Insights

On April 28, 2026, the House Ways and Means Committee held a hearing to examine the cost of health care and invited hospital system CEOs to testify on the role of these systems in addressing health care cost concerns. Additionally, Democratic members of the committee invited the President of a health care advocacy organization. There was bipartisan concern about the rising costs of providing health care, as well as questions about site-neutral payments, hospital classifications, and the impact of the One Big Beautiful Bill Act (OBBBA).

OPENING STATEMENTS

• Chairman Jason Smith (R-MO-8)
• Ranking Member Richard Neal (D-MA-1)

WITNESS TESTIMONY

• Mr. Sam N. Hazen, Chief Executive Officer, HCA Healthcare – Testimony
• Mr. Wright Lassiter III, President and Chief Executive Officer, CommonSpirit Health – Testimony
• Dr. Brian G. Donley, President and Chief Executive Officer, New York-Presbyterian – Testimony
• Dr. Michael Waldrum, Chief Executive Officer, ECU Health – Testimony
• Mr. Brad Woodhouse, President, Protect Our Care – Testimony

MEMBER DISCUSSION

Site Neutral Payments

Multiple Republican members were curious about site-neutral payments. Reps. David Kustoff (R-TN-8) and Greg Steube (R-FL-17) wanted to understand how hospitals justify increases in payments for services performed in hospitals as opposed to those same services provided in an outpatient setting. Dr. Donley emphasized that patients in hospitals are often sicker than those seen in other settings. Mr. Hazen shared that the extra fees support broader hospital operations, such as the 24/7 staffing, that ambulatory centers do not have. Dr. Waldrum added that hospitals have federal mandates to provide care to all patients, which the additional payments help meet. Mr. Lassiter and Dr. Donley indicated that they would be open to some reforms in the payment system to shrink the differences in site payment.

Impact of OBBBA

Democratic members of the Committee used today’s hearing to raise concerns about how the OBBBA could impact future hospital costs. Rep. Terri Sewell (D-AL-7) asked Dr. Waldrum to explain what steps ECU Health is taking in regard to provisions in the OBBBA. Dr. Waldrum explained that the bill creates a fairly large reduction in payment for rural areas that will not be offset by the included Rural Health Transformation Program which will likely lead to reductions in services offered at provider sites. Rep. Steven Horsford (D-NV-4) asked about the service impacts of the OBBBA, to which Mr. Lassiter explained that CommonSpirit Health estimates a loss of $5 Billion in reimbursement over the next decade.

Hospital Classification

A few Republican members wanted clarification on the tax-exempt status on some hospitals. Rep. Lloyd Smucker (R-PA-11) asked if there was a difference in which for profit and non-profit hospitals operated, to which Mr. Hazen said there was not. Rep. Greg Murphy (R-NC-3) questioned how a hospital can justify being for-profit with the high cost of care. Mr. Hazen stated that the model of HCA Healthcare is working well for providing care to patients and they can still provide uncompensated care as needed. Rep. Kevin Hern (R-OK-1) had concerns about how tax-exempt status and community benefit spending can be reported as an individual facility within a large system. Dr. Donley responded that hospitals are following IRS guidelines when they report their community benefit, which New York-Presbyterian estimates is about 4 times the amount they would contribute to taxes. Rep. Nicole Malliotakis (R-NY-11) asked what Congress should keep in mind if it were to set minimums for charity care and community benefits. Dr. Donley requested that Congress should not only consider charity care in calculations but should also include the care reimbursed under Medicaid, which is the bulk of New York-Presbyterian’s community benefit.

There were also strong Republican concerns about how hospitals are classified as rural vs urban. Chairman Jason Smith (R-MO-8), as well as Reps. Carol Miller (R-WV-1) and Rudy Yakam (R-IN-2) all wondered how New York-Presbyterian could be classified as a rural hospital when it operates in Manhattan, NY. Dr. Donley explained that while New York-Presbyterian is not geographically rural, they are a rural referral hospital under regulations from the Centers for Medicare and Medicaid Services (CMS). Chairman Smith and Rep. Yakam questioned whether these regulations should be changed to prevent the classification. Dr. Donley emphasized that Congress needs to ensure the sustainability of rural and urban hospitals.

Cost and Competition

There were bipartisan questions about the rising cost of hospital care. Rep. Adrian Smith (R-NE-3) asked how HCA Health can justify charging private insurance companies 3 times the Medicare reimbursement rate for the same services. Mr. Hazen explained that hospitals are seeing a greatly increased demand for services and providing care has become more complex. Rep. Brian Fitzpatrick (R-PA-1) questioned how New York-Presbyterian sets higher prices than surrounding systems. Dr. Donley stated that pricing is complex but is based on the quality and complexity of care, as well as underlying hospital costs. Rep. Randy Feenstra (R-IA-4) was curious about cash pay discounts. Mr. Hazen shared that for HCA Healthcare cash payments resulted in a more than 20% reduction in costs because the hospital system did not need to deal with the health insurance administrative complexity. Rep. Susan DelBene (D-WA-1) question the usefulness of prior authorization practices and the increased administrative cost and burden. Mr. Lassiter shared that CommonSpirit estimates that prior authorization costs the system more than $1 billion in additional work each year. Ranking Member Richard Neal (D-MA-1) highlighted that the cost of technology and prescription drugs has greatly increased, which is also a driver of increased hospital spending.

Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) and Rep. Jimmy Panetta (D-CA-19) wanted to understand the role that Medicare and Medicaid reimbursement plays in rising costs. Representatives from multiple health systems shared that CMS reimburses less than the cost of providing care, which means they must make up the difference in other areas. Mr. Lassiter also stated that CommonSpirit currently has $4.3 billion in unpaid claims from Medicare and Medicaid patients.

