‘Primary care is the answer’ to Make America Healthy Again

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Primary care could and should be at the center of any plan to Make America Healthy Again, said public health experts who shared their reactions to public testimony of the nation’s health leader.

Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, met with congressional leaders on May 14 to describe that department’s proposed fiscal year 2026 budget. The spending plan totals $93.8 billion, or 26% less than in 2025.

In the morning, Kennedy spent more than two hours testifying before the House Appropriations Committee. Afterward, public health advocates from the Safe States Alliance and the American Public Health Association (APHA) met online with news outlets to discuss their reactions to Kennedy’s statements.

While they have years of experience working in public health, they shared their thoughts about the importance of primary care in the U.S. health care system and how it relates to their own work.

Medicaid cuts

Regarding primary care, the proposed HHS budget cuts little from the U.S. Centers for Medicare & Medicaid Services, said APHA Executive Director Georges Benjamin, MD, MACP.

“But they've done several interesting things,” said Benjamin, who has been a vocal critic of Kennedy. “Number one, they're dramatically pulling back on anything that impacts the workforce.”

An example is funding for preventive medicine residencies, which are funded differently than other medical residencies, Benjamin said. The budget will pull back on everything that the HRSA is doing, and will cut training programs on diversity, equity and inclusion, which helps ensure a diverse workforce, he said.

“And then when they cut the Medicaid budget, they will dramatically cut primary care in the country,” Benjamin said. If jurisdictions freeze physician payment, people will lose access to primary care. Rural hospitals often are linked to communities by serving a primary care function, Benjamin said.

Loss of access

The budget proposal does not make significant cuts to the Federally Qualified Health Center (FQHC) program, said Raynard Washington, PhD, health director of Mecklenburg County, around Charlotte, North Carolina. In that community, his agency supports a network of other providers operating free and low-cost clinics that are not FQHCs, and community health workers help connect people to primary care.

“Also, I will note that relative to Medicaid and the impact that it may have relative to primary care, is that a lot of what we do in public health is because people are not connected to a primary care doctor, too few people in the country have primary care as a routine part of their life,” Washington said. “And so we’re working to try to get more people into primary care so they don’t have to come to safety net clinics and get STI testing, for example.”

Without access to primary care, the result will be people being less healthy, he said.

‘Primary care is the answer’

“We've known for decades that countries that have robust primary care systems not only have better outcomes, but they have lower cost, and we have never ever embraced that in this country,” said Marissa Levine, MD, MPH, professor of public health practice at the University of South Florida College of Public Health and a former director of the Virginia Department of Health.

“I have not heard anything or seen anything that makes me think that we're going in that direction here,” she said. “But as you've heard from the others, cuts in Medicaid with absolutely make sure that we don't go that route,” she said.

Washington agreed.

“As it relates to chronic disease and making America healthy relative to chronic diseases, primary care is the answer. It is the answer for early diagnosis, it's the answer for management of chronic disease, it’s the answer for prevention, and so we really should be going further in terms of our investments in primary care, not just keeping them stable,” Washington said. “Our FQHCs are already struggling to keep up with demand, and so I think it's important that we add more investment versus even staying stable because Primary Care it will help not just the residents primary care, but also will help us in public health as a whole.”

What we do, where we live

In the discussion, Levine cited “Community Health and Economic Prosperity — Engaging Businesses as Stewards and Stakeholders — A Report of the Surgeon General,” published in January 2021 during the president’s first term. It is a 292-page report analyzing seven “vital conditions” that shape health, wealth and well-being: basic needs such as clean air, water, nutritious food and a safe environment; meaningful work and wealth; humane housing; reliable transportation; a thriving natural world; life-long learning; a sense of belonging and “civic muscle.”

“What I’m hearing from this administration, which seems to be supported by the Republican majority, is the idea that health is just the result of what we do to ourselves or what we don't do,” Levine said. “And we've learned over decades now that it's much more than that, that the whole idea of well-being is impacted, not just by our behaviors, but that our behaviors themselves are impacted by where we live, work, recreate, et cetera, and that was even in the report that I mentioned from the Surgeon General under the first Trump Administration.

“So, a primary care is a critical part of that, but there's really nothing in any of what we're hearing that focuses on creating the conditions that make it easier for people to be healthy, and that’s what we really need right now,” she said.

The nation does not need to improve health care by having people looking up information on Google and trying to figure out health solutions, Levine said. Instead, the United States needs to make it easy for options to improve their health, such as food, activities, or mental health resources, she said.

“We can do that. I actually see the opportunity because we have the knowledge, the skill, but what we don't have is the political will,” Levine said. “The politics have taken us in a different direction, and I think it's really important to make it clear that health is much more than what we do to and for ourselves and that it's really about an interdependence, which is exactly what public health is all about.”

Government responsibilities

Meanwhile, the budget shifts health care responsibility from the federal government to states, but without a lifeline, said Sharon Gilmartin, MPH, executive director of the Safe States Alliance. Local health departments cannot replicate the response coordination, research capabilities and expertise of the federal government, she said.

“It's not the job of private philanthropy to make up for what our federal government should be doing to keep our Americans healthy,” Gilmartin said.

Three ‘big lies’ and a question

Regarding public health, the leaders described a range of issues and how potential changes at HHS will affect them.

Benjamin, who has called for Kennedy to resign, said there were “three big lies” and a question about the HHS budget.

• The budget cuts will keep public health infrastructure functionality intact and not hurt anything. “That’s clearly a lie,” Benjamin said, because it will take apart public health infrastructure that was underfunded to begin with.
• Cutting $700 billion from Medicaid is not only for waste, fraud and abuse. The Congressional Budget Office forecasted at least 13 million people will lose health coverage due to that cut.
• Cuts to the federal health agencies, totaling $6 billion, will be made with a $500 million budget in the new Administration for a Healthy America. “The math doesn’t add up,” Benjamin said.

For the question, Benjamin cited Kennedy’s discussion about a possible $94 billion discretionary fund. That is not in the budget proposal and could be introduced later, but no member of Congress will give a presidential cabinet member $94 billion to do whatever they wish, and the representatives and senators should ask Kennedy about that, Benjamin said.