Don Berwick, President Obama’s nominee for the top job at the Centers for Medicare & Medicaid Services, was not on a list of federal nominees approved by the Senate Tuesday morning.

The Senate approved more than 60 of Obama’s nominees Tuesday, including a handful of appointees to the Department of Health and Human Services. Berwick’s appointment has reopened the entire healthcare debate for some legislators on the Hill, and Republicans are using his drawn-out nomination process as ammunition in the 2010 mid-term election battle, The New York Time reported. Berwick has consistently called for healthcare providers to reduce costs without reducing quality of care or rationing services. Some conservative members of Congress have tried to argue that his work with, and affinity for, the British National Health Service is evidence of his support for rationing care.

This week, 10 hospital groups, including the American Hospital Association and the American Medical Rehabilitation Providers Association, sent a letter to the Senate, urging members to approve Berwick’s nomination. Berwick has received widespread support during his nomination process from doctors, hospitals, medical schools and consumer groups, among others.