What policies could RFK Jr. actually change at HHS?

Appointed to lead the nation’s vast Department of Health and Human ServicesRobert F. Kennedy Jr. has big ideas for breaking the rules of public health policy.

His Senate confirmation hearings, should they happen, will come with many questions about what Kennedy’s ideas would look like in practice.

His new role would mean giving up his outside critic status and working inside a massive government system, leading an 80,000-employee agency and dealing with everything from drug approvals to food recalls to pandemic response.

So what happens when his “Make America Healthy Again” slogan collides with one of Washington’s biggest government bureaucracies?

“He’s very clear about what he wants to do. I’m not sure he understands what it will take to do it,” said a former senior HHS official who worked in the Biden administration.

Vaccines

On vaccines, President-elect Donald Trump’s appointment of Johns Hopkins University professor Marty Makary to head the Food and Drug Administration, former GOP Rep. Dave Weldon to head the Centers for Disease Control and Prevention, and Dr. Janette Nesheiwat as surgeon general certainly add. Kennedy’s ability to make changes – if confirmed by the Senate.

Both Makary and Weldon have raised questions about the side effects of vaccines, although they have sometimes supported the role that vaccines play in public health. Kennedy himself has falsely claimed that vaccines cause autism, which has been disproved by numerous studies.

In their new positions, Makary, Weldon and Kennedy would have the power to select existing experts on important FDA and CDC advisory panels. These panels play a key role in vaccine recommendations and authorizations for the general public, ultimately creating public health guidelines for years to come.

“By and large, I think the health care community would continue to push vaccines as they are now, because they see it as one of the massive public health successes of the last 100 years. And I don’t think that would change,” said Tom Inglesby, of the HHS and House Former senior White advisers in Biden administration during COVID-19.

“But what may change is the cost of vaccines, access to vaccines, guidance about new vaccines that may be online, and confusion about the federal government’s public messaging about vaccine safety and effectiveness,” Inglesby said.

Food and nutrition

When it comes to chemicals and the food Americans consume, it’s less clear how Kennedy might make changes at HHS, as opposed to the Environmental Protection Agency or the Department of Agriculture, which oversees areas like water fluoridation, which Kennedy opposes. or school lunches, he says he wants to make them healthier. However, he said he would eliminate the FDA’s entire food division.

Kennedy could also move funding – he has said he would deprioritize infectious disease research in favor of chronic disease research, for example. As cases of bird flu continue to rise – raising concerns about a new pandemic – public health experts and former government officials have strongly pushed back against the idea.

But he has also called for restrictions on food additives, dyes and ultra-processed foods, something that could have direct effect through the FDA, which sets safe “Tolerable Daily Intake” thresholds for substances.

Kennedy has generally received more welcome wise from the public health community about its focus on healthy foods.

“There are some things here that are worth working on. You know, if we look at the school lunch program in America, 30 million kids get more than half their calories from that program. It would be a wonderful thing to do. It’s the best school lunch program,” said Dr. Richard Besser, Former CDC Directors.

But many public health experts are also wary of crediting Kennedy, fearing it could lend credence to other misinformation he promotes. He advocates drinking raw milk, for example, even though the pasteurization process kills bacteria that can cause serious illnesses, including bird flu.

“One of the dangerous things about RFK Jr. is that some of the things he says are true, and they’re mixed up. And it makes it very difficult to sort out what things you should follow because they’re based on fact and what things aren’t,” he told her. Besser told ABC News, where he was the former health and medical director.

Experts also question Kennedy’s ability to stand up to powerful lobbyists in Washington — one of his stated goals — in a Trump administration focused on working with big business to deregulate the industry.

Abortion access

Another area where Kennedy may be out of line with the Trump administration is abortion access. Kennedy has said he supports legal access to abortion until fetal viability (despite an earlier comment on the campaign trail, he later supported a 15-week ban) and that those decisions should be up to women.

Many abortion rights advocates still expect the Trump administration to roll back protections and the Biden administration to overturn Roe v. They moved quickly to stop the legal battles that began after Wade’s downfall, but they are hopeful that Kennedy and the broader administration will not attempt a broad ban.

“(Trump’s) known about this issue and a thousand other times, so I’m not going to trust every word he says, but I think there’s a chance that he and his administration have seen that abortion access is really popular,” said Katie O’ Connor, senior director of abortion policy at the National Women’s Law Center.

“We’ve seen that in the last three elections, and there could be a backlash if this administration does something to further reduce access to abortion.”

There are certainly members of Trump’s orbit who support broader restrictions on abortion, but Trump himself has said he would not sign a federal ban if Congress passed it.

Some of the policies O’Connor hopes to roll back would include the Pentagon paying service members who must cross state lines because of where they were stationed, as well as expanding access to telemedicine abortion pills.

As HHS secretary, Kennedy could undo these rules and build on the efforts of the first Trump administration. It could expand protections for health care providers who don’t want to perform abortion procedures, allowing more providers to deny care and making it harder for private insurers to cover abortion, making it more expensive for patients, O’Connor said.

Large-scale bans, if enacted, would focus on removing access to the abortion pill mifepristone, either by trying to take the abortion pill off the market through the FDA approval process or by using a very old law called the Comstock Act. to prohibit the mailing of pills.

“I hope this administration doesn’t want to expand its political capital on abortion,” O’Connor said.