Rep. Ron Estes (R-KS-4) questioned the rapid consolidation of health systems, suggesting that this is explained by a desire to increase profit. Dr. Waldrum argued that consolidation was not driven by profit but instead occurred because hospitals in rural areas could not afford to remain operational if they were not part of a larger system. Rep. Blake Moore (R-UT-1) raised concerns about smaller markets driving anti-competitive contracts. Mr. Lassiter shared that CommonSpirit operates in many different markets, and their contracts are not market-based. Rep. Beth Van Duyne (R-TX-24) suggested repealing the ban on physician-owned hospitals to increase market competition. Mr. Hazen stated that he is for competition, but that physician-owned hospitals do not have emergency rooms or provide care to uninsured populations, which means that they would be operating on an unequal playing field.

Other Topics

• Rep. Mike Carey (R-OH-15) argued that not extending the ACA tax credits has led to a larger uninsured population and asked about the rise in uninsured populations seeking care. Mr. Hazen shared that HCA Healthcare has seen a 15% rise in uninsured patients in the first quarter of 2026 compared to 2025.

• Rep. Don Beyer (D-VA-8) wanted to know how to reduce administrative costs in hospitals. Mr. Hazen suggested improving digital integration between payors and providers, as well as reducing overlap between regulations.

• Rep. Linda Sanchez (D-CA-38) raised concerns about immigration officials entering health facilities and preventing patients from receiving care.

On April 21 and 22, 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. appeared before the Senate Appropriations Labor-HHS Subcommittee, the Senate Finance Committee, and the Senate Health, Education, Labor, and Pensions (HELP) Committee to defend the fiscal year 2027 (FY 27) president’s budget request for HHS. During these hearings, Sec. Kennedy focused on the administration’s work on prior authorization, increasing transparency, and emphasizing whole foods. There were bipartisan concerns about vaccines and health care affordability, with an emphasis on most-favored-nation drug pricing deals. Senators also discussed nutrition initiatives and rural health issues, among other topics.

OPENING STATEMENTS

• Senate Appropriations Labor-HHS Subcommittee Chair Shelley Moore Capito (R-WV)
• Senate Appropriations Labor-HHS Subcommittee Ranking Member Tammy Baldwin (D-WI)
• Senate Finance Committee Chair Mike Crapo (R-ID)
• Senate Finance Committee Ranking Member Ron Wyden (D-OR)
• Senate HELP Committee Chair Bill Cassidy (R-LA)

WITNESS TESTIMONY

• Robert F. Kennedy, Jr., Secretary, Health and Human Services – Testimony

MEMBER DISCUSSION

One thing that distinguished the Senate hearings from the House hearings was that concerns about certain vaccine policies pursued by Sec. Kennedy were bipartisan. During the Senate Appropriations Labor-HHS Subcommittee, Sen. Jeanne Shaheen (D-NH) asked whether HHS was planning to release the funding allocated to the GAVI Vaccine Alliance for FY 25 and FY 26. Sec. Kennedy explained that, in his view, GAVI has been intransigent and previously gave a lot of money to the World Health Organization (WHO), but he said he is willing to work to resolve these issues. During the Senate Finance Committee hearing, Ranking Member Ron Wyden (D-OR) and Sen. Ben Ray Lujan (D-NM) questioned if the rise of measles cases was due to lower vaccination rates, to which Sec. Kennedy responded that there has been a global rise in measles cases and that the US is handling it better than other countries. Sen. John Barrasso (R-WY)(R-WY) raised concerns that changes to the vaccine schedule and the Advisory Committee on Immunization Practices (ACIP) were creating confusion for families and providers. He requested that the secretary commit to ensuring vaccine guidance is clear, evidence-based, and trustworthy. Sec. Kennedy assured Sen. Barrasso (R-WY) that new vaccines would undergo placebo-controlled trials to ensure their safety, but said he could not say more due to ongoing litigation. Sen. Michael Bennet (D-CO) expressed concern that the US experienced the highest modern childhood mortality rate from influenza in 2025, noting that most children who died had not received the flu vaccine. Sec. Kennedy responded that the flu vaccine’s efficacy is low. When Sen. Roger Marshall (R-KS) asked if there was work to create a more effective flu vaccine, Sec. Kennedy said that he is hoping to create a complete flu vaccine that would not need to be given annually. During today’s hearings, Sen. Maggie Hassan (D-NH) asked if President Trump approved of firing members of ACIP and changing the charter. Sec. Kennedy did not know whether President Trump personally approved the decisions, but stated that the domestic policy council approved them.

In contrast to concerns about Sec. Kennedy’s vaccine policies, Sen. Ron Johnson (R-WI) raised an alarm at the Senate Finance Committee about adverse events, including deaths, from COVID-19 vaccines, asking if HHS is creating an ICD code for vaccine injuries. Sec. Kennedy shared that HHS is actively working on an ICD code and that studies on vaccine injuries will be completed by HHS.

At the HELP Committee hearing, Chairman Bill Cassidy (R-LA) did not directly question Sec. Kennedy’s personal opinions on vaccines, but noted his disagreement with Sec. Kennedy’s conclusion that a certain study indicated that vaccines were not the cause of a decrease in childhood mortality. Chairman Cassidy (R-LA) said that the study actually found it was a cause, among other factors. Sen. John Hickenlooper (D-CO) questioned Sec. Kennedy’s support for vaccines. Sec. Kennedy countered that he is supportive, citing the recent approval of a cancer vaccine.

