RFK Jr Fails to Offer a Clear Medicaid, Medicare Strategy

During today's confirmation hearing with the Senate Committee on Finance, Sen. Bill Cassidy, MD (R, Louisiana), questioned Robert F. Kennedy, Jr, the nominee for HHS Secretary, on health care policies, particularly for Medicare and Medicaid.¹ Kennedy acknowledged that the current system does not serve these individuals well and emphasized the need for better integration of care, though he admitted he did not yet have a specific plan for aligning Medicare and Medicaid funding structures.

Robert F. Kennedy Jr

Cassidy, who holds a key vote in determining Kennedy’s confirmation, tried to use his time to hear the nominee’s plans to reform Medicaid. Earlier this month, Republicans stated their intent to cut trillions of dollars in order to fund President Donald Trump’s priorities, including tax cuts and border security proposals, which will cost as much as $10 trillion over the coming decade.² Published proposals suggest the GOP-controlled Congress will eye the country’s public health insurance program, which provides low-income and disabled Americans with health coverage, as a target for recouping more than $2 trillion to fund the administration’s orders.

Sen. Bill Cassidy Seeks Solutions for CMS Reform

When asked about his plan for dual-eligible individuals—those who qualify for both Medicaid and Medicare—Kennedy expressed that he looks forward to working with Cassidy on consolidating the programs to improve care.¹ Cassidy pressed further on Medicaid reform, to which Kennedy criticized the program for failing its target population, arguing that while Medicaid costs have risen significantly, quality and access to care have declined.

“How do you propose that we integrate those programs?” Cassidy asked. “Does Medicare pay more, Medicare pay less? [Does] Medicaid pay more, Medicaid pay less? How do we do that?”

Kennedy claimed that many Medicaid recipients struggle with high premiums, deductibles, and narrow networks and that top-tier providers often do not accept Medicaid. In fact, federal rules restrict how much cost-sharing is permitted in Medicaid.

Sen. Bill Cassidy, MD (R, Louisiana)

“I'm not exactly sure because I'm not in there,” Kennedy answered. “I mean, it is difficult to integrate them, because Medicare 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. So, I do not know the answer to that. I look forward to exploring options with you.”

However, later in the hearing, Sen. Maggie Hassan (D, New Hampshire) clarified that funding for Medicaid is jointly provided by the federal government and by individual states.

“Millions of disabled children in this country are alive because of Medicaid,” she explained. “Millions of people with addiction are in recovery because of the services provided to them by Medicaid, and millions of chronically ill people, who until Medicaid expansion was enacted, who couldn’t get health care and therefore couldn’t work because they were too sick, got health care through Medicaid expansion then went back to work and they’re now on private insurance.”

Kennedy offered broader health care reform principles, such as transparency, accountability, and a shift toward value-based care. He suggested exploring innovations like telemedicine, artificial intelligence, and direct primary care systems. While he did not propose dismantling Medicaid, he advocated for state-level pilot programs to test new models.

Cassidy was also persistent about Kennedy’s potential ideas for Medicare. According to Kennedy, there’s a growing preference for Medicare Advantage (MA).

“I think more people would rather be on Medicare Advantage because it offers very good services,” he said. “But people can't afford it; it's much more expensive [than traditional Medicare]... There are all kinds of exciting things that we can be doing, including cooperatives, which President Trump has supported, including health savings accounts, which President Trump has supported, all of these things to make people more accountable for their own health.”

Other key topics discussed during the 3.5-hour hearing covered state-specific barriers to care, like rural health care deserts, scrutiny over his well-documented vaccine skepticism, and his inconsistent views on abortion. While he defended his stance on vaccine safety and denied being anti-vaccine, senators pressed him on past controversial statements.

Trump Administration Rescinds Federal Funding Freeze

Before the hearing concluded, the Trump administration reversed course, rescinding the directive that had ordered federal agencies to freeze trillions in financial assistance, a move that raised alarms in Washington and the health care industry as it jeopardized coverage for nearly 80 million Americans enrolled in Medicaid.^3,4

However, just hours before today's announcement, Sen. Mark R. Warner (D, Virginia) expressed his disdain for Kennedy's support of the federal freeze, citing an announcement Kennedy's campaign team released on Monday, apparently as a fundraising strategy to offset the debt from his presidential run.^1,5

Sen. Mark R. Warner (D, Virginia)

"For literally hundreds of thousands of Virginians, Medicaid is what prevents them from health crisis on a daily and weekly basis... Your presidential campaign celebrated that the freeze, on all new regulations, guidance, and announcements, is a way to protect unelected bureaucrats from further undermining our health freedom," Warner said during the hearing. "Then you ask your donors to help pay for your campaign debt."

Kennedy denied knowing anything about the fundraising email from his campaign and defended himself with a partially incorrect response, stating that the administration wasn't planning to interfere with Medicare or Medicaid coverage. Warner offered clarification, saying, "I would hope that you would have known that."

The now-withdrawn memo, M-25-13, had instructed agencies to halt all federal financial aid disbursements unless they were direct payments to individuals or part of Medicare or Social Security.³ The administration’s reversal follows a federal judge’s decision late Tuesday to temporarily block the funding freeze.

Across the various topics addressed, Kennedy ultimately reiterated his pledge to combat chronic disease by addressing processed foods and financial conflicts in health agencies, as well as his mission to enforce greater transparency in the health system, particularly in drug costs.¹

While Democrats largely challenged him on misinformation and policy knowledge, some Republicans praised his positions on chronic disease and industry reform. Kennedy will face further questioning in a second confirmation hearing with the Senate Committee on Health, Education, Labor and Pensions (HELP) before the Senate votes on his nomination.

References

1. Hearing to consider the nomination of Robert F. Kennedy, Jr., of California, to be Secretary of Health and Human Services. United States Senate Committee on Finance. January 29, 2025. Accessed January 29, 2025. https://www.finance.senate.gov/hearings/hearingto-consider-the-nomination-of-robert-f-kennedy-jr-of-california-to-be-secretary-of-health-and-human-services

2. Leonard B, Lee Hill M, Tamborrino K. House GOP puts Medicaid, ACA, climate measures on chopping block. Politico. January 10, 2025. Accessed January 29, 2025. https://www.politico.com/news/2025/01/10/spending-cuts-house-gop-reconciliation-medicaid-00197541

3. Pifer R. White House rescinds memo pausing federal funding following pushback. Healthcare Dive. January 29, 2025. Accessed January 29, 2025. https://www.healthcaredive.com/news/white-house-rescinds-federal-funding-freeze-healthcare/738667/

4. Klein H. Trump's medical grant freeze threatens Medicaid funding. AJMC. January 28, 2025. Accessed January 29, 2025. https://www.ajmc.com/view/trump-s-federal-grant-freeze-threatens-medicaid-funding

5. Cueto I, Cohrs Zhang R. RFK Jr. campaign uses HHS freeze as a fundraising tool. STAT. January 27, 2025. Accessed January 29, 2025. https://www.statnews.com/2025/01/27/rfk-jr-campaign-fund-raising-hhs-communications-freeze/