Robert F. Kennedy Jr., a prominent vaccine critic who President Donald Trump directed to “go wild” on healthcare, was confirmed Thursday by the U.S. Senate as the country’s top health official.
The 52-48 vote to confirm Kennedy was nearly along party lines. Every Republican senator voted for Kennedy except Sen. Mitch McConnell, R-Ky., who joined with the 47 senators caucusing with the Democrats in opposition.
Sen. Bill Cassidy, R-La., was a key vote to secure Kennedy’s confirmation to lead the Department of Health and Human Services. Cassidy, a physician, had admitted to “struggling” with Kennedy’s history of promoting vaccine misinformation during a confirmation hearing last week. But ultimately Cassidy voted to advance the nomination and confirm him Thursday, after Kennedy promised to “work within” existing vaccine approval and safety systems.
As HHS secretary, Kennedy will run one of the federal government’s largest agencies, which oversees the Food and Drug Administration, the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services.
Under the banner of the “Make America Healthy Again” movement, Kennedy has promised to tackle the country’s rising incidence of chronic disease and take aim at over-processed foods that contribute to obesity.
He also said he would follow President Donald Trump’s lead on abortion policy, despite his prior political position supporting a woman’s right to choose. His support on this front could signal further scrutiny of mifepristone, the first medication in a two-drug regimen that can be used to end a pregnancy through 10 weeks of gestation. Often referred to as the abortion pill, mifepristone is also used to care for women who have miscarriages.
Kennedy’s plans for other major healthcare programs he’ll now oversee, like Medicare and Medicaid, are unclear, however. During confirmation hearings, he made errors about how Medicaid was funded and fumbled Medicare basics.
RFK Jr. unlikely to take lead on Medicare, Medicaid policy
Kennedy likely won’t play a huge role when it comes to Medicare and Medicaid, given his focus on chronic disease and food and his limited knowledge of the programs, experts told Healthcare Dive. As HHS secretary, he’ll oversee the CMS, which provides insurance coverage to more than 160 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act marketplaces.
“I’ve had the distinct impression that he will have no influence on Medicare and Medicaid,” said Paul Ginsburg, senior scholar at the USC Schaeffer Center for Health Policy and Economics. “The White House will be making those decisions, and Republicans in Congress will be playing a large role as well.”
Still, the programs — and other insurance and payment policies — could come to the forefront as congressional Republicans work to cut federal spending and preserve tax cuts.
Medicaid is one target for cuts, either through work requirements that would reduce eligibility for the safety-net insurance program or through caps on federal funding sent to states, experts said. This week, House Republicans released a budget blueprint that orders the Energy and Commerce Committee, which oversees healthcare issues, to find $880 billion in savings.
But cutting Medicaid may be challenging politically, Ginsburg said. The program is generally popular, and hospitals would likely balk at cuts that increase the uninsured population and hit their bottom lines.
Many hospitals are still recovering financially from the COVID-19 pandemic. Rural facilities, which more commonly operate in Republican-led states, have long struggled to avoid shuttering services or closing down altogether.
Another significant policy question for the Trump administration and lawmakers is whether more generous financial assistance for people who buy coverage through the ACA exchanges should continue.
Republicans argue the enhanced premium subsidies, which are set to expire at the end of this year, are pricey and create opportunities for fraud. However, if the subsidies are allowed to lapse, premiums could rise and millions more Americans could become uninsured, according to the Congressional Budget Office.
“[Republicans] are generally not interested in the federal government being on the hook for more and more spending when it comes to the ACA,” said Lindsay Bealor Greenleaf, head of federal and state policy at consultancy Advi Health. “Now, again, the balancing of that is, once someone has been given something, it’s hard to take it away.”
Still, there are areas for bipartisan compromise. Reducing overpayments to Medicare Advantage insurers could be attractive for both parties, as Republicans look for cost savings, Ginsburg said.
Increasing Medicare payment rates to physicians could also be on the table. A stopgap funding bill would have included relief from scheduled pay cuts, but the legislation was scuttled and replaced at the end of last year.
“The idea that physicians need higher payment rates in Medicare is something that Republicans and Democrats agree on,” Greenleaf said. “Where they start to disagree is, how do you pay for that increase?”
