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RFK Jr.'s First HHS Confirmation Hearing: 7 Healthcare Takeaways
Becker’s Hospital Review
President Donald Trump's HHS secretary pick Robert F. Kennedy Jr. faced more than three hours of questioning by the Senate Finance Committee Jan. 29, the first of two hearings this week in an effort to secure the nomination.
Wednesday's hearing covered a range of health topics, from vaccine mandates to rural hospital closures and plans for Medicare and Medicaid. Mr. Kennedy faces another hearing Jan. 30 with the Senate Committee on Health, Education, Labor and Pensions.
Here are seven takeaways and excerpts from the hearing. A recording of the hearing in full can be found here.
- Medicare and Medicaid: There were nearly 80 mentions of Medicaid, about 40 mentions of Medicare and only five mentions of Medicare Advantage throughout the Senate Finance Committee hearing.
The focus on Medicaid came one day after widespread disruptions to the program's portals and confusion about the program's inclusion in the Trump administration's plans to freeze an array of federal funds, grants and programs. This became a point of contention, with Sen. Ron Wyden, D-Ore., claiming the Trump budget office shut down the federal Medicaid payment portal, while Committee Chairman Sen. Mike Crapo, R-Idaho, countered that reports of disruptions were "proven false overnight," asserting that the portal was fully operational at the time of the hearing.
Sen. Bill Cassidy, MD, R-La., pressed Mr. Kennedy about his plans to reform Medicare and Medicaid, which collectively provide health coverage to more than 150 million Americans. At times, Mr. Kennedy's comments indicated confusion between the two programs. When asked about integrating Medicare and Medicaid for dual-eligible individuals, he inaccurately described Medicaid as being "fully paid for by the federal government," when in fact it is funded jointly by state and federal governments.
Mr. Kennedy suggested that most people are unhappy with federal health programs, and stated several times throughout the hearing that Medicaid premiums and deductibles are too high. A relatively small portion of Medicaid beneficiaries pay premiums and deductibles, however. He did not confirm whether he supports adding work requirements for Medicaid coverage or cuts to the program, though suggested improvements are needed. "I don't have a broad proposal for dismantling the program," Mr. Kennedy said.
A KFF poll conducted in 2023 found strong satisfaction with federal insurance programs, with 91% of Medicare beneficiaries and 83% of Medicaid enrollees rating their coverage positively.
Despite its prominence in previous policy discussions, Medicare Advantage received little attention during the hearing. One of its few mentions came when Mr. Kennedy disclosed that he is personally enrolled in a Medicare Advantage plan. "Most Americans like myself, I'm on Medicare Advantage and I'm very happy with it," he said during an exchange with Mr. Cassidy about Medicare and Medicaid…
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Trump’s Initial Orders Reverse Biden on Health Care Costs, Protections from Discrimination
Stat News / By Sarah Owermohle, John Wilkerson, Rachel Cohrs Zhang, and Lizzy Lawrence
WASHINGTON — President Trump began his second term Monday with a sweeping order aimed at reversing dozens of former President Biden’s top priorities, from regulations aimed at lowering health care costs, to coronavirus outreach, Affordable Care Act expansions, and protections against gender-based discrimination.
The “initial rescissions” order, signed in front of cheering crowds at the Capital One Arena, revokes dozens of Biden administration policies that the new White House called inflammatory, inflationary, and possibly illegal. They include an October 2022 order to test Medicare and Medicaid models that could lower health care costs, an extension, Biden said, of his administration’s signature achievement to negotiate drug prices in the Inflation Reduction Act.
Trump is also peeling back certain Biden administration efforts to expand access to Covid-19 treatments and vaccines, the 2021 formation of a Gender Policy Council, and multiple gender and sex discrimination protections. He ordered federal workers to return to their offices full time, and he froze federal hiring, with some exceptions.
Separately, Trump ordered the U.S. to begin the process of withdrawing from the World Health Organization, which he blames for mishandling the Covid-19 pandemic.
Trump’s broad proclamations, like any president’s executive orders, generally begin the process of regulations and rulemaking at federal agencies. The reversals could meet legal challenges or congressional intervention. Several of Biden’s orders were tied to laws
passed by Congress…
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How the Incoming Trump Administration Could Impact Home-Based Care
Home Health Care News / By Jim Parker
Questions always abound when a new presidential administration comes in, but Republicans’ focus on cost-cutting hold potential for home-based care — if providers can advocate for themselves in Washington.
Though uncertainties abound when it comes to the Trump administration’s approach to health care, many notable policies have been implemented during Republican administrations. From the establishment of the Medicare Hospice Benefit under Ronald Reagan to the unveiling of Programs for All-Inclusive Care of the Elderly (PACE) under the first Bush administration, this track record can be source of optimism, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.
