By PAUL NATINSKY
As Robert F. Kennedy eases into the Health and Human Services director’s chair, his flashpoints and shortcomings are widely publicized, but lightly opposed.
Kennedy’s skeptical views on vaccine effectiveness and safety, fondness for fringe conspiracy theories and likely embrace of deep Medicaid cuts have the healthcare community and many policymakers concerned about the new secretary’s public health stewardship.
Kennedy’s lack of administrative acumen looms large as he assumes control over a department that employs 80,000 and oversees a $3 trillion annual expenditure representing 22.8% of the U.S. federal budget.
Kennedy lacks managerial experience at organizations even a small fraction of that size. HHS is responsible for the care of 140 million Americans. That number is largely made up of the country’s most vulnerable citizens, including people too poor to afford to buy health insurance, those whose employers don’t offer coverage, and people over age 65 or who have disabilities.
Yet, despite these glaring warning signs, the healthcare community is oddly silent or seemingly eerily reassured.
Nationally, the online news outlet Politico could round up only a handful of healthcare insiders to comment under a veil of anonymity. Only the American Public Health Association spoke on record.
“They think he’s the wrong person for the job,” Dr. Georges Benjamin, executive director of the American Public Health Association told Politico. “With good respect to all my buddies, they’re making the false assumption that if they stay silent, they will get something in return.
“Kennedy has suggested that hospitals, doctors and drugmakers work together to keep Americans sick, argued that industry influence needs to be ripped away from federal policymaking, insinuated that health institutions intentionally bury inconvenient evidence and proposed lopping off entire parts of the health regulatory structure.”
But the AMA, the pharmaceutical industry and the American Academy of Pediatrics have been circumspect in their comments on Kennedy’s nomination.
In Michigan, I found scant interest in commenting among the healthcare provider community.
I obtained a letter from a broad coalition of healthcare providers, insurers, employers and advocacy organizations sent to Michigan’s congressional delegation in mid February that warned against large-scale cuts to Medicaid. Specifically, the coalition discouraged block grants and per capita caps on Medicaid spending, pointing out that such strategies “decouple” funding from “actual costs.”
I spoke to veteran health policy expert Marianne Udow-Phillips about Kennedy’s appointment. She noticed that the American Public Health Association seemed to be the only major healthcare interest willing to go on record.
“A number of senators said they interpreted the silence from the mainstream medical community as endorsement,” said Udow-Phillips who, among other roles, is a lecturer at the University of Michigan School of Public Health.
She said many eyes were on Sen. Bill Cassidy, who is a physician and a huge advocate for vaccines. Cassidy seemed to be placated.
While Cassidy expressed his concerns in the confirmation hearing, he stopped short of a “no” vote on Kennedy. Cassidy was one of seven GOP senators to vote in favor of impeaching Donald Trump for inciting the Jan. 6, 2021 insurrection at the U.S Capitol, for which he faced censure by the Republican Party in his home state of Louisiana. Facing reelection in 2026, Cassidy might have been out of political capital.
“The medical community needs to speak the truth and needs to stand up for patients and for science, because if these statements are allowed to go unchallenged by the mainstream medical community, they will take hold for a generation,” said Udow-Phillips. “Physicians need to be on the right side of history and on the right side of what they took their oath to protect, which is patient health.”
Kennedy is not a physician and does not bring that background to his new post, said Udow-Phillips. He is an environmental attorney and his positions on ultra-processed foods and food additives are things that have been long-supported in the public health community. But even here, there are problems.
“It’s not that he’s not aligned with some important public health issues, but he has some ideas that are way outside what science supports.”
What is even more troubling is Kennedy’s lack of understanding about the department he will run. During his confirmation hearings, he seemed confused about the difference between Medicare and Medicaid and the purview of each—an ignorance that seems to stretch across the Trump administration. Trump pledged publicly to not cut Medicaid as Congress finalized for consideration a budget bill that would do just that.
One-quarter of Michigan’s population is on Medicaid and 70 million nationwide rely on the program for healthcare services.
“The economic impacts on the state would be enormous,” said Udow-Phillips. “It’s a huge problem for our state, it would be a huge problem for the health systems in our state and a huge problem for the state budget and for the people of the state of Michigan if they cut Medicaid.”
I asked Udow-Phillips how she would advise the healthcare community.
“They are behind the eight ball in my view and they need to accelerate.
“I would have been more vocal if I was in the medical community about the concerns about RFK Jr. and I would have stood up because I think they gave permission for people to confirm him who might have thought twice about confirming him if they had heard more.
“The medical community still has a lot of credibility and the public health community less so. I think they need to stand up and speak up more. I think they need to be more vocal.”
Udow-Phillips pointed to a January 2025 KFF Tracking Poll that indicated 85 to 95 percent of those polled across the political spectrum trust their physician to “make the right recommendation when it comes to health issues,” compared to scores as low as 39 percent for other groups that include “The CDC,” “The FDA,” and “Their state and local public health officials.”
“The medical community needs to speak the truth and needs to stand up for patients and for science, she said. Because if these (false) statements are allowed to go unchallenged by the mainstream medical community, they will take hold for a generation. Physicians need to be on the right side of history and on the right side of what they took their oath to protect, which is patient health.”
Udow-Phillips doesn’t think the healthcare community writ large was prepared for a second Trump administration. She said people made the misjudgment that the second Trump administration would be like the first. They expected incompetence and disorganization and did not read Project 2025.
“The people who are running the departments are totally carrying out Project 2025.”