Congressional Budget Office director
The Harvard-trained economist, who in January replaced Peter Orszag at the Congressional Budget Office, is both referee and scorekeeper in the health-care-reform effort. Elmendorf and his staff at the CBO will be the final arbiters of how much any health-reform proposal is likely to cost the Treasury and whether it will abide by the budgetary rules that require the legislation to pay for itself within a decade. Already, they have sent the Senate Finance Committee back to the drawing board — they came in with an estimate that a preliminary draft would cost $1.6 trillion over the next decade. Passing muster with Elmendorf will continue to be one of the biggest challenges for health reform, especially at a time when the soaring federal-budget deficit has politicians on both sides of the aisle anxious.