Affordability

There were bipartisan concerns about health care affordability across the Senate hearings. During the Appropriations Labor-HHS Subcommittee hearing, Sen. Jon Husted (R-OH) asked about 340B and ways to ensure it actually helps those in need. Sec. Kennedy shared his concern, citing fraud and abuse as the main problem that has allowed more hospitals to use the program. He noted the current litigation surrounding the program but said that Congress is the only body that can make changes. Sen. Mike Rounds (R-SD) specifically asked about the proposal to turn 340B into a rebate model, which would require hospitals to pay upfront. Sec. Kennedy didn’t know where the proposal sits but committed to ensuring it doesn’t just benefit pharma. Sen. Jeff Merkley (D-OR) requested that details of the most-favored-nation agreements be shared with Congress so they could understand exactly what they were being asked to codify. Sec. Kennedy explained that some aspects can be shared, but others are proprietary and contain sensitive information. He directed Sen. Merkley (D-OR) to talk directly with Chris Klomp, Director of Medicare and Deputy Administrator of the Centers for Medicare and Medicaid Services (CMS). During the Finance Committee hearing, Ranking Member Wyden (D-OR) and Sens. Elizabeth Warren (D-MA), Peter Welch (D-VM), and Bernie Sanders (I-VT) also requested information on the most-favored-nation pricing agreements, pointing out that many times the drugs with agreements on the TrumpRx website are cheaper to purchase in other nations or through insurance plans. Sec. Kennedy again responded that some information would be shared and that the drug prices are the lowest in the world for the specific brands of drugs advertised. Sen. Tom Tillis (R-NC) questioned how the most-favored-nation pricing deals would actually lower drug costs compared with other pricing agreements that, in his view, have not worked. Sec. Kennedy explained that each agreement was unique and that the agreements have proven to be helpful. Sen. Tillis (R-NC) then asked how Congress was expected to codify deals that are so unique to each company, to which Sec. Kennedy said that Klomp was working on the legislative language. Sen. Cassidy (R-LA) and Sen. Rand Paul (R-KY) asked if Sec. Kennedy supported expanding access to Health Savings Accounts (HSAs) to improve health care affordability. Sec. Kennedy was in favor of the proposals.

Research

There was bipartisan concern about investment in biomedical research, specifically maintaining the U.S. status as a leader. During the Appropriations Labor-HHS Subcommittee hearing, full Committee Chair Susan Collins (R-ME) asked about the proposed 15% cap on indirect research costs across the board, which she opposes and that Congress rejected in FY 26 negotiations. Sec. Kennedy stated that nobody wants to cut anything from the agencies, but the U.S. has a debt that needs to be addressed, and HHS was asked to cut costs by 12%. Appropriations Labor-HHS Subcommittee Ranking Member Baldwin (D-WI) asked specifically about cancer and Alzheimer’s research funding under the National Institutes of Health (NIH). Sec. Kennedy shared her belief that there should be more research on both and stated that the National Cancer Institute (NCI) is one of few agencies with a proposed budget increase, which Sen. Baldwin (D-WI) countered is only a .01% increase.

Rural Health

Across the hearings, there was bipartisan questioning on the future of rural health. Appropriations Labor-HHS Subcommittee Chair Capito (R-WV) asked generally what Sec. Kennedy plans on doing to address rural health concerns. The secretary explained that both Republicans and Democrats have made it clear that rural health is a priority, which is why they implemented the Rural Health Transformation Program (RHTP) to improve rural facilities and care. Sen. Jerry Moran (R-KS) later asked if he was pleased with the rollout of the RHTP. Sec. Kennedy shared that he couldn’t be happier as money is out the door and they can begin seeing impacts. Sen. Cindy Hyde-Smith (R-MI) questioned how to adjust the CMS Area Wage Index (AWI), which she argued is destabilizing rural hospitals, and how to retain the Office of Rural Health at the Centers for Disease Control and Prevention (CDC). Sec. Kennedy agreed that the AWI is very dangerous, but it is up to Congress to make any changes. The secretary explained that he is working to return the CDC to their core mission of addressing infectious diseases, but he expects congressional feedback. During the Senate Finance Committee hearing, Sen. Marsha Blackburn (R-TN) highlighted the success of RHTP for rural communities and requested Sec. Kennedy’s support for altering the AWI for rural hospitals. Sec. Kennedy once again voiced his support for the change but stated that action would need to come from Congress before HHS could make changes. Sen. Marshall (R-KS) highlighted the rural emergency hospital model and the positive effects of using telehealth in emergency rooms. Sec. Kennedy agreed with the model, saying that emergency care is highly needed in rural areas and telehealth is extremely helpful. Chairman Crapo (R-ID) was curious about the most innovative uses of RHTP funding. Sec. Kennedy shared that the state applications were extraordinary and that he is most excited about the use of telehealth to improve care delivery and efforts to improve residency programs.

