Robert F. Kennedy Jr. faces a clear path forward to a full Senate confirmation thanks in large part to a key yes vote from a GOP physician-senator facing a 2026 primary challenge.
During a confirmation hearing with Kennedy last week, Sen. Bill Cassidy, R-La., a gastroenterologist who chairs the Senate Health, Education, Labor and Pensions Committee, said he was struggling to reconcile his loyalty to the Trump administration with his duty as a physician.
“I want President Trump to be successful. It’s important for our country,” he said. “Any action you take as HHS secretary will shape his legacy, and we both want that legacy to be positive.”
He pressed Kennedy on his controversial history regarding vaccines but ultimately agreed to support his nomination after receiving a series of commitments from Kennedy on how he would work with Cassidy and the committee.
Cassidy faces a primary challenge from former House member John Fleming, who is currently Louisiana’s state treasurer. Louisiana will switch to a closed primary system in 2026, meaning that Cassidy will be competing for a smaller pool of votes than in his last primary run. He won his 2020 general election with nearly 60 percent of the vote.
Cassidy has a history of pushing back on the Trump administration. He was one of seven Senate Republicans to vote to convict Trump at his second impeachment trial over his role in the Jan. 6, 2021, attack on the U.S. Capitol. He and two others, Lisa Murkowski of Alaska and Susan Collins of Maine, are still in the Senate.
Fleming doesn’t want to let Cassidy live that down.
Fleming, who worked as a senior adviser to Trump during his first administration, has begun his campaign on a pledge to bring Louisiana values back to Washington, D.C., and has accused Cassidy of becoming part of the “regulatory, spend-a-rama, pro-open borders crowd.”
For its part, the Republican Party of Louisiana thanked Cassidy for his vote on X, the social media platform owned by Trump adviser Elon Musk, saying it was a “pivotal day in our shared goal to Make America Healthy Again.” The comment in support of Cassidy is notable after the state party’s executive committee voted to censure him in 2021 after his vote to convict Trump on impeachment charges.
Speaking on the Senate floor after announcing his support for Kennedy, Cassidy said he had agreed to a host of commitments to provide Cassidy and the committee with more access to HHS. He said Kennedy agreed to meet or speak with Cassidy “multiple times a month” and to quarterly appearances before the HELP Committee if requested.
Cassidy said Kennedy committed to maintaining the vaccine recommendations made by the Centers for Disease Control and Prevention’s vaccine advisory panel. He said Kennedy committed to allowing the HELP Committee chair, whether it’s Cassidy or another senator, to select a representative on any board or commission to review vaccine safety.
If all Democrats oppose him and if Vice President JD Vance casts a tie-breaking vote, Kennedy can afford to lose three Republican votes.
Promises made, promises kept?
But some medical and public health experts said they’re not convinced that the commitments to which Cassidy said he and Kennedy agreed will come to fruition.
Georges Benjamin, executive director of the American Public Health Association, said in an interview with CQ Roll Call that he was disappointed in Cassidy’s decision to support Kennedy. He said the level of involvement that Cassidy said he and Kennedy agreed to isn’t realistic.
“That would be like a member of Congress sitting over the shoulder of one of our generals that is trying to make a decision in combat,” Benjamin said.
“Cassidy is not going to be there helping him manage the department,” Benjamin added. “He’s not going to be there when he makes important management decisions that Mr. Kennedy may not think he needs to talk to somebody about, but has profound implications because he does not know.”
He said the APHA is still going to try to lobby members to deter senators from voting in favor of Kennedy before his nomination reaches the Senate floor.
Cassidy on Wednesday declined to answer a question about how he would hold Kennedy accountable to the commitments he laid out, referring to his Senate floor remarks.
Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and infectious disease physician, said he’s not convinced Kennedy’s commitments will actually play out.
Further, Adalja said allowing lawmakers to weigh in on decisions selecting members for any board or commission that reviews vaccine safety will bring politics into the health agencies, which are meant to operate independently.
“I don’t think those reassurances mean anything, because RFK Jr. will say anything to be in that position,” he said.
Mary Ellen McIntire contributed to this report.
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