Despite millions of dollars spent by groups opposed to his nomination, the Senate voted to install Robert F. Kennedy Jr. at the helm of the Department of Health and Human Services.
Kennedy faced opposition from the left for his decades of espousing conspiracy theories about vaccines and from the right for his past support of abortion rights. For several weeks, it was uncertain whether he had enough senators backing him to get through. On Wednesday, Democratic senators made speeches on the floor past midnight in protest. But on Thursday morning, he had the votes to be confirmed.
The vote was 52 to 48. Sen. Mitch McConnell, the former Republican majority leader and a polio survivor, was the sole Republican joining Democrats to vote against Kennedy.
"In my lifetime, I've watched vaccines save millions of lives from devastating diseases across America and around the world," McConnell said in a statement explaining his vote. "I will not condone the re-litigation of proven cures, and neither will millions of Americans who credit their survival and quality of life to scientific miracles."
There are many questions about what happens next for Medicare, vaccines and medical research. Here is a guide to five key issues to watch as Kennedy takes control at the huge health agency in the coming weeks:
1. Congress could cut Medicaid and maybe Medicare
Kennedy hasn't spoken much about the future of Medicaid or Medicare, and in his hearings he fumbled basic questions about how they are set up. But he now oversees both popular programs that together insure about 140 million Americans.
As soon as the 119th Congress was sworn in, Republicans began to talk about ways to cut spending in Medicaid, a public health program for low-income people that is paid for partly by the federal government and partly by states. Historically it has been very popular with the public — a KFF survey from last year found that 71% of Americans wanted the program to continue mostly as it is.
Amid talks of cuts, President Trump declared that his team would "love and cherish" Medicare, Medicaid and Social Security and that any cuts would be related to waste or abuse and wouldn't affect beneficiaries.
But cuts well beyond waste and abuse may well be coming anyway to free up funds for Trump's priorities like tax cuts and border security. Conservative groups and Republican lawmakers have long argued that Medicaid has grown too big — during the COVID-19 pandemic, enrollment grew to 80 million people. The proposal from House Republicans would seek to find $880 billion in cuts to Medicaid. States would likely cut benefits and limit eligibility. Medicare could also be in for cuts of some kind as well.
Mehmet Oz, the heart surgeon, TV personality and former candidate for U.S. Senate in Pennsylvania, is Trump's pick to lead the Centers for Medicare & Medicaid Services, which is part of the Department of Health and Human Services (HHS). A date for Oz's confirmation hearing is not yet set.
2. Future of vaccine policy after confusing signals in hearings
As senators voted to confirm Kennedy, a measles outbreak continued in Texas. As Marfa Public Radio reported, nine people have been hospitalized in an outbreak of at least 24 measles cases in Gaines County, which has one of the lowest vaccination rates in the United States. All cases are in people who were unvaccinated, and most are children.
Kennedy is one of the country's most prominent vaccine opponents. During confirmation hearings, he repeatedly claimed he was not anti-vaccine or against the vaccine schedule, and he said he supported certain vaccines, including the one for polio. He would not accept, however, that the link between autism and vaccines has been thoroughly debunked.
Kennedy won confirmation on the strength of his promises to Sen. Bill Cassidy, R-La., a physician and the chair of the Senate's health committee. Those promises included that he would not interfere with current vaccine policy and that Cassidy would have oversight over some of his decisions at HHS.
The committee's former chair, Sen. Patty Murray, D-Wash., said in a news conference this week that those promises were not credible. "Republicans are choosing to pretend like it is in any way believable that RFK Jr. won't use his new power to do exactly the thing he has been trying to do for decades: undermine vaccines," she said.
There is a lot Kennedy could do on vaccines in terms of appointing advisers, directing National Institutes of Health research and changing public health messaging about the importance of vaccines. Public health and medical advocates will be watching closely to see what Kennedy does in this arena.
3. Will HHS get the DOGE treatment?
The Department of Government Efficiency (DOGE), the Elon Musk-led effort to unilaterally dismantle agencies through furloughs, firings and stop-work orders, could well be coming to HHS.
Right now, HHS has a budget of nearly $2 trillion and a staff of 90,000 people. A huge part of that budget is Medicare and Medicaid, the public health programs for seniors and low-income people, respectively. DOGE staffers have been at the Centers for Medicare & Medicaid Services for the past several weeks, CMS officials told NPR.
Other health agencies that are part of HHS include the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Institutes of Health (NIH).
Project 2025, the blueprint from the Heritage Foundation that has so far aligned closely with DOGE's actions, proposes dramatic changes to HHS, including splitting the CDC into two agencies and eliminating Head Start. Kennedy hasn't spoken much about his plans for the agencies, except to say that he would fire 600 NIH researchers and instruct the agency to redirect resources from infectious disease and toward investigating the root causes of chronic diseases.
4. Science information and research in disarray
Already, without congressional cuts or DOGE, actions by the Trump administration have caused tectonic changes to science in America.
Several executive orders about "ideology" caused federal health agencies to delete scores of databases and webpages that included forbidden terms like "gender," although seemingly unrelated websites on tuberculosis and natural disasters went dark as well. A federal judge has since instructed the agencies to restore those pages, but that sudden disappearance of resources — including those used by doctors routinely when treating patients — has alarmed many in public health and medicine. It's especially unclear how research that involves groups that cannot be mentioned, like transgender people, can now proceed.
Biomedical research — long a source of bipartisan support and national pride — has not been spared either. NIH's grants to research institutions have already been targeted for dramatic cuts, another move that is currently paused by a federal judge. Several Republican senators, including Cassidy, Susan Collins of Maine and Katie Britt of Alabama, have spoken out about how damaging this blanket policy could be to universities with large research institutions. Collins wrote in a statement that Kennedy promised her he would "re-examine" the policy when confirmed.
5. How can "Make America Healthy Again" translate to policy
Kennedy spoke in his confirmation hearings about how he understood the health agencies from a unique point of view — as a science outsider who had spent decades filing lawsuits against many of them. He asserts that the agencies have lost their way and that this is reflected in the fact that Americans have poor life expectancy and many chronic diseases.
He hasn't yet laid out how he can use policy and his power overseeing the agencies to "put the health of America back on track." He spoke a lot during the hearings about food programs outside of HHS' jurisdiction, suggesting maybe he will seek to work with the Department of Agriculture to collaborate on programs like the Supplemental Nutrition Assistance Program.
There are powerful industries, like Big Food and Big Pharma, that could push back against some of his goals, as NPR has reported. And some public health researchers question how realistic such an overhaul will be in a Republican-controlled, regulation-unfriendly federal government.
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