Trump identifies nominees for top healthcare positions

The Buzz This Week 

In the weeks following the election, President-elect Donald Trump has announced many of the nominations for cabinet members and other positions in his upcoming administration. Last month, Trump nominated candidates for the following positions:

• Secretary of the Department of Health and Human Services (HHS): Robert F. Kennedy, Jr. An environmental lawyer by training and a former presidential candidate, RFK Jr. has been a vocal vaccine skeptic and proponent of the “Make America Healthy Again” agenda, including an overhaul of the Food and Drug Administration (FDA). He’s also expressed concerns about the chronic disease crisis in America, criticized inaction of public health organizations, pledged to end “corporate corruption” at federal health and science agencies, and said he would purge staff at the FDA and National Institutes of Health (NIH).
• Director of the Centers for Disease Control and Prevention (CDC): Dave Weldon, MD. A former Florida Congressional Representative and physician, Weldon introduced legislation to move oversight of vaccine safety from the CDC to an independent agency within HHS. He also pushed for and helped to pass an amendment that HHS cannot discriminate in funding decisions against organizations that do not provide abortions.  
• Director of the NIH: Jay Bhattacharya, MD, PhD. A Stanford University professor, health researcher, and health economist, Bhattacharya was one of three authors of “The Great Barrington Declaration.” Released in October 2020, the document challenged lockdowns and mask mandates and suggested herd immunity could be reached prior to a publicly available vaccine by protecting the most vulnerable populations while allowing low-risk individuals to get infected. The strategy was condemned by many public health experts for being unscientific and irresponsible.
• Commissioner of the Food and Drug Administration (FDA): Martin Makary, MD. A pancreatic surgeon at Johns Hopkins and an ally of RFK Jr., Makary has supported the “Make America Healthy Again” movement and criticized the FDA’s management practices. He supported early lockdowns and universal masking during the pandemic, but he was also critical of vaccine mandates and the CDC under the Biden Administration. He has criticized and researched the flaws of the US healthcare system, including deaths due to medical errors and drug maker exploitation of the FDA’s rare disease drug program.
• Administrator of the Centers for Medicare & Medicaid Services (CMS): Mehmet Oz, MD. A cardiothoracic surgeon by training, Oz became a television personality and served as a professor of surgery at Columbia University. During the pandemic, Oz served as an informal advisor to then President Trump. Previous comments from Oz indicate he would support making Medicare Advantage the default option for Medicare enrollees and adding work requirements for Medicaid, limiting eligibility.
• Surgeon General: Janette Nesheiwat, MD. A family and emergency medicine doctor and Fox News medical contributor, Nesheiwat is also the medical director for CityMD. Contrary to the other nominees, Nesheiwat has advocated for getting vaccinated against COVID-19 and other infectious diseases.

Additional healthcare nominations made last month include Jim O’Neill for the HHS deputy secretary, who, if confirmed, would work under RFK Jr. to oversee the day-to-day operations of the department’s sub-agencies.  

Why It Matters

All healthcare nominations require Senate confirmation, including for the first time, the CDC director. However, Trump has expressed interest in bypassing Senate confirmation through recess appointments. Each of these nominees, if appointed, could produce significant changes in healthcare policy and regulations as well as an overhaul of their respective agencies. 

While it remains unclear what specific policy changes will be enacted, many healthcare experts have raised concerns about these nominees. The most notable of these include overhaul of government agencies (one possible result is a loss of funding for scientific research), vaccine skepticism (and the related public health consequences), and cuts to government insurance programs (which could contribute to increased uninsured rates and rising consumer costs). Ge Bai, PhD, a professor of health policy at Johns Hopkins University, notes that hospital CEOs should “be more concerned by this administration” with “skeptical people being appointed to health agencies.”

The nominations could “represent a complete overhaul of the vision and priorities of key agencies for health care and public health.” For instance, RFK Jr. has expressed interest in terminating 600 NIH employees and eliminating entire departments at the FDA.  

Some of the nominees have been especially vocal against the Biden Administration agencies’ pandemic policies. Prior to the pandemic, support for the NIH was bipartisan, resulting in annual budget increases for the agency. But since the pandemic, support from Republicans has wavered. This may be exacerbated as the new leadership transitions. Budget cuts and restructuring could undermine scientific and economic benefits generated by agency-funded research. This includes “gain-of-function” research, which studies how pathogens become more dangerous, a field that became especially politically charged during the pandemic.

Kennedy’s vaccine skepticism combined with a Weldon CDC appointment could bolster an anti-vaccine agenda and stand to have serious repercussions in a time when infectious disease rates are already rising. Kennedy and other nominees’ vocal criticism of vaccines could lead to a shift in vaccine regulation and oversight and a continued unfounded degradation of public opinion leading to more frequent and severe preventable infectious disease outbreaks.

Many hospitals and health systems are specifically concerned with the impact of cuts to the Affordable Care Act (ACA) exchanges and Medicaid, which could make millions of Americans unable to afford or ineligible to receive coverage. While reducing funding for Medicaid or not extending ACA tax credits would require congressional action, Trump’s healthcare nominees will influence final rule determinations for eligibility and administration of the programs. They will also have a platform to share their opinions. Several of the nominees have been critical of Medicaid and the ACA exchanges, including Oz, who has spoken in favor of adding Medicaid work requirements, and Trump’s Attorney General nominee Pam Bondi. Though not in a direct healthcare role, she led a failed effort to overturn the ACA in 2012.  

The confirmation hearings will begin in January to determine official appointments of these positions. But until then, much uncertainty exists. It is unclear whether all nominees will have the necessary Senate support. Even if all nominees get Senate confirmation, they may not actually prioritize all of the stated initiatives. As hearings unfold and the new administration begins work, continued monitoring will be necessary to understand which issues will gain traction.   

RELATED LINKS

KFF Health News:
9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding

NPR:
Trump picks Nesheiwat for surgeon general, Makary, Weldon for FDA, CDC  

PBS:
Meet the health care critics Trump picked to lead top U.S. health agencies under RFK Jr.

The Hill:
Donald Trump's health agency nominations signal major shift in focus

Wall Street Journal:
Why Republican Governance and RFK Jr. Are Spooking Hospitals   

Editorial advisor: Roger Ray, MD, Chief Physician Executive.