What policies could RFK Jr. actually change at HHS?

Appointed to head the nation’s sprawling Department of Health and Human Services, Robert F. Kennedy Jr. has big ideas for breaking the norms of public health policy.

His Senate confirmation hearings — if they happen — will come with plenty of questions about what Kennedy’s ideas would look like in practice.

Her new role would mean giving up her status as an outside critic and working within a massive government system, running an agency of 80,000 employees and handling everything from drug approvals to food recalls to the response to the pandemic.

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

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

Vaccines

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

Both Makary and Weldon have raised questions about vaccine side effects, although they have at times also supported the role vaccines play in public health. Kennedy himself falsely claimed that vaccines caused autism, which has been debunked by numerous studies.

In their new roles, Makary, Weldon and Kennedy would have the authority to select experts who will serve on important advisory committees to the FDA and CDC. These groups play a key role in vaccine recommendations and authorizations for the general public, creating public health guidance for years to come.

“I think for the most part, the health care community would continue to move forward with vaccines as they are now, because they are considered one of the massive public health successes of the last 100 years. And I don’t think that’s the case, I think that would change,” said Tom Inglesby, a former senior adviser to HHS and the White House during the COVID-19 crisis under the Biden administration.

“But what could change is potentially the cost of vaccines, access to vaccines, guidance regarding new vaccines that might come online, as well as confusion around public messaging from the federal government about safety and the effectiveness of vaccines,” Inglesby said.

Food and nutrition

When it comes to the chemicals and foods Americans eat, it’s less clear how Kennedy might make changes at HHS, unlike the Environmental Protection Agency or the Department of Agriculture, which have more oversight over areas such as water fluoridation, which Kennedy opposes, or school meals, which he says he wants to make healthier. However, he said he would gut the FDA’s entire nutrition department.

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

But he also called for restrictions on food additives, dyes and ultra-processed foods, a topic he could have direct influence on through the FDA, which determines safe thresholds for “daily intake.” acceptable” for substances.

Kennedy has generally received a more cautious reception from the public health community regarding his emphasis on healthy eating.

“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. That would be a wonderful thing to make sure that the best school meals program possible,” said Dr. Richard Besser, former acting director of the CDC.

But many public health experts are also hesitant to give Kennedy credence, for fear it could lend credibility 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, which spreads quickly.

“One of the dangerous things about RFK Jr. is that he says there are bits and pieces of things that are true, and they’re mixed together. And that makes it very difficult to determine which things you should follow because “They’re based on fact, and what things aren’t,” Besser told ABC News, where he was a former health and medicine editor.

Experts also question Kennedy’s ability to counter powerful Washington lobbies — one of his main stated goals — in a Trump administration focused on working with big business to deregulate industries.

Access to abortion

Another area where Kennedy could diverge from the Trump administration is on abortion access. Kennedy said he supported legal access to abortion up to fetal viability (despite an earlier comment on the campaign trail that he later reversed his support for a 15-week ban) and that such decisions should be made by women.

Many abortion rights advocates still expect the Trump administration to move quickly to roll back protections and end legal fights launched by the Biden administration after the fall of Roe v. Wade – but hope that Kennedy and the administration as a whole do not attempt a sweeping ban.

“[Trump’s] Obviously, I’ve been baffled a thousand times on this and other issues, so I’m not going to trust every word he says, but I think it’s possible that he and his administration saw that “In reality, abortion access is very popular,” said Katie O. Connor, senior director of abortion policy at the National Women’s Law Center.

“We’ve seen this over the last three elections, and there could be retaliation if this administration does something to further restrict access to abortion.”

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

Some of the policies O’Connor expects to be rolled back would include the Pentagon paying service members who have to cross state lines to get abortions because of where they were stationed, as well as a expanded access to abortion pills through telemedicine.

As HHS secretary, Kennedy could roll back those rules and also build on the efforts of the first Trump administration. It could expand protections for health care providers who do not want to perform abortions, allowing more providers to refuse care, and make it harder for private insurers to cover abortion, making it more costly for patients, O’Connor said.

Large-scale bans, if implemented, would focus on removing access to the medical abortion pill called mifepristone, or attempting to remove medication abortion from the market through the approval process of the FDA, or by using a very old law called the Comstock Act. to ban the sending of pills by mail.

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