Put on the spot, a lot of Americans might hesitate over the difference between Medicaid and Medicare. People who aren’t affected by one of these programs, which together enroll about 150 million people in the U.S., don’t generally have a need to be well versed in their intricacies, and the two programs sound quite similar. The names don’t really hint that Medicare is a federal program that covers older Americans and Americans with disabilities, and that Medicaid covers low-income people in the United States.
Most Americans, though, are not nominated to become secretary of the Department of Health and Human Services. Robert F. Kennedy Jr. is. And yet today, at his confirmation hearing before the Senate Finance Committee, he made clear that he also does not know very much about Medicare and Medicaid.
As HHS secretary, Kennedy would oversee a suite of government agencies, including the FDA, CDC, and National Institutes of Health, that are focused on improving American health. He also would oversee the Centers for Medicare and Medicaid Services, which, as the name implies, manages those two programs. HHS services, in other words, touch the lives of every American—and Medicaid and Medicare are, in particular, two of the most common ways for people to directly benefit from the government’s services.
During the three-and-a-half-hour hearing, in which the Senate committee pressed Kennedy on a range of issues—his anti-vaccine views, endorsements of conspiracy theories, stance on abortion, potential financial conflicts—senators grilled Kennedy on various aspects of the two government programs. In his new role, Kennedy could be charged with overseeing substantial changes to one of them. Donald Trump has pledged to preserve Medicare. He has made no such promise about Medicaid, which health-policy experts anticipate may be targeted for spending cuts. (On Tuesday, Medicaid reimbursement portals abruptly stopped working after the Trump administration ordered a freeze on federal grants and loans; states have since regained access to the portals.) Some Republicans have argued that an increased focus on public-health insurance in the U.S. won’t make Americans healthier, and Kennedy appeared to echo that viewpoint today when he criticized Medicaid, saying “our people are getting sicker every single year,” and lamented the program’s expansion to people with higher incomes. “The poorest Americans are now being robbed,” he said.
But Kennedy also seemed to mix up the two programs when he described them. Part of the issue with Medicaid, he said, is that “the premiums are too high, the deductibles are too high.” The majority of people enrolled in Medicaid don’t pay premiums or deductibles; federal law actually prohibits premiums for the program’s lowest-income enrollees. (He did seem better versed in Medicare Advantage, a program that provides private insurance coverage for older Americans and that he himself is enrolled in.)
To be fair, Kennedy was in a high-pressure situation. But being HHS secretary is a high-pressure job. Kennedy had time to prepare in advance of today’s hearing. If confirmed, he won’t need to master every minute detail of Medicare and Medicaid, but he will need to be able to navigate both programs—their differences, their weaknesses, and how they might evolve. People who are eligible for both programs, for instance, have created sticking points in the health-care system, in part because coordinating coverage between the two is difficult and can complicate care. When pressed by Senator Bill Cassidy of Louisiana on how to deal with that issue, Kennedy suggested that the programs should be “consolidated” and “integrated”—but when asked how that might happen, said, “I’m not exactly sure.”
Kennedy struggled with other policy specifics, too. One of his goals, Kennedy said, is to fulfill Trump’s directive to improve the quality of care and lower the price of care for all Americans. But he was vague on any plans to reform Medicaid, explaining that he’d “increase transparency” and “increase accountability.” When pushed by Cassidy to clarify, Kennedy said, “Well, I don’t have a broad proposal for dismantling the program.”
Nor did Kennedy have a clear sense of how he would approach one of the more contentious and legally sensitive health questions of the past few years: whether women whose lives are threatened by pregnancy should be able to receive emergency abortions under EMTALA, the law that requires emergency rooms that receive Medicare funding to provide care to anyone in a life-threatening situation. The Biden administration argued that this federal law supersedes state abortion bans, and in 2024, after the Supreme Court demurred on the issue, the administration made clear to doctors, in a letter co-authored by Health and Human Services Secretary Xavier Becerra, that abortions could qualify as emergency treatment. Kennedy admitted this morning that he didn’t know the scope of the authority he’d have to enforce the law in his new job.
Jacinda Abdul-Mutakabbir, a clinical pharmacist at UC San Diego, told me that Kennedy’s apparent failure to understand the intricacies of the two programs wasn’t just a harmless fumble. If the health secretary is not well versed in the programs he’s tasked to run, he might not appreciate the impacts of his decisions. Should health coverage for some of the most vulnerable Americans be altered—perhaps even taken away—then health disparities in this country would likely widen. And if any part of his agenda does include increasing transparency, as Kennedy described in today’s hearing, expertise will have to be a prerequisite. “You can’t increase transparency on something you don’t have clarity on,” Abdul-Mutakabbir told me. (Kennedy’s press team did not immediately return a request for comment on his performance at today’s hearing.)
During the hearing, Kennedy’s more radical views on vaccines and infectious disease did come up. He copped to describing Lyme disease as “highly likely a militarily engineered bioweapon.” (The bacterium, which has been around for at least tens of thousands of years, is not.) He stood by his assertion that the measles vaccine killed two children in Samoa in 2018. (The vaccine did not; those children died following the administration of an improperly mixed vaccine by two nurses who were ultimately sentenced to five years in prison for the act.) He said that young children are at “basically … zero risk” from COVID-19. (Young children are at risk, especially babies under six months of age, who have similar hospitalization rates from the disease as adults 65 to 74 years old.) Kennedy’s falsehoods about infection and immunity were already well known, though. What the country learned today was that he may lack basic competency in some of the most wide-reaching aspects of his future job—and didn’t take the time to prepare answers for Congress, which he’ll ultimately have to answer to.