Nutrition

Senators also spent time clarifying the various nutrition initiatives HHS plans to pursue. During the Appropriations Labor-HHS Subcommittee hearing, Sen. Katie Britt (R-AL) asked what HHS is doing to strengthen and expand Head Start. Sec. Kennedy explained that they have proposed maintaining the budget at FY 26 levels and allocating additional funds to develop school infrastructure to provide fresh, nutritious food. Sen. Rounds (R-SD) raised concerns with lab-grown fake meat. Sec. Kennedy shared his concern and committed to exercising FDA oversight. Sen. Brian Schatz (D-HI) focused his questioning on glyphosate and its dangers. Sec. Kennedy agreed that glyphosate is not healthy to consume and can cause cancer. However, he defended Trump’s executive order boosting domestic production because the EO doesn’t increase glyphosate use. Sen. John Kennedy (R-LA) asked how HHS plans to communicate concerns about ultra-processed foods best and ensure Americans aren’t eating them. Sec. Kennedy explained that HHS has developed a definition under review, and once it is approved, it will enforce mandatory front-of-package labeling. During the Senate Finance Committee hearing, Chairman Crapo (R-ID) asked how HHS plans to build on actions taken to improve nutrition education. Sec. Kennedy shared that many medical schools have committed to including nutrition education in their curricula, and he is working with states to develop legislative plans on the topic. During the Senate HELP Committee hearing, Ranking Member Sanders (I-VT) questioned the timeline for placing warning labels on unhealthy foods. Sec. Kennedy said that HHS had recently completed their definition of ultra-processed foods and that it was now undergoing interagency review. Ranking Member Sanders (I-VT) also asked if Sec. Kennedy agreed with banning TV ads for junk food, and Sec. Kennedy affirmed. Sens. Ashley Moody (R-FL) and Tommy Tuberville (R-AL) praised the secretary for his accomplishments in improving nutrition and asked about next steps. Sec. Kennedy highlighted work on reviewing substances generally recognized as safe and empowering physicians to give better nutrition advice. Sen. Hassan (D-NH) agreed on the importance of healthy food options but questioned how families could afford fresh meat and produce amid high food prices. Sec. Kennedy shared that the cost of food is affordable and that families have many options for healthy food.

HHS Management

There was also bipartisan questioning during the hearings about the management of certain HHS agencies and funding for various projects within them. At the Senate Finance Committee, Sen. Barrasso (R-WY) raised strong concerns about the fate of the US Preventive Services Task Force (USPSTF), specifically whether the task force will continue to meet and how the evaluation process will work. Sec. Kennedy assured Sen. Barrasso (R-WY) that he agrees that the task force is important and that new members will be selected shortly. From there, Sec. Kennedy said meetings will resume and the task force’s functions will remain the same, with additional representation from a broader range of specialties. Sen. Tina Smith (D-MN) associated herself with Sen. Barrasso’s comments and questioned why Sec. Kennedy is proposing cuts to various screening programs, such as those for women’s health, depression, and smoking cessation. Sec. Kennedy affirmed his commitment to preventive health and shared that, under the proposed budget, preventive care is being returned to states through block grants, so each state can administer the care. Sen. Raphael Warnock (D-GA) asked Sec. Kennedy about the low funding levels for CDC programs on rabies and prion diseases. Sec. Kennedy explained that cuts were necessary and that these diseases affect very few people each year, so focusing the budget on chronic disease makes more sense.

During the Senate HELP Committee hearing, Sen. Andy Kim (D-NJ) raised concerns about the proposed elimination of many programs and departments that support individuals with disabilities. Sec. Kennedy stated that he was asked to make funding cuts across the board but would be happy to talk to Sen. Kim about how to support the disability community. Sen. Alan Armstrong (R-OK) questioned the consolidation of many agencies into the Administration for a Healthy America. Sec. Kennedy emphasized that the reorganization would streamline the agencies, reduce overlap, and improve efficiency.

Other Topics

During the Appropriations Labor-HHS Subcommittee hearing:

• Appropriations Chair Collins (R-ME) asked how HHS plans to address health disparities in women, as there has been a 31% decline since 2025 in research projects that include the word ‘women’. Sec. Kennedy referenced grants studying Alzheimer’s and diabetes, his focus on chronic disease, and the perinatal pilot program.
• Sen. Dick Durbin (D-IL) shared his concerns surrounding tobacco and the promotion of vaping. Sec. Kennedy explained there is intra-agency controversy as career scientists see vaping as a tool to reduce tobacco use, but there is also concern with marketing vapes to minors.
• Sen. Chris Murphy (D-CT) asked about the decision to overturn the minimum staffing rule in nursing homes. Sec. Kennedy responded, saying there was pressure from Congresspeople representing rural areas about the damage it was causing. Sen. Murphy (D-CT) then asked him to share any data showing the rule’s impact on rural areas. Sec. Kennedy said he would do so.

During the Finance Committee hearing:

• Sen. Steve Daines (R-MT) requested an update on safety studies for Mifepristone and reimplementing in-person prescribing requirements. Sec. Kennedy stated that he could not comment due to ongoing litigation.
• Sen. Maria Cantwell (D-WA) asked for the secretary’s support in fully funding Federal Medical Assistance Percentage (FMAP) for urban Indian hospitals. Sec. Kennedy agreed to work with the senator.

During the HELP Committee hearing:

• Sen. Josh Hawley (R-MO) requested that HHS investigate the health risks of data centers. Sec. Kennedy said that some studies were already underway but more would follow.

In April 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. appeared before the House Ways and Means Committee, the House Appropriations Labor-HHS Subcommittee, the House Education and Workforce Committee, and the House Energy and Commerce Health Subcommittee to discuss the Fiscal Year 2027 (FY 27) presidential budget request for HHS. Sec. Kennedy used these hearings to share how the budget proposal is designed to align with the administration’s plans to reorganize the department to reduce duplication and focus on addressing the chronic health crisis. He also used the hearings to highlight what he saw as the administration’s wins in areas related to improving nutrition and reducing health care costs. Notably, he did not highlight his actions related to vaccine policy in any hearing. However, Democratic members in each hearing expressed concerns about this topic. The four hearings featured member questions on rural health care, nutrition, prescription drugs, the management of various HHS agencies, and efforts to eliminate fraud, waste, and abuse within the department.

