Her opposition to the public option played a major role in the crafting of the 2010 Patient Protection and Affordable Care Act, as she did not agree to support it until additional concessions were granted to support Louisiana's Medicaid system. In 2011, she became a cardinal (chair) of the Senate's Homeland Security Appropriations Subcommittee. She chaired the Senate Committee on Small Business and Entrepreneurship from 2009 to 2014, and chaired the Senate Committee on Energy and Natural Resources from 2014 to 2015.