RFK Jr. hearing kicks off test of Trump’s health nominees
Key takeaways:
- Nominees for top health positions will appear in front of various Senate committees starting this week.
- We asked experts how a range of important health issues could be impacted under the new administration.
On Wednesday, the Senate will hold the first of two scheduled hearings to consider the nomination of Robert F. Kennedy Jr. to lead the nation’s health care apparatus as HHS secretary.
Kennedy will appear before the Senate Finance Committee, which will vote on whether to advance his nomination to the full Senate for a confirmation vote. [Editor’s note: You can watch the hearing, which is scheduled for 10 a.m. ET, here.] Kennedy is also set to appear in front of the Health, Education, Labor, and Pensions Committee on Thursday.
As of Tuesday, confirmation hearings for President Donald J. Trump’s nominees for other top health positions have not yet been announced, although the new administration has already begun to reshape how the country’s public health agencies’ operate. Other moves foreshadow potential cuts to foreign aid programs like the President’s Emergency Plan for AIDS Relief.
Trump has also nominated former Republican Congressman Dave Weldon, MD, as CDC director, Stanford professor Jay Bhattacharya, MD, PhD, to lead the NIH, Johns Hopkins surgeon Marty Makary, MD, MPH, as the next FDA commissioner, and physician Janette Nesheiwat, MD, to be U.S. Surgeon General.
We reached out to experts to get their feedback on how a range of important issues for patients and providers could be affected during the new administration, and what impact Trump’s nominees might have on the nation’s health.
[Editor’s note: Clinicians are discussing how the change in leadership in Washington will affect them and their patients. Join the conversation on Healio Community .]
Vaccines
Kennedy, an environmental lawyer, is well known for his longtime support of scientifically disproven claims about the safety of vaccines and other debunked views on medicine — views that make him “uniquely unqualified” to lead HHS, according to Lawrence O. Gostin, JD, cofaculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.
“I have little doubt that if RFK Jr. were confirmed by the Senate for HHS secretary, patients, providers and the entire population would suffer grave health consequences,” Gostin told Healio.
Other stances, such as Kennedy’s desire to reform dietary guidelines and the food industry, are more popular.
As HHS secretary, Kennedy would have “broad power in overseeing health care and public health for the entire country,” said Paul A. Volberding, MD, chief medical editor of Healio | Infectious Disease News and professor emeritus of medicine at the University of California, San Francisco.
“The nomination of one who has been publicly skeptical of vaccines causes concern,” Volberding told Healio.
Kennedy would be able to clear out and refill advisory committees at the FDA and CDC that guide federal recommendations about vaccines, according to Paul A. Offit, MD, director of the Vaccine Education Center at The Children’s Hospital of Philadelphia, who currently sits on the FDA’s Vaccines and Related Biological Products Advisory Committee and previously served on the CDC’s Advisory Committee on Immunization Practices.
“He thinks those committees are corrupt. He thinks they're deeply in the pocket of industry, and he's implied that he would like to, if not completely rid this country of those committees, then stock them with the kind of people who have his beliefs, which are that vaccines are far more dangerous than they are beneficial,” Offit told Healio. “I think those committees are at risk.”
There has already been an erosion of trust in vaccines in the United States. CDC data published in October showed that kindergarten vaccination rates continued to decline in the 2023-2024 school year, dipping below 93%, and that the proportion of students who received at least one vaccine exemption increased to 3.3%, with 14 states reporting rates over 5%.
Healio | Infectious Disease News Editorial Board Member J. Glenn Morris, MD, MPH&TM, said Kennedy’s confirmation could swell the wave of anti-vaccine sentiment already growing in the country and potentially turn the clock back to when vaccine-preventable diseases were more prominent.
“Vaccines are one of the great medical advances of the past century,” Morris, a professor and director of the Emerging Pathogens Institute at the University of Florida, told Healio. “As an infectious diseases specialist who trained 50 years ago and watched children die or have lifetime disabilities from childhood diseases because critical vaccines were not yet available or not administered, I feel strongly that vaccines are an essential part of patient care. Anything that discourages vaccine use will, inevitably, impact patients.”