OPENING STATEMENTS

• House Ways and Means Committee Chairman Jason Smith (R-MO-8)
• House Ways and Means Committee Ranking Member Richard Neal (D-MA-1)
• House Appropriations Labor-HHS Subcommittee Chairman Robert Aderholt (R-AL-4)
• House Appropriations Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3)
• House Education and Workforce Committee Chairman Tim Walberg (R-MI-5)
• House Education and Workforce Committee Ranking Member Bobby Scott (D-VA-3)
• House Energy and Commerce Full Committee Chairman Brett Guthrie (R-KY-2)
• House Energy and Commerce Health Subcommittee Vice Chair Diana Harshbarger (R-TN-1)
• House Energy and Commerce Full Committee Ranking Member Frank Pallone (D-NJ-11)
• House Energy and Commerce Health Subcommittee Ranking Member Diana DeGette (D-CO-1)

WITNESS TESTIMONY

• Robert F. Kennedy, Jr., Secretary of Health and Human Services – Testimony

MEMBER DISCUSSION

Rural Health

During the Committee hearings, Republican representatives focused on rural health care and the need for continued investments in this area. During the Ways and Means Committee hearing, Chairman Jason Smith (R-MO-8) requested Sec. Kennedy’s commitment to ensuring Rural Health Transformation Program (RHTP) funds are distributed to rural communities, improving the Rural Emergency Hospital designation approval process, and working to equalize payments between rural and urban hospitals. Sec. Kennedy reaffirmed his commitment to work on these issues. Reps. Adrian Smith (R-NE-3), Michelle Fischbach (R-MN-7), and Randy Feenstra (R-IA-4) asked what additional actions could further improve access to rural health care. Sec. Kennedy highlighted recent investments in community health centers and the RHTP, as well as previous and ongoing efforts to move toward site-neutral payments. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Aderholt (R-AL-4) asked how the Centers for Medicare and Medicaid Services (CMS) is evaluating whether the hospital wage index accurately reflects true labor costs. Sec. Kennedy explained that changing the wage index is extremely complex because the program must remain budget-neutral, so Congress needs to intervene to affect changes. During the Energy and Commerce Health Subcommittee hearing, Full Committee Chairman Guthrie (R-KY-2) asked the secretary about his experience administering RHTP and what he is most excited about. Sec. Kennedy explained that he is most excited about how RHTP dollars will help address what he described as a crisis in rural health and an epidemic of hospital closures, Reps. Troy Balderson (R-OH-12) and Mariannette Miller-Meeks (R-IA-1) asked how the funds can be used for recruitment to address staffing shortages. Sec. Kennedy shared that RHTP funds can be used to expand residency programs in rural areas, but he is unsure if they can be put towards recruitment bonuses.

Nutrition

There was bipartisan support for the nutrition initiatives that Sec. Kennedy has been championing across the hearings, although Democratic members questioned cutting funds for programs they argued are vital to supporting Americans’ nutrition. During the Ways and Means Committee hearing, Health Subcommittee Chair Vern Buchanan (R-FL-16), as well as Reps. Lloyd Smucker (R-PA-11) and Brian Fitzpatrick (R-PA-1) asked what future actions HHS plans to take to improve nutrition. Sec. Kennedy responded that he was interested in reviewing the list of substances generally recognized as safe (GRAS) and in driving cultural changes in diet and exercise. Rep. Gwen Moore (D-WI-4) expressed her disappointment with the proposed budget cuts to Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP), arguing that these cuts hamper efforts to improve nutrition. Sec. Kennedy acknowledged her disappointment, sharing that he was not happy with the funding changes, but with the large federal debt, cuts had to happen. During the Education and Workforce Committee hearing, Rep. Alma Adams (D-NC-12) questioned the budget cuts to programs that she argued promote nutrition, such as the Farm-to-School Program and school lunch grants. Sec. Kennedy shared that President Trump did not discuss the proposed cuts with him, but that he preserved Head Start and is focused on expanding access to whole foods. Rep. Kevin Kiley (I-CA-6) asked Sec. Kennedy to expand on the link between our food supply and chronic health issues. In response, the secretary reiterated his view that the lack of regulation of GRAS substances is a major problem. Rep. Glenn Thompson (R-PA-15) then asked about efforts to improve access to nutritional foods in schools. Sec. Kennedy explained that schools have abandoned their kitchens, that we need to help them rebuild to make good food, and that they need to continue encouraging the provision of whole milk during meals.

