Robert F. Kennedy Jr. appears to be on track to be confirmed by the U.S. Senate as Secretary of Health and Human Services, after he won the approval of a committee last week on a party-line vote.
He, and the rest of the Trump administration, have been talking about a number of health care issues from vaccines to gender-affirming care to the future of Medicare and Medicaid.
James Hodge, a professor in Arizona State University’s Sandra Day O’Connor College of Law and the director of the Center for Public Health Law and Policy, joined The Show to discuss what the future in the world of health care could look like.
Full conversation
MARK BRODIE: Let's start broadly. What is most on your radar at this moment?
JAMES HODGE: It is so many different fronts that are hitting us simultaneously, Mark, that's actually kind of hard to answer, but I'll be the first to say: Listen, it's about leadership among some of the major federal agencies responsible for health care, public health and other critical health services.
Nationally, we still don't have those persons completely in place, but what we're seeing from the Trump administration is the chosen leaders, for which the Senate is working to confirm right now, including Robert F. Kennedy Jr. for HHS, will result in very systematic changes at these major federal agencies, and the impacts will affect all Americans.
BRODIE: So let's talk about Robert Kennedy Jr., I mean, and it looks as though his confirmation will be going ahead. So assuming that he does become HHS secretary, what areas you mentioned, a lot of potential changes, what are some of the biggies to you that could sort of have the most widespread impact on people's day to day lives?
HODGE: Among the premier issues you saw senators grill him over in relation to the confirmation hearings was, of course, vaccine policies going forward. He's made promises to senators of how he will actually take on vaccine issues more appropriately, more in line with public health measures. Those promises are ones we will have to see how far we can keep. But let's be clear on one thing, if he is actually put into place leading HHS, it's so much more than vaccines that's going to be at the front and center of our concerns.
This individual did not express or show real significant understanding of even core basic health services done through HHS like Medicare and Medicaid and other specific initiatives that do affect millions of Americans. Some of the ways in which those programs could change are really going to be watched heavily. And then there's the whole factor around misinformation, the types of data that will be allowed or not allowed for the public to access and see on websites, all of which is under HHS purview. Some of those particular concerns, Mark, are at the highlight of our list.
BRODIE: Let me ask you about some of that data, because in some areas of government, you know, researchers and others who use that data have already talked about some of it missing from websites or databases. Are you seeing that already in terms of health care, or, you know, anything coming from, you know, the Centers for Medicare and Medicaid Services or any other sort of federal health care agencies?
HODGE: Yeah, you bet. The amount of information already to date, in the first week since this order came through the Trump administration, that's been pulled from websites at CDC, the Centers for Disease Control and Prevention, Food and Drug Administration agency, FDA. These specific sites have pulled data that matter a lot to researchers, to others working in these specific arenas, public health officials, the sort of purge of data around some really critical topics, including highly vulnerable populations that rely on these data, persons with HIV and others to that nature, has been systematic and just discouraging without doubt.
Now on the flip side, there are real, significant legal challenges that have already been raised to those specific purges of data. There's every opportunity for some of that data to reappear. This is not a permanent fix, but rather the initial reaction to some of what has been offered up for how we will reposition health data to the American public and to others as well. Globally, it's been quite profound. You've rarely seen a level of sort of rescission of data of this nature over many years accumulated gone in a matter of hours.
BRODIE: Well, so you mentioned potential legal challenges. Given what you do for a living, how robust do you think those will be? I mean, how much time do you think federal courts will be spending over the next months and years potentially dealing with issues arising from what this administration does or tries to do in the world of health care?
HODGE: Right, Mark, on the data front for example, lawsuits have already been filed to challenge some of what CDC and FDA have taken down off of their sites. Whether that lawsuit will be successful, of course, is months in the making. Let's be sure one of the only opportunities that we're seeing available to persons, you know, objecting to some of these policies, and particularly how that may impact their personal health status, is through courts.
So we're not seeing Congress step up to any of the plates. We're seeing federal agencies having to succumb to some of what the current administration is basically directing them to do. Courts remain that outlet. Multiple different lawsuits have already stopped in place, multiple different President Trump sort of related initiatives that have had the potential to impact health. We're going to see more of that to come, but it relies on something, Mark, that's really quite pivotal, and that is just how far courts are willing to go to strike down initiatives of this nature.
BRODIE: Especially, you know, talking about things like Medicare and Medicaid that you mentioned earlier, I'm wondering what kind of impact the focus on reducing government spending might have on the way that health care is administered. And maybe, you know, sort of even the legal landscape for how we think about and maybe litigate health care in this country?
HODGE: You know it. Mark, listen, very few Americans want to see the government tinker with or touch much in relation to Medicare. Medicare is a fairly solid bet that it will retain its sort of essence of being a stable program able to pay for those expenses for persons over age 65 or disabled persons who largely access Medicare benefits.
But Medicaid is a whole other story. That's the federal-state program that states like Arizona, through our access program, and every other state, relies on federal dollars to run, but also state dollars to actually pull off. Medicaid is subject to considerable refinements across states, but also at the federal level, you're already seeing congressional proposals to reinstitute things like work requirements for persons who are able to access Medicaid.
In Arizona, this could result in tens of thousands of persons who would lose access to Medicaid if we were implemented on a federal basis as a requirement of the program. That falls in the Centers for Medicare and Medicaid Services, CMS, that's going to be potentially under the direction of … Dr. Oz, that we have no clear sense of how he would run that program, and of course, subject ultimately, to a potential secretary, Robert Kennedy Jr., who couldn't even accurately explain the difference between those two programs during a Senate confirmation proceedings. If you're worried about what those future benefits of Medicaid might be, there's good cause for concern without doubt.
BRODIE: It sounds like, I mean, just so much of what we think of now and what we have known as how this country's health care system has operated could be really different, even just, you know, within a year or two.
HODGE: Within months even, Mark. You know, I've described it before as whether or not the status quo of health care being for sale in the United States will continue under a Trump administration. And what I mean by that is, you know, we've always had great health care available in the United States if you can afford it, or you can buy it, but we rely systematically, for millions of Americans on federal and state funded programs that make that option available, including through the Affordable Care Act, which is clearly still on the chopping block as far as this administration.
When you tinker with those programs, when you make even slight adjustments to them, when you remove essential health benefits that Medicaid will cover or that you don't allow drug pricing to go forward through Medicare to lower the price of those drugs for seniors, you affect millions of persons lives. I do predict those effects will start to be kind of realized in the next several months and throughout the entirety of the current administration.
