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Donald M. Berwick, the soon-to-be-nominated chief of the Centers for Medicare & Medicaid Services, will face new administrative challenges his predecessors didn’t have, thanks largely to the newly passed healthcare reform law.

One of Berwick’s primary tasks will be to slice nearly a half-trillion dollars from the Medicare budget without reducing beneficiary services. In his current role as president and CEO of the Institute for Healthcare Improvement, Berwick has challenged healthcare providers to improve care and reduce costs, The New York Times reports. One of his goals was to have providers reduce costs by 10% over three years “without a single instance of harm, without rationing effective care, without excluding needed services for any population you serve,” the newspaper noted.

Berwick also will oversee a drastic expansion of the Medicaid program. Under the new healthcare reform law, Medicaid will add roughly 16 million people to its rolls in the coming years. The position of CMS administrator requires Senate confirmation—a process that is likely to re-ignite debate over healthcare reform, a Bloomberg News report suggests. Obama, who has aggressively already named more than a dozen new appointments during Congress’s spring break, is expected to officially nominate Berwick “soon,” according to published reports.