The agency is the Centers for Medicare and Medicaid Services and the nominee is Marilyn Tavenner. Being the administrator of the Centers for Medicare and Medicaid Services is a big deal: the agency has a massive budget, oversees Medicare, Medicaid and the Children's Health Insurance Program, and is in charge of implementing crucial parts of Obama's health care reform law.
So why might Tavenner's nomination not matter? For one thing, she basically already has the job: she's been running the place since December 2011 in an acting capacity.
More to the point, though, is the fact that the Senate hasn't bothered to vote on a Centers for Medicare and Medicaid Services nominee since Mark McClellan quit the job in October 2006 during President George W. Bush's second term.
Were Bush's and Obama's previous nominees grossly unqualified? Not really. But the Senate has become so dysfunctional the nominations are routinely help up or filibustered. If a veteran, nonpartisan federal budget official and a pediatrician and health policy expert weren't good enough for the Senate, why would Tavenner -- a nurse, former senior health official in Virginia and ex-hospital company executive -- fare any better?
This isn't even Obama's first attempt to get Tavenner confirmed. He nominated her back in November 2011, just before the resignation of the previous unconfirmed nominee, Donald Berwick. Tavenner never got so much as a Senate committee hearing.