Washington healthcare world steels itself for RFK Jr.’s HHS

Robert F. Kennedy Jr. has a famous name and infamous views on vaccines, COVID-19 and other health issues. But the would-be Health and Human Services secretary is a virtual stranger to the healthcare sector.

The former independent presidential candidate is President-elect Donald Trump's choice to lead a department that regulates every aspect of healthcare and distributes more than $1 trillion a year in payments to providers and health insurance companies. Yet Kennedy's views on Medicare, Medicaid, the health insurance exchanges and other crucial programs are mostly unknown.

Related: Trump selects RFK Jr. to head HHS

Trump said he'll let Kennedy "go wild on health."

What that means is a mystery to people in the healthcare business and policy worlds, but they are watching warily and looking for clues about what the Trump administration may do beyond predictable regulatory rollbacks and reviving initiatives he launched during his first term.

"We know a lot about RFK Jr.’s views on food safety and vaccines, but he seems to be pretty much a blank slate on the huge range of healthcare issues HHS deals with in Medicare, Medicaid and the Affordable Care Act," said Larry Levitt, executive vice president of health policy at the research organization KFF.

Similarly, lobbyists and consultants whose businesses depend on working with HHS said privately that they have no idea what to expect, with few willing to go on the record before getting a better sense of Kennedy and the soon-to-be Trump administration's specific goals.

It's not that Kennedy is shy about sharing his opinions.

Medicare, Medicaid and more

After Trump nominated him with the statement that "Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation and disinformation," Kennedy signaled HHS' scientific agencies such as the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration would be in his crosshairs.

"I look forward to working with the more than 80,000 employees at HHS to free the agencies from the smothering cloud of corporate capture so they can pursue their mission to make Americans once again the healthiest people on Earth," Kennedy posted on X. Notably, he used the phrase "corporate capture," a term progressives have long lobbed at the FDA over its relationships with pharmaceutical companies.

"Together we will clean up corruption, stop the revolving door between industry and government, and return our health agencies to their rich tradition of gold-standard, evidence-based science," Kennedy wrote. "I will provide Americans with transparency and access to all the data so they can make informed choices for themselves and their families."

None of that, however, illuminates how Kennedy would focus on the nitty gritty business of healthcare and the practices at the Centers for Medicare and Medicaid Services that are so central to much of the healthcare sector.

There are some hints from Kennedy's presidential run that not everything will be a radical departure from Trump's past policies or those of President Joe Biden.

For instance, Kennedy has talked about enforcing mental health parity laws on insurers and improving Black maternal health, which are Biden administration priorities. Kennedy has discussed aligning U.S. drug prices with lower costs in the rest of the world, similar to Trump's proposals to institute international reference pricing for pharmaceuticals.

Beyond the top-line items Kennedy emphasizes, industry sources are not convinced he would go much deeper.

Richard Hughes, a lawyer with Epstein Becker Green, is among several skeptics. "My sense is that CMS will remain on a fairly steady trajectory," he wrote in an email.

"I am doubtful that Robert F. Kennedy, Jr. will venture very much into that domain. He's far more interested in science issues over at CDC, NIH and FDA," Hughes wrote. "We are likely to see him defer to Trump's choice, and that choice is likely to be someone with a combination of extensive public and private health sector experience like Michael Burgess, Joe Grogan or Brad Smith."

Depending on your political perspective, that could be a good or bad thing.

Andrea Ducas, vice president of health policy and the liberal Center for American Progress, said the healthcare world is justified in fretting about Kennedy, in part because Kennedy may leave issues outside his wheelhouse to veteran conservatives who would carry out agendas hostile to the Affordable Care Act of 2010 and other Democratic priorities.

"What I guess I would worry about, when you have somebody running HHS that doesn't seem to have a pretty clear perspective on that, is that it opens the door to some of these policies that are out there, that are ostensibly the playbook for the incoming administration," Ducas said. "If he would be open to the Project 2025 plan to make Medicare Advantage a default option, I worry about that program ballooning even more than it already has," for example, she said.

Even if Kennedy himself were to become interested in effecting dramatic change at CMS, it would not be easy, said Stephanie Kennan, senior vice president for federal public affairs at McGuireWoods Consulting and a former Senate Democratic aide.

"I have heard some former CMS administrators say that trying to move CMS is like trying to get a ship to turn," Kennan said. "It doesn’t happen by itself and you need people who know where the levers are. Even if you are trying to streamline processes and the regulatory apparatus, the people who can often be the most helpful are those who have been there and have an understanding of the policies you want to change."

