Medicaid, Medicare, and the Challenges of Healthcare Leadership: A Look at Robert F. Kennedy Jr.’s Confirmation Hearing

The Hearing and the HHS Secretary Role

On a day that could shape the future of American healthcare, Robert F. Kennedy Jr. faced the Senate Finance Committee for his confirmation hearing to become Secretary of the Department of Health and Human Services (HHS). The role is monumental, overseeing critical agencies like the FDA, CDC, and National Institutes of Health, as well as the Centers for Medicare and Medicaid Services. Together, Medicare and Medicaid serve over 150 million Americans, making them cornerstone programs of the U.S. healthcare system. Yet, during the hearing, Kennedy’s lack of understanding of these programs raised significant concerns about his readiness to lead.

Kennedy’s performance was scrutinized on multiple fronts, from his anti-vaccine views to his stance on abortion and financial conflicts. However, his apparent confusion about Medicare and Medicaid stood out as particularly troubling. When asked about the differences between the two programs, Kennedy struggled, at one point incorrectly stating that Medicaid enrollees face high premiums and deductibles—a deeply inaccurate claim, as federal law prohibits such costs for low-income participants. His mixing up of the two programs was not just a momentary lapse; it highlighted a potential inability to grasp the intricacies of healthcare policy.

Medicaid and Medicare: Understanding the Basics

For most Americans, Medicaid and Medicare are names that sound similar but serve distinctly different purposes. Medicare, a federal program, primarily covers older adults and people with disabilities, while Medicaid provides health insurance to low-income individuals and families. Together, these programs form the backbone of the U.S. healthcare safety net, touching the lives of nearly half the country.

Kennedy’s misunderstanding of these programs is alarming, given his potential role in overseeing them. He criticized Medicaid, claiming that “our people are getting sicker every single year” and arguing that its expansion to higher-income individuals harms the poorest Americans. However, many of his criticisms were based on misconceptions. For example, he lamented the program’s high premiums and deductibles, which, in reality, do not apply to most Medicaid enrollees. His confusion was particularly striking given that, if confirmed, he would be tasked with managing these programs and potentially overseeing significant changes to them.

Policy Ambiguity and the Future of Healthcare

Kennedy’s lack of clarity extended beyond his grasp of Medicaid and Medicare. When pressed on how he would address challenges like coordinating care for individuals eligible for both programs—a known sticking point in the healthcare system—he suggested consolidating and integrating the programs but admitted he had no specific plan for how to achieve this. His vagueness on reforming Medicaid was equally concerning, with his only concrete proposal being to “increase transparency” and “increase accountability.” When asked to elaborate, he offered no detailed strategy.

Kennedy’s ambiguity was particularly problematic given the high stakes of his potential leadership. President Trump has pledged to preserve Medicare, but Medicaid’s future remains uncertain. Health-policy experts warn that Medicaid could face spending cuts under the Trump administration, as evidenced by the recent freeze on federal grants and loans for Medicaid reimbursement. If Kennedy were to oversee such changes, his lack of understanding could lead to decisions that harm vulnerable populations.

Controversial Views and Their Implications

Kennedy’s confirmation hearing also highlighted his controversial views on vaccines and public health. He has long been known for his anti-vaccine stance, and during the hearing, he doubled down on debunked claims. For instance, he reiterated his belief that the measles vaccine caused the deaths of two children in Samoa in 2018—despite evidence showing that the tragedy resulted from improper vaccine preparation by healthcare workers, not the vaccine itself. He also downplayed the risks of COVID-19 for young children, claiming they face “basically zero risk,” a statement contradicted by scientific evidence.

These falsehoods are not just a matter of opinion; they have real-world consequences. If Kennedy were to lead HHS, his views could influence policy decisions, undermining public trust in vaccines and threatening the health of millions. His inability to distinguish between fact and fiction is particularly concerning in the context of his potential role in addressing future public health crises.

The Broader Implications of Leadership Failures

The hearing revealed a deeper issue: Kennedy’s apparent lack of preparation and basic competency in understanding the programs he would oversee. Jacinda Abdul-Mutakabbir, a clinical pharmacist at UC San Diego, summed up the stakes: “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 Kennedy’s leadership result in changes to Medicaid or Medicare, the consequences could be profound, exacerbating existing health disparities and leaving vulnerable populations without adequate care.

Abdul-Mutakabbir also emphasized the importance of expertise in increasing transparency, a goal Kennedy referenced during the hearing. “You can’t increase transparency on something you don’t have clarity on,” she said. Kennedy’s performance suggested that he lacks the necessary expertise to lead HHS effectively, raising questions about whether he is prepared to navigate the complexities of the role.

A Call for Accountability and Competency

In the end, Kennedy’s confirmation hearing left more questions than answers. His struggle to understand Medicaid and Medicare, combined with his controversial views on vaccines and public health, cast doubt on his ability to lead HHS. The secretary of HHS is not just an administrator; they are a steward of the nation’s health, responsible for ensuring that all Americans have access to quality, affordable care.

For those who relying on Medicaid and Medicare, as well as for healthcare providers and advocates, Kennedy’s lack of preparation and basic understanding of these programs is deeply unsettling. His confirmation would place the health and wellbeing of millions in the hands of someone who appears unprepared for the challenges of the job. As the Senate considers his nomination, they must weigh not only his views but also his ability to lead—one of the most critical departments in the federal government.

The stakes could not be higher. America’s healthcare system is at a crossroads, with millions of lives depending on the decisions made by its leaders. Kennedy’s hearing was a reminder that leadership matters—and that understanding the programs one is tasked to oversee is not optional, but essential.