Vaccines

Many Democrats during all hearings expressed concerns about Sec. Kennedy’s views on vaccines and recent changes to vaccine recommendations. During the Ways and Means Committee hearing, Rep. Judy Chu (D-CA-28) questioned the removal of the universal Hepatitis B vaccination recommendation. Sec. Kennedy defended the change in recommendation, saying that infants are not generally at risk, vaccination is still recommended when the mother is positive for Hepatitis B, and that insurance companies can still cover the vaccination. Rep. Madeliene Dean (D-PA-4) asked how many members of the Advisory Committee on Immunization Practices (ACIP) he replaced. The secretary responded that he fired all 17 members because he didn’t like the work they were doing. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Lois Frankel (D-FL-22) shared her concern about the lack of funding released to GAVI, the Vaccine Alliance that produces vaccines for underdeveloped countries, which was appropriated in both FY 25 and FY 26. Sec. Kennedy did not have a response. Reps. Mike Thompson (D-CA-4) and Linda Sanchez (D-CA-38) on Ways and Means, and Rep. Dean (D-PA-4) on the Appropriations Labor-HHS Subcommittee, focused on the rise in measles cases and the decline in measles vaccination rates. When asked by Reps. Sanchez (D-CA-38) and Dean (D-PA-4), if the vaccine was safe and effective, especially compared with contracting the disease, Sec. Kennedy agreed that it was. During the Education and Workforce Committee hearing, Rep. Suzanne Bonamici (D-OR-1) and Rep. Haley Stevens (D-MI-11) asked why Sec. Kennedy does not approve of the measles vaccine. The secretary stated that he has never been anti-vaccine, but that the combined measles vaccine for those under two was dangerous. He also cited a new cancer vaccine that HHS approved to show his support for vaccines. House Education and Workforce Committee Chair Tim Walberg (R-MI-5) provided the secretary with an opportunity to defend his actions by asking Sec. Kennedy to address allegations that he was responsible for the measles outbreak. Sec. Kennedy responded that the accusation is not science-based because the outbreak began before he took office. Sec. Kennedy also shared that if the 2 children who died in Texas had been given proper treatment when they went to the hospital, they could have been saved. During the Energy and Commerce Health Subcommittee hearing, Reps. Kim Schrier (D-WA-8) and Marc Veasey (D-TX-33) pressed the secretary on his rhetoric surrounding vaccines and the impact of said rhetoric. Sec. Kennedy reiterated that he has never been anti-vaccination and never removed measles from the list of recommendations. Rep. Schrier (D-WA-8) specifically focused on what she called the “RFK Jr. Spillover Effect,” which she “RFK Jr. Spillover Effect,” which she characterized as leading to overall distrust of doctors and negatively Vitamin K injections for newborns. Sec. Kennedy again emphasized that anybody could get vaccines covered by insurance and noted that he has never said anything about Vitamin K.

Fraud, Waste, and Abuse

Addressing fraud, waste, and abuse was a major topic in all hearings. During the Ways and Means hearing, Full Committee Ranking Member Richard Neal (D-MA-1) and Health Subcommittee Ranking Member Lloyd Doggett (D-TX-37) questioned the Trump administration’s pardoning and reinstatement of those who were charged with Medicare and Medicaid fraud to be brokers. Sec. Kennedy did not have an answer to these questions. Reps. Beth Van Duyne (R-TX-24) and Rudy Yakym (R-IN-2) asked what steps HHS has taken to reduce fraud, waste, and abuse. Sec. Kennedy pointed to investigations into durable medical equipment, hospice, and home health, as well as ensuring proper Medicaid enrollment. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Andy Harris (R-MD-1) asked broadly what the secretary is doing to crack down on fraud, waste, and abuse. Sec. Kennedy said that HHS is ending the pay-and-chase system and auditing state Medicaid claims. During the Education and Workforce Committee hearing, Rep. Burgess Owens (R-UT-4) raised concerns about fraud, waste, and abuse and asked what specific deficiencies were being addressed. Sec. Kennedy stated that there is fraud in both red and blue states, but he argued that Florida cooperated in their investigation while Minnesota did not. During the Energy and Commerce Health Subcommittee hearing, Chair Guthrie (R-KY-2) asked if the secretary was surprised by the amount of fraud, waste, and abuse he has found. Sec. Kennedy explained that the Biden administration opened the door with the pay-and-chase model and by only evaluating reimbursement validations once a year. Rep. Miller-Meeks (R-IA-1) requested Sec. Kennedy’s support for her legislation aimed at investigating programs with significant increases in billing over a 6-month period to prevent fraud, which the secretary described as a great idea but something that he would need to look into further.

Affordability

During the hearings, there was bipartisan interest in health care affordability. At the Ways and Means hearing, Rep. Steven Horsford (D-NV-4) was specifically interested in knowing what steps HHS was taking to lower premiums and increase insurance coverage. Sec. Kennedy emphasized HHS’s actions to negotiate lower drug prices. Reps. Jodey Arrington (R-TX-19) and Max Miller (R-OH-7) asked what steps Congress and HHS can take to support affordability in the future. Sec. Kennedy shared that he would like to address perverse incentives that lead to higher costs, address concerns about certain pharmacy benefit manager (PBM) practices, increase direct primary care, and promote individual choice in health. Rep. Miller (R-OH-7) requested a framework for the future. During the Energy and Commerce Health Subcommittee hearing, Reps. Cliff Bentz (R-OR-2) and Nick Langworthy (R-NY-23) asked what steps HHS is taking to drive down prices. Sec. Kennedy shared that they have dozens of initiatives, including the most favored nation deals, cost-sharing, and “cleaning up the coverage pool.”

Members from both parties also raised questions about efforts to lower prescription drug prices. Education and Workforce Committee Ranking Member Scott (D-VA-3) asked if the secretary could commit to releasing the information on the deals from the most-favored-nation deals, to which he responded that most of the information is public, and he said that all that hasn’t been shared is proprietary. Rep. Rick Allen (R-GA-12) and Rep. James Comer (R-KY-1) turned the focus to PBMs and vertical integration. Sec. Kennedy explained that they are driving up costs everywhere and steering patients towards more expensive medications to receive higher compensation. The secretary also stated that vertical integration is a major safety issue and has led to people without medical degrees making decisions about which medications patients have access to. During the Energy and Commerce Health Subcommittee hearing, Rep. Buddy Carter (R-GA-1) raised concerns about the 340B program and its shift away from its intended goals. Sec. Kennedy shared his concerns and stated that any change to the program would need to be statutory, but he would be happy to work with Congress on any solutions.

