RFK: U.S. ‘at a generational turning point’ to change health care for the better

After 15 months of progress, the administration intends to continue its efforts to Make America Healthy Again, said Health and Human Services Secretary Robert F. Kennedy, Jr.

However, members of Congress split over the best practices and policies to do that.

On April 16, Kennedy appeared before the House Ways & Means Committee to discuss HHS’ priorities. Those generally are more of the same, he said during his five-minute opening statement.

“We stand at a generational turning point: Our children are the sickest generation in modern history, and decades of failed policy captured agencies and profit driven systems have caused it,” Kennedy said. “Parents across the country demanded change, and we are delivering it. We are ending the era of federal policies that fueled the chronic disease epidemic and replacing them with policies that put the health of Americans first.”

Kennedy said the administration had already achieved significant results in its first 15 months.

HHS had negotiated most favored nation drug pricing agreements with 16 major pharmaceutical companies, a policy intended to ensure Americans pay no more for medications than patients in other wealthy nations, Kennedy said. The department had also pushed hospital price transparency requirements, convened health insurance executives to reform prior authorization — the process by which insurers require approval before covering certain treatments — and worked to crack down on waste, fraud and abuse, he said.

On food and nutrition, Kennedy said HHS and the U.S. Department of Agriculture had issued new dietary guidelines emphasizing whole foods, that more than 50 medical schools had committed to expanding nutrition education from an average of two hours to 40 hours, and that more than 40% of the food industry had committed to phasing out petroleum-based artificial dyes. He said the Food and Drug Administration had also approved six natural food colorings derived from fruits and vegetables.

Kennedy echoed Smith's emphasis on rural health care, calling the $50 billion Rural Health Transformation fund the largest federal investment in rural health in the nation's history and noting that HHS had committed more than $135 million this month to expand rural medical residency programs and nutrition services. He cited research indicating that physicians who train in rural communities are more likely to practice there.

"The data is clear," Kennedy said. "Physicians train in rural communities, they're more likely to practice there."

Kennedy framed opposition to the administration's health agenda as coming from entrenched interests and institutions that "put profits ahead of the American people," invoking a line from his uncle, President John F. Kennedy, about change having enemies.

"We can reverse the chronic disease epidemic, improve public health and lower costs," Kennedy said. "I stand ready to work with this committee and Congress to seize this opportunity."

Site-neutral payment on the agenda

The hearing lasted almost three hours, with Kennedy taking questions or listening to statements from at least 30 lawmakers. Discussion was wide-ranging across health care and generally involved the business conditions that affect physicians. But there was little direct talk about the details of operating a physician’s practice.

America’s health care system is the best and the worst. The best physicians and other clinicians have the best technology and best facilities, but the worst, most inefficient system relative to the rest of the world, said Rep. Jodey Arrington (R-Texas).

Transparency, choice and competition deliver the best values for taxpayers, but the nation has a distorted incentives that create “sort of monopoly dynamics,” Arrington said. He cited an example of drug patents, and another example.

“One simple one for me is this disparity between what we pay hospitals and physician groups for the same outpatient service, and the effects of that are not just higher premiums on seniors in Medicare, higher costs for all of us as taxpayers, but there's a giant sucking sound of independent physician groups and docs into hospital systems, leaving us with less choice,” Arrington said. He asked Kennedy about potential solutions for anticompetitive behaviors.

“Ten years or 15 years ago, 80% of the doctors in our country were independent and 20% were corporate. Today, 20% are independent, 80% are corporate, and the number that are independent are dropping precipitously, because of the economic forces that are result of these perverse incentives,” Kennedy said. “Site neutrality, which we're fixing, is key to that,” along with reforms for PBMs and other elements of health care.

Kennedy touted the $50 billion Rural Health Transformation Program as a way to help rural hospitals, including in Iowa, home state of Rep. Randy Feenstra (R-Iowa).

“Is there anything that we can do to try to keep these specialty care doctors and even family docs in rural America? I mean, it just seems like they're all gravitating to the urban centers and we're having a hard time recruiting family doctors, oncologists, OBGYN,” Feenstra said.

“We've just finally finalized and promulgated the site neutrality rule, which should help,” Kennedy said. He also suggested reforming Medicare’s wage index, though he did not offer details and said that change needs to come from Congress.

Next directions in health care

No one argued against good health care, healthy living and eating habits, or crackdowns on fraud. Kennedy largely earned praise from Republican members while Democrats blasted various points of Kennedy’s emphasis and HHS operations, along with President Donald J.Trump at times pardoning people known to be involved in multimillion-dollar health care fraud schemes.

Rep. Greg Murphy, MD (R-North Carolina), a urologist and surgeon, slammed Anthony Fauci, MD, for his actions that “destroyed the confidence of the American public in the health care system” in the COVID-19 pandemic, and former HHS Secretary Xavier Becerra for his actions around up to 20 million people entering the United States illegally.

Murphy railed against PBMs as a major driver behind skyrocketing health care costs in the country. He also described seeing an 8-year-old patient that weighed 262 pounds.

