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As President Donald Trump has implemented his agenda with a flurry of executive orders, Congress has been holding the first hearings for some of his agency head nominees, including Robert F. Kennedy (RFK), Jr.

As a nominee for the role of Health and Human Services (HHS) Secretary, Kennedy faced blistering questions from lawmakers over the span of two days on major public health issues like vaccines, abortion, GLP-1s and Medicare and Medicaid.

If Kennedy is confirmed as HHS Secretary, he could have the power to be “extraordinarily influential” on healthcare, according to Richard Frank, senior fellow and director of the Brookings Center on Health Policy.

With the HHS spanning 13 agencies – including the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) – and overseeing 80,000 employees, Kennedy would have jurisdiction over food and drug regulation, research funding, vaccine policy, public health guidelines and a number of other healthcare and pharma issues.

“There are a lot of ways that, as the boss, you can affect decision-making that happens below you – even if these are quasi-independent agencies,” Frank said.

Here are some of the key issues Kennedy touched on during the hearings that offer a glimpse into how he might run HHS.

Drug pricing

During the second day of hearings, Kennedy confirmed for the first time that he would support Medicare’s drug price negotiating power passed into law in 2022.

“I’ve spoken to President Trump about negotiations,” he said. “He’s absolutely committed to negotiating lower drug prices.”

The Trump administration had separately made its first statement on the future of the Medicare negotiation program on Wednesday, noting that lowering the cost of drugs was a “top priority.”

The administration indicated it would be following through on the second round of Medicare negotiations with the 15 drugs chosen by the Biden administration earlier in January. But it emphasized it would be working with “stakeholders” to improve the program in order to continue fostering innovation.

Frank noted the statement was “reasonably ambiguous,” leaning slightly toward supporting the negotiations as they were currently written, but not necessarily offering full support either. He added it was unclear how drug pricing reform would play out under an RFK-led HHS, given Trump’s high level of engagement with industry.

Vaccine about-face

Kennedy is largely considered a controversial pick for HHS Secretary due to his views on vaccines. For decades, he positioned himself as an anti-vaccine advocate, including promoting the debunked notion that vaccines lead to autism. He also led a nonprofit dubbed Children’s Health Defense, which supports anti-vaccine laws and regulations and has campaigned to foster vaccine hesitancy in the U.S.

Both Democratic and Republican lawmakers grilled Kennedy on vaccine policy. Sen. Bill Cassidy (R-La.), a Republican who chairs the Senate health committee, expressed skepticism about Kennedy’s vaccine stance – and asked the nominee to clarify whether he believed vaccines cause autism.

Kennedy waffled on answering the question clearly, and instead asked lawmakers for the studies showing that vaccines don’t cause autism.

At the same time, throughout the hearings, Kennedy emphasized that he wasn’t anti-vaccine, and instead he was “pro-safety.” He pointed out that all of his children were vaccinated; that he supports the measles and polio vaccines; and that he would “do nothing as HHS Secretary that makes it difficult or discourages people from taking either of those vaccines.”

“I worked for years to raise awareness about the mercury and toxic chemicals in fish, and nobody called me anti-fish,” he said. “I believe that vaccines play a critical role in healthcare.”

Several times, lawmakers raised concerns that despite Kennedy’s claims of supporting vaccines at the hearings, they couldn’t trust his words given his track record – signaling he may not garner enough support for confirmation.

“The question is, how candid was he being when he responded to those questions?” Frank said. “Senators are going to have to make a judgment call about how that balance plays out.”

Concerns of a lack of knowledge around Medicare and Medicaid

Lawmakers also grilled Kennedy on his understanding of Medicare and Medicaid, which revealed gaps in his knowledge of the technical underpinnings of the federal programs.

At one point, Sen. Maggie Hassan (D-NH) asked Kennedy to explain what Medicare Part A, B and C were. Kennedy appeared to falter in answering the questions accurately, and Hassan abruptly corrected him each time.

“Mr. Kennedy, you want us to confirm you to be in charge of Medicare, but it appears you don’t know the basics of this program,” she said.

Kennedy made several other inaccurate statements about Medicaid, the national health insurance program for low-income Americans, including that it’s entirely funded by the federal government when in reality it’s funded at both the state and federal level. He also blundered his understanding of Medicaid premiums, arguing that they were too pricey when most Medicaid enrollees don’t pay premiums.

“He doesn’t have much of a handle on Medicaid at all,” Frank pointed out. “His comments, for example, that premiums are killing Medicaid enrollees when essentially none of them pay premiums was an indicator of just how little understanding he has of the actual workings of the program.”

When asked about Republican plans to cut Medicaid or Medicaid reform in general, Kennedy did not provide a clear plan.

“Trump has given me the charge of improving quality of care and lowering the price of care for all Americans,” he said. “There’s many things we can do. The ultimate outcome I think is to increase transparency, increase accountability and transition to a value-based system rather than a fee-based system.”

GLP-1s

The hearings also spotlighted Kennedy’s stance on GLP-1 drugs like Ozempic, Wegovy and Zepbound.

Toward the end of the Biden administration, the Centers for Medicare and Medicaid Services (CMS) announced it supported Medicare and Medicaid coverage of the drugs for obesity. Currently, they’re only covered by the federal programs for diabetes.

Kennedy has previously expressed skepticism about GLP-1 drugs and Big Pharma in general. During the hearings, he noted GLP-1s were “miracle” drugs but that they shouldn’t be first-line treatments for obesity. He added that he believed prescribing GLP-1s for all patients with obesity would be too pricey for the federal government to cover.

How likely is Kennedy’s confirmation?

In order to be confirmed as HHS Secretary, Kennedy would need 51 votes in the Senate. Republicans currently have a majority with 53 seats, but it’s possible Kennedy might lose several conservative votes due to his controversial stance on vaccines.

“It’s on a razor’s edge,” noted Philip Galewitz, a senior correspondent at Kaiser Family Foundation during a post-hearing webinar. “He clearly looks like he doesn’t have much support among Democrats, and he can only afford to lose [three] Republican votes.”

Sen. Cassidy will be a key vote, experts said. While Cassidy is a conservative Republican, he’s also a gastroenterologist who’s pro-vaccine – and he served as one of the biggest critics of Kennedy’s vaccine contradictions during the hearings.

“You have a bunch of people who take public health pretty seriously on both sides of the aisle in the Senate, and the ambiguities there might be very troubling for them,” Frank said.

The Senate vote on Kennedy’s confirmation isn’t set yet, but might occur as early as this week.

Frank, who previously worked for former HHS Secretaries Kathleen Sebelius and Sylvia Burwell under the Obama administration, noted that Kennedy’s potential plans as head of the department will be subject to the curveballs and crises inherent to public health. He pointed to the COVID-19 pandemic and the Ebola outbreak as a few examples.

“You can’t anticipate what’s going to hit you when you’re [HHS] Secretary and you’re going to get distracted from your best-laid plans by things like flu, COVID, the next epidemic,” he explained. “[If you’ve] never led a massive bureaucracy where people’s lives are on the line, it’s hard to be prepared for that.”