The appointment could also erode trust in physicians, “making it harder to [us] to advocate for evidence-based treatments,” said Healio | Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine at the University of California, San Francsico.
As of Tuesday morning, more than 24,000 physicians had signed a letter asking the Senate to not confirm Kennedy, calling him “not only unqualified to lead this essential agency [but] actively dangerous.”
“One can only hope that the U.S. Senate rejects this nomination,” Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, told Healio.
Offit also criticized the nomination of Weldon to lead the CDC, saying the former congressman shares Kennedy’s disproven beliefs about several vaccines, including that the MMR vaccine causes autism.
About Makary, Offit noted several ways in which the surgeon took contrarian positions during the COVID-19 pandemic that ultimately ended up being correct, in Offit’s opinion.
“When he said, for example, that schools for young children were closed for too long, that was right,” Offit said. “He was right about a number of things.”
But Makary has also been wrong, including about myocarditis, a rare complication of COVID-19 vaccination that he has said is worse than myocarditis caused by a natural SARS-CoV-2 infection.
Nutrition
The administration’s policies could affect the country’s nutrition, from how it is taught to the way it is regulated, according to Fatima Cody Stanford, MD, MPH, MPA, MBA, MACP, FAAP, FAHA, FAMWA, FTOS.
Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School, told Healio that any administration’s impact on obesity and nutrition “largely depends on the policies they prioritize.”
If Kennedy, an outspoken critic of the FDA and of Americans’ nutrition, is confirmed to lead HHS, “his critical stance could significantly change how nutrition policies are developed and implemented,” Stanford said.
“He might push for more transparency in food labeling, stricter regulations on food safety and changes to dietary guidelines to reflect his views,” she said. “His leadership could also influence the prioritization of alternative health approaches and impact funding for nutrition research and public health campaigns.”
According to NPR, the “Make America Healthy Again” movement led by Kennedy has taken aim at the food industry’s alleged use of its lobbying power to exploit Americans’ health in favor of maximum profits. An adviser to Kennedy and the Trump transition team, Calley Means, spoke with NPR before Kennedy was officially nominated.
Means said Trump and Kennedy “have bonded over tying the core of MAGA — which is a distrust of institutions and getting corruption out of institutions — to our health care industries.”
Some of Kennedy’s priorities include reforming dietary guidelines and tackling ultra-processed foods.
“The likelihood of banning unhealthy or processed foods in the U.S. is generally low due to several factors, including the significant economic impact on the food industry, potential resistance from consumers who value personal choice, and the complex nature of defining what constitutes ‘unhealthy’ or ‘processed’ foods,” Stanford said. “Public health strategies often focus on improving labeling, imposing taxes on certain products like sugary beverages and encouraging the reformulation of products to be healthier.”
As HHS secretary, Kennedy would have the important task of overseeing the development of the 2025-2030 Dietary Guidelines for Americans.
The guideline advisory committee — of which Stanford is a member — submitted its recommendations to HHS and the U.S. Department of Agriculture in December. The departments will finalize guidelines following an open comment period, which closes on Feb. 10.
Stanford said the committee’s recommendations are based on “the latest understanding of nutrition and health,” but any administration in power can affect their implementation.
“The administration’s political priorities and public health goals can also affect how the guidelines are framed and communicated to the public,” she said.
Beyond direct changes, Stanford said the administration’s positions on health care, education and agriculture could indirectly influence areas like nutrition and obesity.
“Changes in health care policy could affect access to nutrition counseling and obesity treatment services; educational policies influence the quality and extent of nutrition education in schools; and agricultural policies could impact the availability and pricing of healthy food options,” Stanford said.
Stanford also offered the caveat that her “insights are speculative and based on historical trends and policy directions” because “actual outcomes would depend on the specific policies and actions the administration takes.”
Chronic conditions
The selection of Kennedy to head HHS could offer a mixed bag of outcomes for patients with chronic conditions, according to experts.