Confirmation prospects

Many insiders also pointed out that Congress will still exist, and Kennedy and his team would still have to navigate lawmakers' concerns, starting with getting confirmed by the Senate, if Trump cannot convince incoming Senate Majority Leader John Thune (R-S.D.) to allow temporary recess appointments that can delay hearings for more than a year.

Some GOP senators on committees that would hold nomination hearings, such as Ron Johnson (Wis.), Dr. Rand Paul (Ky.) and Tommy Tuberville (Ala.), expressed enthusiasm about Kennedy in public statements.

The Republicans who will chair the Finance Committee and the Health, Education, Labor and Pensions Committee next year were more restrained.

“RFK Jr. has prioritized addressing chronic diseases through consumer choice and healthy lifestyle," Finance Committee ranking member Mike Crapo (Idaho) said in a news release. "American patients, providers and taxpayers deserve a healthcare system that is efficient, effective and affordable. I look forward to considering his nomination before the Finance Committee.”

“RFK Jr. has championed issues like healthy foods and the need for greater transparency in our public health infrastructure,” HELP Committee ranking member Dr. Bill Cassidy (La.) said in a news release. “I look forward to learning more about his other policy positions and how they will support a conservative, pro-American agenda.” Cassidy also is a member of the Finance Committee.

Senate Democrats are adamantly opposed to Kennedy, largely citing his vaccine stances as a threat to public health.

“Kennedy's outlandish views on basic scientific facts are disturbing," Senate Finance Committee Chair Ron Wyden (D-Ore.) said in a news release. "When Mr. Kennedy comes before the Finance Committee, it’s going to be very clear what Americans stand to lose under Trump and Republicans in Congress.”

While both the Finance and HELP Committees hold confirmation hearings on HHS secretary nominees, only the former panel actually votes whether to recommend the candidate to the Senate.

Most Republicans on those two panels did not respond to requests for comment on Kennedy, including moderate senators who may be swing votes, such as Susan Collins (Maine) and Lisa Murkowski (Alaska). With a 53-47 Republican majority next year, Kennedy could only afford to lose three Republican votes.

"If there are confirmation hearings, RFK Jr. will presumably be peppered with questions about Medicaid waivers, Medicare Advantage payments, nursing home staffing standards, ACA navigators, and all kinds of other issues within the purview of HHS," Levitt said.

There is also a chance Kennedy and Trump could overreach, consultants said.

While some in Trump's political base have fully embraced vaccine skepticism and some of Kennedy's more peculiar positions, most Americans — including those with GOP representatives — still want their children protected from infectious diseases. If there is backlash, that would make it more likely that Congress asserts itself and that major shifts in CMS policy reflect common Republican priorities.

Industry response

A common sentiment among lobbyists and consultants is that they and their clients would have to wait and watch carefully.

Major healthcare trade associations seem to be keeping their powder dry.

The American Hospital Association had this to say about Kennedy: "The AHA has congratulated President-elect Trump and looks forward to working with his administration on our priorities as he continues to assemble his Cabinet."

The American Health Care Association/National Center for Assisted Living, which represents long-term care providers, offered a similarly circumspect reaction. "AHCA/NCAL extends our congratulations to all nominees to serve in our nation’s leading agencies," President and CEO Clif Porter said in a statement. "We look forward to continuing this important work with all incoming and returning officials under President-elect Trump’s administration.”

"While RFK’s goals and intentions for various departments such as FDA have been outlined and otherwise made public, we don’t yet have clear insight into his views or potential plans for key agencies such as CMS," Medical Group Management Association Senior Vice President for Government Affairs Anders Gilberg said in a statement. "We look forward to working alongside the administration."

Apart from the Medical Group Management Association, none of the healthcare industry organizations that commented even mentioned Kennedy by name.

The Federation of American Hospitals, America's Essential Hospitals, the health insurance trade group AHIP and the American Medical Association did not provide comments.

Despite being barraged by Kennedy's attacks for years, the Pharmaceutical Research and Manufacturers of America didn't address any of his positions in its response.

"We want to work with the Trump administration to further strengthen our innovation ecosystem and improve healthcare for patients," PhRMA President and CEO Stephen Ubl said in a statement that otherwise summarizes the drug industry's long-standing policy agenda.