure served in the Obama administration as a senior CMS official who helped implement the Affordable Care Act’s coverage expansion and insurance-market reforms. She also previously worked on Capitol Hill as a Democratic staff memberfor the House Ways and Means Committee, building ties with then-Rep. Xavier Becerra, Biden’s choice to lead the Health and Human Services department and who sat on the committee at the time.

Brooks-LaSure’s selection has not yet been announced. If confirmed by the Senate, she would run the $1 trillion agency that oversees Medicare, Medicaid – vast public health insurance programs for older Americans and for the poor. The agency also is responsible for large parts of the Affordable Care Act, including the insurance marketplaces through which millions of Americans buy coverage.

As a result of that broad reach and enormous budget, the administrator of CMS is regarded as the second-most powerful position within the Department of Health and Human Services after the HHS secretary.

The agency also is central to Biden’s goals of expanding insurance coverage – in large part by buttressing the ACA, widening the role of Medicaid and lowering the age at which people can join Medicare from 65 to 60. Brooks-LaSure has repeatedly discussed expansions of Medicaid and improving health coverage, as well as addressing high rates of maternal mortality.

During the presidential transition, Brooks-LaSure served as a team lead for Biden’s HHS review team, helping assess the Trump administration’s operations. She has most recently served as a managing director at Manatt Health, a consulting firm that works with the health care industry – a role that raised some concerns inside the Biden administration given the president’s stringent ethics pledge and the potential for Brooks-LaSure to shape policies that might affect her former clients, said one person familiar with those concerns.

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However, Brooks-LaSure was championed by allies on Capitol Hill, including the Congressional Black Caucus. Mandy Cohen, the North Carolina health secretary and a fellow Obama veteran, was also considered for the role.

“The biggest coverage gap exposed (and exacerbated) by the covid-19 crisis is that many U.S. residents are not enrolled in affordable, comprehensive health coverage that will cover covid-19 testing and services and other health care costs,” Brooks-LaSure wrote in a Manatt Health commentary last year.

Dan Mendelson, founder of Avalere Health, a consulting firm, said that when it comes to CMS, Brooks-LaSure has “lived it from all perspectives, and I think that will make her effective in the role.” She worked for Mendelson at the Office of Management and Budget during the Clinton administration, where she focused on Medicaid, and then again at Avalere, where she worked on issues involving Medicaid and Medicare for an array of clients. She then worked in CMS for seven years.

HHS, the White House and Manatt Health did not immediately respond to request for comment.