“He has said he wants to stop all chronic diseases in 2 years, which is certainly a lofty goal,” John R.P. Tesser, MD, FACP, of Arizona Arthritis & Rheumatology Associates and Midwestern University, told Healio. “The question is how it is going to happen.”
The complicated nature of chronic diseases will demand comprehensive and nuanced interventions if they are to be mitigated or eliminated, according to Tesser.
“We know that systemic, chronic inflammation has been associated with conditions ranging from cardiovascular disease to the autoimmune conditions we deal with,” he said. “But Kennedy is not a doctor, not a researcher, he has no medical background, so I may have some concerns with someone lacking that background in this position.”
Madelaine A. Feldman, MD, FACR, vice president of advocacy and government affairs at the Coalition of State Rheumatology Organizations, said Kennedy’s focus on nutrition would be a potential positive.
“We need a reckoning when it comes to what we put in our mouths in this country,” Feldman said, although she was critical of Kennedy’s distrust of vaccines, especially the polio vaccine.
Whether that reckoning can be achieved and whether it will have the desired impact on chronic disease remains to be seen, according to Tesser.
“Can intervention in diet achieve eliminating chronic diseases within 2 years?” he said. “That seems unlikely. It is a nice sound bite without any teeth in it.”
Kennedy’s aim to increase transparency in the health care system overall was another potential positive highlighted by Robert W. Levin, MD, past president of the Florida Society of Rheumatology, president of the Alliance for Transparent and Affordable Prescriptions, and associate affiliate professor of medicine at the University of South Florida. “Understanding drug pricing, out-of-pocket costs and rebates and eliminating the middlemen could be something that would be very welcome for our patients with chronic disease,” he said. “Kennedy has also talked about transparency in medical advertising, which is necessary not just for our medications but vaccines and other interventions.”
Insurance
The administration’s plans for Medicaid, Medicare and the Affordable Care Act are still largely unclear, according to several news reports.
During a presidential debate in September 2024, Trump said he had plans to replace the ACA but has not expanded on the idea.
“Back in 2017 when [the first Trump administration] tried the repeal and replace efforts, it was such a debacle for Republicans in general that my sense is that the Trump administration is eager to stay away from the issue as much as possible,” Daniel L. Heil, a policy fellow at the Hoover Institution at Stanford University, told Healio. “The one thing he has said is if you have ACA benefits, [they are] not going to touch it. But the specifics are not there.”
In relation to Medicare, a survey conducted by eHealth showed 64% of Medicare beneficiaries reported feeling “more confident in the future of Medicare after the election, whereas 72% of Medicare beneficiaries expect the Trump administration to prioritize their needs.” Heil said this trust in the Trump administration may be due in part to Trump’s statements that “they are not going to do anything to jeopardize Medicare benefits for anyone.”
“What you are more likely to see, particularly in the Medicare space, is more piecemeal reforms that are not explicitly going to be affecting patients,” including site-neutral payments, prescription drugs and price transparency, Heil said.
According to Heil, the big question is whether the administration will continue the subsidy extensions outlined in the Inflation Reduction Act.
“My sense from the administration is that there are enough conservatives in there where they are not going to want to extend it, but there are people on [Capitol] Hill on the right who are definitely more in line to think that we do not want to go down the road of saying we are taking insurance away from [people],” Heil said.
Physicians’ biggest concern revolves around the future of the CMS physician fee schedule, which may experience significant cuts in the upcoming months, Heil said.
“We are back in that doc fixed world that we had with the Sustainable Growth Rate back in 2015, where every year doctors need to be concerned over whether or not Congress is going to get their act together and increase the fee schedule or if they are going to let the scheduled cuts take place,” Heil said.
Reproductive health care
Since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision in June 2022 overturned the constitutional right to abortion, 17 states have banned abortion entirely or implemented expansive restrictions, according to a report from the Center for Reproductive Rights. The current climate has left health care professionals worried about what changes may come in the second Trump administration.
