Retired Johns Hopkins neurosurgeon Ben Carson was confirmed by the Senate on Thursday to lead the Department of Housing and Urban Development, a position that President Donald Trump has described as central to his effort to revitalize the nation's cities.
Carson, 65, who has no experience in government or housing policy, sailed to confirmation on a largely party-line vote Thursday morning and took the oath of office later in the day. Republicans have said the renowned pediatric neurosurgeon and former presidential candidate will bring fresh perspective to a bureaucracy that helps millions of Americans pay the rent and has extensive reach in the mortgage market.
The Republican-controlled Senate confirmed Carson, 58-41, with six Democrats and one independent joining all Republicans in support. Maryland's two Democratic senators — Ben Cardin and Chris Van Hollen — both opposed Carson's confirmation.
"Right now, our country is the patient," Carson said at his swearing in. "And it's not a Democrat or a Republican patient. ... It's an American patient.
"We have a duty to use the gifts that God has given all of us in order to heal that patient."
Sen. Mike Crapo, the Idaho Republican who chairs the Senate Banking, Housing and Urban Affairs Committee, said he looked forward to working with Carson on issues such as ending homelessness and streamlining federal regulations at the department.
"There really is an excitement for his leadership to be brought to the department," Crapo said. "I look forward to having a strong partner at HUD."
Carson escaped poverty in Detroit to become an internationally celebrated physician. He lived in Baltimore County while practicing at Hopkins.
Carson promised during his confirmation hearing in January to begin his tenure with a "listening tour." He said he would later develop a comprehensive plan for the department.
The only African-American in Trump's Cabinet, Carson will oversee a department with 8,000 employees and a budget of nearly $50 billion.
Trump has frequently discussed his desire to revitalize cities — the president tends to use the term "inner cities," and has named Baltimore several times — but has yet to offer a specific plan to address joblessness, struggling schools and crime that confront many of those communities.
Trump has said he and Carson are "going to do great things in our African-American communities together."
"Ben is going to work with me very, very closely," Trump said during a visit last month to the National Museum of African American History and Culture.
"HUD has a meaning far beyond housing," he said. "If properly done, it's a meaning that's as big as anything there is."
The department has taken on a more expansive role in the mortgage market since the housing collapse of 2008 through its Federal Housing Administration, which provides mortgage insurance. Some Republicans would like to see that role reduced to minimize taxpayer risk. Others say it has made mortgages affordable to more Americans.
Carson will face a national shortage in low-income housing. The National Low Income Housing Coalition on Thursday reported a shortage of 7.4 million affordable housing units for extremely low-income households. The coalition said there are just 35 units available for every 100 very-low-income families nationwide.
Housing advocates are watching to see how Carson will address that shortage while under pressure from the White House to cut federal spending — reductions that would presumably fall in part on HUD. Many of the agency's programs have come under fire from conservatives as wasteful.
For now, advocates say they are hopeful.
Diane Yentel, the president of the National Low Income Housing Coalition, said Carson sounded many of the themes the group supports during his confirmation hearing. Carson said he supported rental assistance programs, public housing and lead-abatement efforts, and said he would be an advocate for increasing resources for affordable housing.
"Dr. Carson affirmed that he will advocate for increasing resources for affordable housing for people with the lowest incomes," Yentel said in a statement.
Many advocates have expressed concern about Carson's position on an Obama administration regulation that requires local housing agencies to develop plans to confront segregation and ensure that poor, minority families receiving assistance are not forced to live in blighted neighborhoods.
Carson described the rule in 2015 as a "mandated social-engineering scheme." His tone on that rule was softer during his January hearing, but his position on the regulation was not entirely clear.
Baltimore, one of the most segregated cities in the nation, was the focus of a landmark federal court settlement in 2012 that required HUD to help families move from areas of poverty to stronger neighborhoods in the city and surrounding counties.
"Housing discrimination continues to be a significant problem in this country, unfairly limiting people's choices about where to live," Lisa Rice, executive vice president of the National Fair Housing Alliance, said in a statement Thursday. "We look to Secretary Carson to marshal the resources of the department he leads to combat this problem, and to fight all forms of housing discrimination."
More than 5 million Americans rely on federal rental assistance. About 27,000 families in Baltimore live in HUD-subsidized public housing or receive help to pay the rent.
Democrats on Capitol Hill have been skeptical of Carson. They point to his criticism of safety-net programs during his presidential campaign.
Cardin questioned Carson's commitment to HUD's mission, and wondered if his answer to questions during his confirmation process were "just what he thought the committee wanted to hear."
"As impressive as his medical resume might be, he is not the right choice to lead the Department of Housing and Urban Development, one of our federal government's most complex agencies," Cardin said. "Dr. Carson's political beliefs are simply antagonistic to the critical goals of our HUD programs."
With the help of scholarships, Carson earned degrees at Yale and the University of Michigan medical school. He was named director of pediatric neurosurgery at Johns Hopkins at 33, the youngest person to lead a major division at the institution. He retired from Hopkins in 2013 and moved to Florida.
Carson burst onto the national political scene that year with a fiery speech at the ordinarily nonpolitical National Prayer Breakfast in Washington. Two years later, he entered the race for the Republican nomination.
His campaign theme alluded to his career in neurosurgery: "Heal, inspire, revive."