MedPage Today story.
Robert F. Kennedy Jr.’s statements before the Senate Finance Committee on Wednesday revealed a concerning lack of knowledge about the major health programs he’d oversee, should he be confirmed as HHS secretary.
On several occasions during the 3.5-hour hearing, Kennedy seemed to conflate Medicare, Medicaid, and Medicare Advantage, and appeared to mistakenly refer to the Affordable Care Act health exchanges.
“Medicaid is not working for Americans, and it’s specifically not working for the target population,” he said in response to questions from Sen. Bill Cassidy, MD (R-La.), a physician, who asked him in what ways he would improve the healthcare delivery system.
“I’m on Medicare Advantage and I’m very happy with it,” Kennedy replied. “Most people who are on Medicaid are not happy. The premiums are too high, the deductibles are too high, the networks are narrow.”
In fact, Medicaid plans generally do not have premiums, or if they do, under federal law they must be kept low based on income.
Asked by Cassidy what reforms he would propose, Kennedy replied, “Well, I don’t have a proposal for dismantling the program.” He later gave vague responses to Cassidy’s question about how he would improve programs for dual eligibles, some 12 million beneficiaries — often with complex health issues — who are eligible for Medicare but because of their low income, are also eligible for Medicaid.
“Well, dual eligibles are not right now served very well into the system,” Kennedy replied. “And you know I suppose my answer to that is to make sure that the programs are consolidated, they’re integrated, and the care is integrated. I look forward to working with you, Dr. Cassidy, on making sure that we take good care of people.”
Cassidy then asked how he proposed to integrate the programs. “Does Medicare pay more? Medicare pay less? Medicaid pay more? Medicaid pay less? How do we do that?”
“I’m not exactly sure, because I’m not in there. I mean, it is difficult to integrate them …” he replied, ultimately saying, “I do not know the answer to that. I look forward to exploring options.”
Kennedy also said that Medicare beneficiaries would “rather be on Medicare Advantage because it offers very good services. People can’t afford it. It’s much more expensive.”
In fact, MA plan beneficiaries generally pay no or very low premiums and choose their plans because of low or non-existent upfront costs. However, it is true that MA plans generally cost the trust fund a lot more than if the same beneficiaries were in traditional Medicare — $82 billion more in 2023 according to the Medicare Payment Advisory Commission.
At another point, Kennedy said that Medicaid is “fully paid for by the federal government,” when in fact it is paid through a mix of state and federal money, with states contributing between 17% and 41% in fiscal year 2023. That’s an important concept to understand, since each Medicaid program’s coverage and eligibility requirements can vary enormously through complex federal waiver programs run by HHS agencies.
The American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) held a joint media briefing Wednesday after the hearing, questioning Kennedy’s fitness to run the agency, which has 13 separate and important divisions, thousands of programs, and 80,000 employees.
“… [H]e demonstrated that he did not have a lot of health experience, and in many of his answers, we saw that he has a … dearth of management experience,” said Georges Benjamin, MD, executive director of APHA.
Benjamin noted that it’s important for someone in this position to be “rigorous about scientific evidence, not cherry pick, and understand things like healthcare financing, which he truly did not know the difference between Medicaid and the health exchanges.”
“He talked about copayments and premiums that were too high for Medicaid when Medicaid doesn’t have premiums to start with,” Benjamin said. Also, “he made a statement about the fact that NIH (National Institutes of Health) doesn’t spend a lot of money on chronic diseases, which is absolutely not true.”
Benjamin was asked — given the number of Kennedy’s misstatements — whether he at this point in the process should be better informed about Medicare and Medicaid, and problems with programs for dual eligibles.
“He did not understand any of that,” Benjamin replied. “And you know, this is not rocket science. … [HHS] does a lot of things, but I said earlier that the nation spends $5 trillion [on healthcare] and we’re at the bottom of the other industrialized nations in terms of health outcomes. There’s a lot of reasons for that, but he ain’t the guy to fix that because he really doesn’t know. He doesn’t even understand the basics of what the department does.”
Julie Sweetland, PhD, senior advisor at the Frameworks Institute, which conducts research on social issues and language, said during the briefing that Kennedy conveyed “quite a few instances of disinformation.”
Multiple times, he suggested “that most Americans are not happy with Medicaid, although some of his comments suggested that perhaps he was unclear on what Medicaid was. … In fact, we know that more than 8 in 10 Medicaid enrollees rate the overall performance of Medicaid positively, according to a 2023 KFF poll.”
Susan Kressly, MD, president of AAP, was asked about Kennedy’s statement to the committee that, “Most experts agree today, even the people who did it back then, COVID vaccines are inappropriate for 6-year-old children who basically have zero risk of COVID.”
Such remarks, along with Kennedy’s often-repeated opposition to other vaccinations — which he now denies — raise concerns that he would find ways to discourage immunizations, perhaps by not requiring that they be covered as an essential benefit by Medicare or health plans.
Kressly said that Kennedy is wrong, as children can experience complications of COVID months after they recover, she said. Also, they “tend to be spreaders of infectious illnesses because they’re not very good at blowing their nose and keeping their germs to themselves,” which can affect their family members, schools, and communities, she said.
“COVID is not something that does not affect children at all,” she said. “In fact, it has enormous impacts.”
