As lawmakers debate Medicare and Medicaid changes, the absence of a leader to oversee these programs has become more glaring.

The Centers for Medicare & Medicaid Services, which manages Medicare and Medicaid, has been without an administrator since October 2006. Charlene Frizzera is the acting administrator. Lawmakers and prominent people in the healthcare community are both confused and troubled by the vacancy, The New York Times reported. 

“You need a general,” Sen. John D. Rockefeller IV (D-WV) told the newspaper. He said of the vacancy: “It’s a big problem. I can’t explain it.”

Officials with the administration said they are searching for the right leader. Others said the president is waiting to pick a leader until Congress resolves healthcare reform. More than a half-dozen people have been seriously considered for the position since Obama took office, the newspaper reported.