“This is what we're dealing with, this is the obesity epidemic,” Murphy said. “And it is sad that the number one drug that is selling now in the country are weight loss drugs. This is endemic. This speaks to the terrible, terrible tragedy that has become the American food industry. So thank you for highlighting that.”

On hospice fraud and hot tubs

Some of the representatives also had posters to illustrate their points.

Rep. Beth Van Duyne (R-Texas) showed a picture of a building in Van Nuys, California, that was the address for more than 100 different licenses for hospice services. Kennedy said perpetrators of fraud were “just stealing money from us,” and Van Duyne called the situation ridiculous, thanking Kennedy for the administration’s crackdown on fraud.

Rep. Linda Sanchez (D-California) tore into Kennedy for stopping or denigrating public health messaging around vaccines for measles, flu and other ailments. In a testy exchange, Kennedy said she had misinformation, but Sanchez said he was making terrible decisions that affected real lives of children, and correlated with dramatic increases in communicable diseases. She also had poster-sized photo of Kennedy.

“One thing that I find incredible is that you suspended this pro-vaccine messaging campaign, but somehow you're spending taxpayer dollars to drink milk shirtless in a hot tub with Kid Rock, and somehow you think that's a better public health message than informing the public about the importance of vaccines? Really?” Sanchez said. The image apparently was from a workout video Kennedy published earlier this year with the musician. Committee Chair Rep. Jason Smith (R-Missouri) banged the gavel to stop the dialogue, saying Sanchez exceeded her four-minute time limit for discussion.

Realigning financial incentives

Smith opened the hearing with pointed criticism of misaligned financial incentives in the U.S. health system, arguing that reimbursement structures reward treating illness rather than preventing it.

“Our health system is full of misaligned incentives, the most glaring being that reimbursement is concentrated to patients who are already sick and does too little to help Americans stay healthy,” Smith said.

Smith cited a field hearing his committee held in Florida earlier in the week, where he said local physicians testified about efforts to refocus patient care on nutrition, exercise, wellness and preventive medicine. He called the hearing a signal that policymakers are beginning to take seriously the question of how to realign financial incentives in health care — a priority he linked directly to Kennedy's Make America Healthy Again initiative.

Smith also took aim at consolidation in the health care industry, with large corporations padding profits at the expense of patients and working-class Americans. U.S. health care is hurting under vertical integration with large corporations owning insurance plans, pharmacies, medical practices and pharmacy benefit managers (PBMs) simultaneously.

"When each insurer owns pharmacies, medical providers and PBM middlemen, it would not surprise you to know they did not have good answers," Smith said, referring to recent Ways and Means hearings at which major health insurance executives were questioned about their business practices. Smith added that large hospital systems would face similar scrutiny in upcoming hearings.

Smith emphasized the stakes for rural communities, noting that roughly 60 million rural Americans face rates of chronic disease significantly above the national average and mortality rates 43% higher than their urban counterparts. He praised the administration's $50 billion Rural Health Transformation Program, enacted as part of Republican tax legislation, saying communities in Missouri were already benefiting from the first distribution of funds.

"Rural communities in my home state of Missouri are thrilled to have this program to protect access to care and expand the quality of services offered to patients," he said, urging Kennedy and HHS to work with Congress on ongoing stewardship of the funds.

Smith also cited what he described as widespread fraud in federal health programs, referencing an alleged $3.5 billion Medicare hospice fraud scheme in Los Angeles County as an example of what he called a massive and underreported problem. He said $60 billion in waste, fraud and abuse was lost through Medicare alone and praised the administration's anti-fraud task force.

Demagoguery and politicization

Ranking Member Richard Neal (D-Massachusetts) offered a sharply different perspective in his opening statement, drawing on Massachusetts' experience building what he called a national model of health care to push back against proposed federal spending reductions.

Neal, who noted a personal and familial connection to the Kennedy family spanning decades, warned that a proposed 12.5% cut to the HHS budget would put 440 hospitals at risk nationwide and called the reductions a trade-off that would benefit the wealthiest Americans at the expense of working families.

“We watch daily as the threats to this health care system that we have constructed,” Neal said, citing concerns about vaccine policy, cuts to childcare payment systems and proposed reductions to the Low Income Home Energy Assistance Program, known as LIHEAP, which he said served 159,000 Massachusetts families last year.

Neal was unambiguous in defending the science of vaccines, invoking the era before the polio vaccine developed by Dr. Jonas Salk became widely available in the 1950s. He said his mother's approach to polio prevention before the vaccine was simply to keep children out of fresh water in August.

“Nothing has changed about the science of vaccines,” Neal said. “We need people not to be preyed upon by demagoguery, and there should not be a politicization of these very issues.”

Neal also took issue with what he described as baseless claims linking common pain medications to autism, and criticized the administration's framing of health care reform, arguing that rising costs are tied in part to current economic conditions including tariffs.

Neal highlighted recent Democratic-led achievements in Medicare drug pricing, including negotiated drug prices and capped out-of-pocket costs for patients, and argued those gains should not be reversed.

“People should not have to choose between medicine and childcare,” he said. “We need to come to the aid of the American family at this very difficult time, Republicans need to understand that Americans deserve a fair shake.”