Robert F. Kennedy Jr. articulates his views on chronic disease, vaccines, Medicaid

Robert F. Kennedy Jr. will seek to chart a new course for U.S. healthcare if he becomes HHS secretary, he explained during a Jan. 29 confirmation hearing before the Senate Finance Committee.

“President Trump has asked me to end the chronic disease epidemic and make America healthy again because I’m in a unique position to do that,” Kennedy said.

“If we don’t solve that problem, all the other disputes we have about who’s paying — whether it’s insurance companies, whether it’s providers, whether it’s HMOs, whether it’s patients or families — all of those are moving deck chairs around on the Titanic.”

The answer may indicate that Kennedy would look to focus primarily on public health matters stemming from issues such as the food-supply network and dietary guidelines while taking a hands-off approach toward longstanding healthcare administrative and payment issues. Food-as-medicine models could emerge as priorities, for example.

“We need to focus more on outcomes-based medicine, on putting people in charge of their own healthcare, of making them accountable for their own healthcare so they understand the relationship between eating and getting sick,” Kennedy said. “Most importantly, we need to deploy NIH and FDA to do the research to understand the relationship between different food additives and chronic disease so that Americans understand it.”

In addition to health and well-being, the cost effectiveness of U.S. healthcare is at stake, he said.

“Our country will sink beneath a sea of desperation and debt if we don’t change course and ask why our healthcare costs are so high in the first place,” Kennedy said.

“The obvious answer is chronic disease,” he added, citing the increasing prevalence of obesity and diabetes, along with cancer in young people, autoimmune disease, neurodevelopmental disorders, Alzheimer’s disease, asthma, depression and addiction.

Vaccine philosophy under scrutiny

Another public-health question that has come to the forefront is Kennedy’s stance on vaccinations, specifically whether prior statements and his eight-year stint as chair of the anti-vaccine organization Children’s Health Defense suggest he would try to influence vaccination policy in ways that contradict established science.

He said Wednesday that vaccines play a critical role in healthcare, but he hopes to promote better vetting of vaccine safety.

“We will create an honest, unbiased gold-standard science at HHS accountable to the president, to Congress and to the American people,” Kennedy said.

Some senators were not persuaded by his assurances. Sen. Ron Wyden (D-Ore.), the ranking member of the Finance Committee, was one of several Democratic senators whose exchanges with Kennedy became heated. Wyden cited two podcast interviews in which Kennedy disparaged vaccines, along with a 2021 petition for the FDA to block access to the COVID-19 vaccine.

Kennedy replied that his statements on the podcasts were taken out of context and that the petition arose from concern that the vaccine was being recommended for young children despite lacking a scientific basis in Kennedy’s opinion.

Wyden also wanted to know why Kennedy wrote a book arguing that measles is not a deadly disease and that the measles vaccine is unsafe and ineffective. Kennedy said he supports vaccines for measles and polio and “will do nothing as HHS secretary that makes it difficult or discourages people from taking either.”

A few senators raised concerns that Kennedy has quipped that he hopes to be able to pause all NIH research about infectious diseases for eight years.

“I said give infectious disease [research] a break because that’s been the principal preoccupation,” he said. “Almost nothing is studied at NIH about the epidemiology of our chronic-disease epidemic.”

He later clarified, “I intend to devote the appropriate resources to preventing pandemics. That’s an essential part of my job.”

Pivotal Medicaid questions

With substantial Medicaid cuts potentially looming and cuts to Medicare benefits apparently off the table, Sen. Bill Cassidy (R-La.) asked what HHS’s policy would be for beneficiaries who are dually eligible for both programs.

Kennedy gave a vague answer about ensuring that the programs “are consolidated, that they’re integrated, and the care is integrated.”

He added that it would be “difficult to integrate them because Medicare is under fee-for-service, is paid for by employer taxes. Medicaid is fully paid for by the federal government, and it’s not fee-for-service.”

In fact, states cover nearly a third of program funding, and roughly 30% of payments nationwide are fee-for-service.

“Most people who are on Medicaid are not happy,” Kennedy claimed. “The premiums are too high, [and] the deductibles are too high. The networks are narrow. The best doctors will not accept it in the best hospitals.”

He soon added, “I would ask any of the [committee] Democrats who are chuckling just now, do you think all that money that we’re sending to Medicaid every year has made Americans healthy? Do we think it’s working for anybody? Are the premiums low enough?”

Wyden at one point suggested Kennedy’s comments showed a lack of familiarity with Medicare and Medicaid.

“It’s not clear which program you’re [referring to] when,” Wyden said.

Regardless, Kennedy sees ways to make Medicaid work better for beneficiaries.

“The ultimate outcome is to increase transparency, to increase accountability and to transition to a value-based system rather than a fee-based system,” Kennedy said. “There are many, many options with telemedicine, with AI right now, including direct primary care systems — we’re seeing that movement grow across the country.”

Other issues of concern

Kennedy also spoke about Medicare, indicating a shift away from Traditional Medicare and toward Medicare Advantage (MA) would be advisable.

“More people would rather be on Medicare Advantage because it offers very good services, but people can’t afford it,” Kennedy said. He talked about promoting co-ops, health savings accounts, direct primary care models and other mechanisms within the program to improve affordability and “make people more accountable for their health.”

However, he agreed with a question about the alleged practices of MA health plans that seek to increase their risk adjustment payments by over-diagnosing conditions. Kennedy said he’s already picked an HHS general counsel who prosecuted the biggest Medicare fraud case in West Virginia history.

“I have never defended [MA] or the rapacious behavior by insurance companies or the PBMs [pharmacy benefit managers],” Kennedy said. “I brought in a prosecutor for that [general counsel] job instead of a bureaucrat precisely to address [those] important issues.”

He also acknowledged the bipartisan perspective on the need to better support rural hospitals.

“President Trump is determined to end the hemorrhage of rural hospitals,” Kennedy said. “He’s asked me to do that through use of AI, through telemedicine. We can provide concierge care to every American.”

He also said graduate medical education can be better funneled to rural hospitals. And he and Dr. Mehmet Oz, the nominee to lead CMS in the new administration, would be open to working with Congress to modify the Medicare wage index.

Up next

Kennedy is scheduled to face questions from the Senate Health, Education, Labor and Pensions (HELP) Committee on Jan. 30, although only the Finance Committee will vote on whether to send his nomination to the full Senate.

The full vote is expected to be close and partisan. Kennedy will be confirmed if he receives approval from at least 50 of the 53-member Republican caucus, regardless of Democratic support.

“You’ve gone through the most thorough vetting process that any committee in this Congress puts anybody through, and I think that you’ve come through well and deserve to be confirmed,” Sen. Mike Crapo (R-Idaho), chair of the Finance Committee, said at the end of the hearing.