Sec. Kennedy also faced questions from Democrats regarding Medicaid and Medicare. At the Ways and Means hearing, Rep. Joe Courtney (D-CT-2) and Rep. Greg Casar (D-TX-5) raised concerns about cuts to Medicaid and Medicare in H.R.1 and argued that these cuts have resulted in a high number of Americans losing their health insurance. Sec. Kennedy emphasized his belief that both Medicare and Medicaid are critical programs that need to be saved and stated that the cuts to Medicaid are solely the result of ending coverage for illegal immigrants. During the Energy and Commerce Health subcommittee, Sec. Kennedy was repeatedly questioned about Medicaid cuts, which he adamantly denied occurred, based on a recent Congressional Budget Office (CBO) report. Rep. Alexandria Ocasio-Cortez (D-NY-14) specifically focused on Medicare Advantage (MA) reimbursement rates and the increase in reimbursement for MA plans that the administration provided for 2027. Sec. Kennedy agreed that insurance companies are fleecing Americans, but said HHS was facing huge blowback from the insurance industry, which was threatening to abandon patients, so the department did what they thought was best.

Agency Management

Hearings also featured bipartisan interest in the management of HHS agencies. During the Ways and Means Committee hearing, Reps. Darin LaHood (R-IL-16) and Blake Moore (R-UT-1) expressed interest in updates about the Food and Drug Administration (FDA). Rep. LaHood (R-IL-16) raised the possibility of mismanagement at the FDA. Sec. Kennedy responded that the FDA has set records for the number of approvals of new drugs, generics, and medical devices, and has improved efficiency through the use of artificial intelligence. Rep. Moore (R-UT-1) asked about coordination between the FDA and CMS to provide temporary coverage of breakthrough medical devices. Sec. Kennedy shared that an announcement would be coming soon. During the Energy and Commerce Health Subcommittee hearing, Reps. Kat Cammack (R-FL-3) and Erin Houchin (R-IN-9) asked what specifically the FDA and HHS were doing to accelerate domestic manufacturing in hopes of maintaining U.S. leadership in pharmaceutical production. Sec. Kennedy described a pre-check program that will fast-track proposals to expand domestic plants and stated that 90% of the FDA is now using AI, which he stated has condensed the time taken to review applications for drugs.

Funding Reductions to Agencies

During all hearings, members of both parties also raised questions about funding reductions for certain agencies. At the Ways and Means hearing, Reps. Brendan Boyle (D-PA-2) and Brad Schneider (D-IL-10) expressed concerns about the proposed funding changes to the National Institutes of Health (NIH), with Rep. Schneider (D-IL-10) saying that it would likely lead to fewer drugs coming to market in the next 5 years. Rep. Boyle (D-PA-2) was specifically concerned about the impact on pediatric cancer research funding. Sec. Kennedy shared that the only Institute within the NIH to see an increase in funding was the National Cancer Institute and emphasized that duplicative programs were reallocated. When asked during the Appropriations Labor-HHS Subcommittee hearing by Rep. Bice (R-OK-5) about the primary areas that would see reductions under the budget, Sec. Kennedy stated that they must make cuts to the NIH to recalibrate funding toward chronic health rather than spending all the agency’s time on genetic testing. During the Education and Workforce Committee hearing, Rep. Donald Norcross (D-NJ-1), Rep. Adelita Grijalva (D-AZ-7), and Rep. Mark DeSaulnier (D-CA-10) voiced concerns with the cuts to research programs within the NIH, the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Sec. Kennedy cited the Great American Recovery Initiative and the increase in funding for the National Cancer Institute as examples of not cutting funding but rather shifting focus. Rep. Grijalva (D-AZ-7) asked which areas he believes deserve less medical research. The secretary stated that diversity, equity, and inclusion (DEI) has never cured any diseases or created new drugs. Rep. Summer Lee (D-PA-12) questioned cuts to research surrounding black maternal mortality rates. Sec. Kennedy explained that maternal mortality impacts everyone, and the perinatal pilot project he has implemented in various hospitals has reduced mortalities by 42% across the board.

Hearings also featured Democratic concerns about staffing changes at agencies. During the Ways and Means Committee hearing, Rep. Don Beyer (D-VA-8) questioned the changes in funding and staffing at the Agency for Healthcare Research and Quality (AHRQ) and SAMHSA, requesting briefings on the agencies. Sec. Kennedy shared that AHRQ has appropriate staffing levels and that the SAMHSA grant termination letters were a mistake. He also agreed to meet about the agencies in the future. During the Appropriations Labor-HHS Subcommittee hearing, Rep. Steny Hoyer (D-MD-5) asked about the changes made to the HHS workforce. Sec. Kennedy explained that there are currently 72,000 employees and that they plan to hire another 12,000 employees who will focus on chronic health. He explained that those who lost their jobs were not bad actors and were doing their jobs, but they had to be fired to change the culture.

Hearings also featured discussions about high-profile vacancies at roles within agencies. For example, during the Ways and Means Committee hearing on April 16th, Rep. Jimmy Panetta (D-CA-19) expressed concerns about vacancies in multiple roles at the Centers for Disease Control and Prevention (CDC) and at the US Surgeon General’s office. This hearing took place before Dr. Erica Schwartz was nominated to be the CDC Director. At the Energy and Commerce Health Subcommittee hearing, Rep. Raul Ruiz (D-CA-25) asked the secretary for his opinion on Dr. Schwartz and why the previous CDC Director, Dr. Monarez, was fired. Sec. Kennedy shared that he was consulted on the nomination and helped vet Dr. Schwartz. He also stated that Dr. Monarez was fired because she said he could not trust her, not because of her differing views on vaccines. During the Appropriations Labor-HHS Subcommittee hearing, Vice Chair Julia Letlow (R-LA-5) gave Sec. Kennedy space to promote Surgeon General nominee Casey Means. The secretary emphasized her importance in upholding the work of MAHA and educating people on metabolic health. He described Means as an effective evangelist for MAHA.