“I think we are all feeling anxious about the [political] uncertainty,” Paula Amato, MD, professor of obstetrics and gynecology at Oregon Health and Science University School of Medicine and immediate past-president of the American Society for Reproductive Medicine (ASRM), told Healio. “Having said that, we are all approaching things with an open mind and hoping for the best. Obviously, we are ready to play defense, if necessary. We could probably expect further restrictions on reproductive rights, as we have seen since the Dobbs decision. We are going to try and protect access to care.”
Concerns extend beyond abortion access and include issues like access to contraception, in vitro fertilization and egg freezing, and emergency services when a pregnant patient may need lifesaving care, Amato said.
“There are other threats that we are keeping an eye on, like so-called ‘gag rules’ defunding any organization that also provides abortion care,” Amato said. “Many of these organizations also provide access to contraception and screenings for cervical and breast cancer. This is not just about abortion; it is about the spectrum of reproductive health care.
"ASRM feels strongly that these decisions should be between a patient and their provider, and the government should not intrude on that relationship. We will aggressively pursue efforts to increase access to health care, particularly to infertility care.”
The current political climate has also impacted where OB/GYN physicians and medical residents and trainees are choosing to practice, according to Angela Chaudhari, MD, associate professor and vice chair in the department of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine.
Data from a survey sent to more than 2,000 physicians and trainees, published in Journal of General Internal Medicine in 2023, showed that 82% of respondents preferred to apply to work or train in states with preserved abortion access. Further, 76% stated they would not apply to work or train in states with legal consequences for providing abortion care.
“The biggest worry I see in my physician colleagues working in [abortion]-restrictive states is their concern that they will cross the vague boundaries set in state law and not be able to provide needed health care for their patients,” Chaudhari told Healio. “This climate creates so much fear for an OB/GYN who wants to ensure they are doing the best for patients but are still abiding by the laws states have put forward that have not always been explained or made clear to providers and hospitals at the local level.”
“Am I nervous? For sure,” Chaudhari said. “But as a physician, I have weathered a lot of ups and downs in my 20 years of practice and cared for a lot of patients under multiple administrations. My biggest concern is for the long-term well-being of patients around the country — that people will make decisions that have a lifelong impact for themselves, and their families based on the rhetoric that has come out of this most recent election and the concern that this change will impact federal law."
[ Editor’s note: For more on this topic, check out this recent episode of Healio’s Physicianary podcast, hosted by Hansa Bhargava, MD .]
References:
- After Roe Fell: Abortion Laws by State. Available at https://reproductiverights.org/maps/abortion-laws-by-state/. Accessed Jan. 8, 2025.
- Bernstain SA, et al. J Gen Intern Med. 2023;doi:10.1007/s11606-023-08096-5.
- Chen LJ. JAMA Health Forum. 2024;doi:10.1001/jamahealthforum.2024.4057.
- Facing increased costs, 64% of Medicine beneficiaries express higher confidence in the future of Medicare under a Trump administration. https://news.ehealthinsurance.com/news/facing-increased-costs-64-of-medicare-beneficiaries-express-higher-confidence-in-the-future-of-medicare-under-a-trump-administration. Published Nov. 19, 2024. Accessed Dec. 18, 2024.
- Hoffman R. Read: Harris-Trump presidential debate transcript. https://abcnews.go.com/Politics/harris-trump-presidential-debate-transcript/story?id=113560542. Published Sept. 10, 2024. Accessed Jan. 8, 2025.
- Lueck S, et al. Trump, republican congress health care proposals could pose risk to access and affordability. https://www.cbpp.org/blog/trump-republican-congress-health-care-proposals-could-pose-risks-to-access-and-affordability. Published Nov. 13, 2024. Accessed Dec. 18, 2024.
- RFK Jr. wants to 'Make America Healthy Again.' He could face a lot of pushback. https://www.npr.org/sections/shots-health-news/2024/11/15/nx-s1-5191947/trump-rfk-health-hhs. Published Nov. 15, 2024. Accessed Jan. 3, 2025.
- Scientific report of the 2025 Dietary Guidelines Advisory Committee. https://www.dietaryguidelines.gov/2025-advisory-committee-report. Accessed Jan. 3, 2025.
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