Robert F. Kennedy Jr., President Trump’s nominee for health secretary, has amassed a significant national following with his suspicions of vaccines, weight-loss drugs and the American diet.
But Mr. Kennedy has said little about some of the issues at the core of the department he seeks to lead, such as the health insurance programs that make up roughly a quarter of the federal budget.
Those programs — Medicare, Medicaid, the Affordable Care Act marketplaces and the Children’s Health Insurance Program — cover more than 160 million Americans, including more than 100 million older and low-income people enrolled in Medicaid and Medicare.
“There is a blank slate,” said Edwin Park, a Medicaid expert at Georgetown University.
Mr. Kennedy’s confirmation hearings, which begin Wednesday in the Senate Finance Committee, and continue Thursday in the Senate health committee, offer lawmakers the chance to push him on the vast array of responsibilities that fall to the nation’s health secretary.
Here are five topics likely to come up in the first hearing Wednesday.
Vaccines
Mr. Kennedy has long sown doubts about the safety of vaccines and the ingredients in them, suggesting that vaccines have been linked to significant injuries and rising rates of autism in children. Scientists have repeatedly discredited that theory. He has said that he would not seek to remove vaccines from the market, but would conduct more federal reviews of them.
As health secretary, Mr. Kennedy could wield significant influence over vaccine programs. He would have authority over an important Centers for Disease Control and Prevention panel that reviews shots before they are distributed. He could lobby the Food and Drug Administration to pause or revoke approvals of vaccines, or stop a vaccine under review from being authorized.
Mr. Kennedy would also have the authority to limit contracts with vaccine makers for more than half the nation’s children under an $8 billion program.
Obamacare
Enrollment in the Affordable Care Act’s health insurance marketplaces exploded during the Biden administration, reaching a record of more than 24 million people this year, in large part because of major federal subsidies that lowered premiums across income groups. But those subsidies are set to expire this year without congressional action to extend them. Mr. Kennedy will most likely be asked about his support for ending or continuing the credits.
He will also probably be pressed on whether he has a broader Obamacare agenda, and whether it would recycle parts of Mr. Trump’s strategy in his first term, when he sought to repeal and invalidate the 2010 health law. The Department of Health and Human Services took a number of steps under Mr. Trump to undermine the marketplaces, including by shortening enrollment periods and encouraging the use of short-term plans that skirt Obamacare regulations.
Chronic Disease
Mr. Kennedy has attracted an enormous following for his attention to what he calls an “epidemic” of chronic disease afflicting America’s children. He has blamed federal food policy, environmental toxins and fluoridated water. Mr. Kennedy may be asked about his call to remove fluoride from American water systems, something he claimed Mr. Trump would do right after taking office.
Some of his views on chronic disease prevention and the political power of the pharmaceutical industry have bipartisan appeal, perhaps giving Mr. Kennedy an opening with progressive members of the committees he testifies in front of this week, such as Senator Bernie Sanders, a Vermont independent.
Medicaid and Medicare
Democrats repeatedly raised the prospect of cuts to Medicaid, the joint federal-state health insurance program that covers more than 70 million people, in a confirmation hearing last week for Russell T. Vought, Mr. Trump’s nominee to lead the White House budget office. Mr. Kennedy will also probably be asked about his support for the program.
Republicans have eyed major cuts to Medicaid to help finance a tax and immigration bill. But the program has become increasingly important in Republican-led states that have expanded it under the Affordable Care Act. Cuts could hurt many of Mr. Trump’s supporters.
Mr. Kennedy may also be asked about his views on Medicare, including the growth of private plans in the program, the way the program’s payments for health services are decided and whether the health secretary should continue negotiating drug prices for the program’s recipients, an initiative advanced by the Biden administration.
Food policy
In his appraisal of what he calls a broken food system, Mr. Kennedy has protested additives, seed oils and government crackdowns on raw milk. As health secretary, he would oversee the F.D.A., which regulates about 80 percent of the nation’s food supply.
Mr. Kennedy’s criticism of corporate America’s influence on food and agriculture policy, including the federal crop subsidies that ultimately offer a boon for manufacturers of products he considers poison, could draw criticism from lawmakers on the committees who represent heavily rural states, such as Senator Charles E. Grassley, Republican of Iowa. Mr. Grassley’s state is a major producer of corn, which is processed into corn syrup, which Mr. Kennedy has blamed in part for the obesity epidemic.
“I may have to spend a lot of time educating him about agriculture,” Mr. Grassley said of Mr. Kennedy after Mr. Trump picked him to lead the Department of Health and Human Services. “And I’m willing to do that.”