When Surgeon General Scheele stepped down in August 1956, President Dwight D. Eisenhower nominated Burney on a recess appointment, and was sworn in as Surgeon General on August 8, 1956, and later confirmed by the Senate in January 1957. Surgeon General Burney applied his administrative know-how to steer PHS successfully through institutional growing pains as the agency responded to new and, at times, conflicting demands from the public, professional and voluntary advocacy groups, the parent Department, and the Congress. The key issues of the day were environmental health and access to health services, the former driven by widely shared alarm over deteriorating environmental conditions and fallout from the atmospheric testing of nuclear weapons and the latter by expectations that national health insurance would soon be realized. In many ways the Kerr-Mills Act of 1960, which authorized government financing of services for senior citizens without adequate means to pay for care, prefigured the Medicare and Medicaid programs that would transform national policy during the following decades.