When president-elect Donald Trump announced that he would nominate Robert F Kennedy Jr to be his secretary of Health and Human Services, the move shocked many. Kennedy, the son of the late senator from New York and US attorney general, has made a name for himself primarily promoting the bogus link that vaccines cause autism.
It is unclear whether Kennedy could get confirmed, even with a Republican Senate majority. Mike Pence, Trump’s former vice president, made the rare move of denouncing Kennedy as insufficiently opposed to abortion.
Needless to say, almost all, if not all, Democrats will oppose Kennedy’s confirmation. Plenty of Republicans might have some objections as well.
But if Kennedy is confirmed, or if Trump tries to adjourn Congress to make recess appointments like he has intimated that he might do, he would be in charge of a sprawling bureaucracy that includes everything from social welfare programs like Medicare and Medicaid, research projects into diseases and the US response to pandemics. Here are some of the ways that Kennedy could reshape some of the most important agencies that are part of everyday life.
How big is HHS?
Established in 1953 as the Department of Health Education and Welfare, the Department of Health and Human Services changed its name in 1979 after the creation of the Department of Education. HHS had about $3.09 trillion available in Fiscal Year 2024. This includes the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration.
The Food and Drug Administration
When Trump announced Kennedy as his pick to lead HHS, he said: “For too long, Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.” Kennedy himself has promoted the slogan “Make America Healthy Again.” Established in 1906, the FDA regulates both food and drug safety. Kennedy has said the employees at the nutrition departments at the FDA would “have to go,” arguing that they “are not protecting our kids.”
Similarly, Kennedy has said that he plans to remove flouride from all US public water systems, despite the fact that multiple public health groups support flouridation in public water on the grounds that it helps prevent tooth decay. While the Environmental Protection Agency has the responsibility ensure the quality standards for tap water, the FDA has responsibility to ensure that bottled water meets EPA standards.
On top of this, the FDA is in charge of approving drugs, including vaccines. After Trump won, he told NBC News that “If vaccines are working for somebody, I’m not going to take them away. People ought to have choice, and that choice ought to be informed by the best information.”
Kennedy has repeatedly promoted the debunked theory that vaccines cause autism. He has also criticized Ozempic, the drug manufactured by Novo Nordisk and which doctors often prescribe for weight loss, for focusing on the symptoms of obesity rather than creating a better food system.
Furthermore, the FDA is the agency that approves the use of abortion drugs such as mifepristone. Abortion drugs account for 63 percent of all abortions in the health care system, according to the Guttmacher Institute.
Medicare and Medicaid
Throughout the presidential campaign, Trump pledged that he would preserve Social Security and Medicare, though he rarely mentioned Medicaid. By far, this is the biggest expenditure of HHS’s budget. Kennedy’s father was the senator from New York when the United States created Medicare. According to the Brookings Institution, the US government spent $832 billion on Medicare. In the past, Kennedy has called for Medicare to include dental coverage. While he has spoken about what he would do with Medicare or Medicaid, he has talked about how chronic illness has exploded the budgets for Medicare and Medicaid.
The Centers for Disease Control and Prevention
The CDC came under severe criticism during the Covid-19 pandemic, which started at the end of Trump’s first presidency and lasted into Joe Biden’s. The centers focus heavily on public information about diseases as well as vaccinations. The current budget for the CDC is a little more than $9 billion, according to the Congressional Research Service. Similarly, the director of the CDC approves recommendations for vaccines under the Advisory Committee on Immunization Practices. If the director approves it, it becomes part of the CDC’s public health guidance. Kennedy has in the past said he would look into research into whether increased vaccinations developmental delays.
The National Institutes of Health
Like the CDC, the NIH gained larger attention at the beginning of the Covid-19 pandemic. Perhaps most famously, it houses the National Institute of Allergy and Infectious Diseases, which Dr Anthony Fauci led. Kennedy loudly criticized Fauci and wrote a book about him called The Real Anthony Fauci. The NIH houses 27 centers, including ones for cancer, substance use, environmental health sciences and mental health. The budget is around $47 billion. Kennedy has regularly criticized researchers and said he wants to drastically reform the agency.
Of course, it is unclear how much Kennedy can actually get done, let alone whether he will actually lead the agency. But if he comes to helm the bureaucracy, he could drastically alter how public health is administered in the United States.