Women’s Health

Both Republicans and Democrats spent time questioning and clarifying various issues related to women’s health. During the Ways and Means Committee hearing, Rep. Nicole Malliotakis (R-NY-11) questioned how HHS plans to advance women’s health. Sec. Kennedy pointed to the RHTP to address issues related to maternal mortality. Rep. Malliotakis (R-NY-11) shared that she would like attention for safety net facilities, especially for those in urban areas that will not benefit from RHTP. During the Appropriations Labor-HHS Subcommittee hearing, Subcommittee Chair Robert Aderholt (R-AL-4) asked how the FDA could appropriately address the risk of chemical abortion drugs, specifically Mifepristone, without the reporting in place on the serious adverse events. Sec. Kennedy stated he couldn’t speak on Mifepristone because of the ongoing litigation in Louisiana. Full Committee and Labor-HHS Subcommittee Ranking Member Rosa DeLauro (D-CT-3) then questioned if Sec. Kennedy plans to reinstate the maternal health experts who were let go, to which he responded that it would be up to the new CDC leadership. Vice Chair Letlow praised the secretary for his work on women’s health and asked about the actions being taken after the national conference. Sec. Kennedy detailed the initiatives in the proposed budget, specifically to address maternal health and disparities among minorities. Rep. Andrew Clyde (R-GA-9) and Rep. Blake Moore (R-UT-1) asked about the use of Title X funding going towards abortion and research using fetal tissue. Sec. Kennedy explained that new rules and regulations are coming soon to address this, and it is illegal to use fetal tissue in NIH-funded research. During the Energy and Commerce Health Subcommittee hearing, Subcommittee Ranking Member Diana DeGette (D-CO-1) and Reps. Robin Kelly (D-IL-2) and Nanette Barragan (D-CA-44) questioned cuts to maternal mortality programs. Sec. Kennedy stated his support for access to birth control but defended the cuts saying there were 27 maternal mortality programs and he is consolidating them.

Other Topics

During the Ways and Means Committee hearing:

• Rep. Carol Miller (R-WV-1) expressed concern about how the bundled payment rate for chronic kidney disease could decrease innovation incentives. Sec. Kennedy expressed that he would be happy to work with her on increasing innovation.
• Rep. David Schweikert (R-AZ-1) requested to work with Sec. Kennedy on ways to improve MA, as the Medicare Payment Advisory Commission (MedPAC) has issued reports about the misalignment of incentives and costs.

During the Appropriations Labor-HHS Subcommittee:

• Reps. Jake Ellzey (R-TX-6) and John Moolenaar (R-MI-4) raised concerns about health care cybersecurity, particularly risks tied to the strategic national stockpile and emerging technologies, with secretary Kennedy responding that HHS is coordinating with the Administration for Strategic Preparedness and Response (ASPR) and CMS, reducing reliance on Chinese products, and emphasizing stronger protections as investments in AI and telehealth expand.
• Rep. Bice (R-OK-5) and Rep. Moolenaar (R-MI-4) asked what HHS is doing to reverse the trend of China conducting more Phase 1 trials than the U.S. Sec. Kennedy explained that they are working to accelerate approvals and shorten time to patients, as well as planning to invest $325 million into reshoring pharmaceuticals that puts drugs researched in the U.S. first in line for approvals. He also stated that there is money coming in from Trump’s tariffs, which are also helping the pharmaceutical companies build more plants in the U.S.

During the Education and Workforce Committee hearing:

• Chair Walberg (R-MI-5) and Rep. Mark Harris (R-NC-8) asked about moving certain programs, such as the Foreign Medical Accreditation, from the Department of Education to HHS. Sec. Kennedy explained that those programs align better with HHS priorities, and they are talking with other agencies to see what can be shifted. He also shared that he believes medical school accreditation should fall under HHS’s purview because of its focus on health education.
• Reps. Glenn Grothman (R-WI-6) and Harris (R-NC-8) shared their disapproval of sex change operations and the promotion of them by mental health professionals. Sec. Kennedy explained that it is a multi-billion-dollar industry that is very corrupt, and the administration has ended all federal funding for puberty blockers and gender surgeries. He also confirmed that they are seeing hospitals rolling back on transgender surgeries and treatments since Trump’s Executive Order to suspend Medicare and Medicaid reimbursements if they perform the procedures.

During the Energy and Commerce Health Subcommittee hearing:

• Rep. Gus Bilirakis (R-FL-12) asked if Sec. Kennedy saw any opportunity to engage further on potential links between environmental toxins and neurodegenerative diseases. The secretary shared that he believes it’s regulatory malpractice that we don’t know the full extent of impacts, and he committed to working on getting answers.
• Rep. John Joyce (R-PA-13) asked what HHS is doing to ensure standards under the Stark Law are enforced. Sec. Kennedy explained that they are reforming the site neutrality rule so rural hospitals don’t get paid less to disincentivize families from moving their relatives.
• Rep. Balderson (R-OH-12) asked for HHS’s view on wearable technology, specifically in early detection. Sec. Kennedy stated that he believes they are critical and can revolutionize chronic disease prevention. He specifically mentioned glucose models and their dramatic impact.
• Rep. Debbie Dingell (D-MI-6) asked if Sec. Kennedy planned on addressing the staffing crisis following the CMS decision to repeal the 2024 nursing home staffing requirements. The secretary explained that the requirements were closing rural facilities that couldn’t withstand the staffing numbers, so repealing it helped.