“The optimistic note is that a lot of the positive things that have happened in health care over the last 30 years have happened under a Republican Congress, a Republican administration or both,” Banach told Home Health Care News. “I think we’re going to see an increase in opportunities when it comes to caring for vulnerable folks, people who have Medicare and Medicaid, people who are chronically and seriously ill. If the incoming administration wants to solve an economic problem, they can’t solve an economic problem without solving that problem. You’re not going to save money if you simply cut services, so you have to be smarter about the way that you deploy those services.”
Banach previously served as deputy director and senior leader at the U.S. Centers for Medicare & Medicaid Services (CMS) during the Obama administration.
A key component of this is the Republican drive to cut costs, particularly as it pertains to the Medicare trust fund. Home-based care has a proven track record of reducing the total cost of care, which could lead to increased government investment in those services.
Hospice is a great example. Hospice care saves Medicare roughly $3.5 billion for patients in their last year of life, according to a joint report from the National Alliance for Care at Home and NORC at the University of Chicago.
Likewise, participants in the home health value-based purchasing model (HHVBP) have saved Medicare more than $1.38 billion over six years in nine states, according to CMS.
The same principle extends to palliative care. Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a 2019 report…
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How Home Health Agencies Can Adapt To TEAM and HHVBP Models
Home Health Agencies / By Audrie Martin
The landscape of home health care is evolving through the introduction of two key models designed to improve patient outcomes and reduce costs: the expanded Home Health Value-Based Purchasing (HHVBP) model and the Targeted Episode-Based Medicare Access and Payment (TEAM) model.
These initiatives incentivize home health agencies to provide high-quality, coordinated care while addressing the challenges associated with insufficient treatment for chronic health conditions. Ultimately, they aim to create a more efficient health care system for Medicare beneficiaries.
The primary model currently impacting home health providers is the expanded HHVBP model, according to ATI Advisory. This model adjusts Medicare payments based on a home health agency’s (HHA) performance on quality measures compared to their peers, rewarding agencies that deliver high-quality care.
In a fee-for-service health system, Medicare beneficiaries who qualify for home health care often receive inadequate and uncoordinated care for their chronic health conditions, according to ATI Advisory. This situation leads to increased emergency department (ED) visits, hospital admissions or placements in skilled nursing facilities (SNFs).
How the expanded HHVBP model affects HHAs
The expanded HHVBP model aims to improve the quality and efficiency of home health care. It was implemented on Jan. 1, 2022, and includes Medicare-certified HHAs in all 50 states, the District of Columbia and U.S. territories. The calendar year 2022 served as a pre-implementation year during which CMS provided HHAs with resources and training. The first full performance year was 2023, and the calendar year 2025 is the first year for payment adjustments based on performance in 2023.
The expanded HHVBP model builds on the success of the original model, which improved total performance scores among home health agencies by an average of 4.6%, according to the Center for Medicare and Medicaid Services (CMS). The original model also decreased unnecessary ED visits, improved patient mobility and reduced Medicare spending by $141 million…
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Health Programs on the GOP Chopping Block
Politico / By Chelsea Cirruzzo
Driving The Day
Many GOP lawmakers want to let ACA health insurance plan subsidies expire, but GOP Sen. Lisa Murkowski feels differently. | Francis Chung/POLITICO
GOP FLOATS HEALTH CARE CUTS — House Republicans are circulating a menu of options amounting to more than $5 trillion in cuts they could use to bankroll President-elect Donald Trump’s top priorities this year.
On the table: changes to Medicare, Medicaid and the Affordable Care Act. The list from the House Budget Committee could be used to finance a party-line reconciliation bill or other spending reduction efforts. The proposed cuts are highly ambitious, but not all are likely to become law, given the narrow margins for Republicans in the House and Senate.
I caught up with POLITICO Congress reporter and former Pulse author Ben Leonard to discuss the state of play.
There would be a few different ways on this “menu” to cut Medicaid. Can you walk us through them?
One big target is per-capita caps, favored by House Energy and Commerce Chair Brett Guthrie (R-Ky.). They’d allocate a set amount of Medicaid funding based on population instead of being an open-ended entitlement. That’s projected to save up to $918 billion.
Another major target is equalizing payments for nondisabled adults with those of traditional Medicaid enrollment — those with disabilities or low-income children, which [Republicans] say would save up to $690 billion.
Adding work requirements in the program is also on the table and is pegged to save $120 billion.
Which ones would get the most opposition from Dems?
They’d pretty much all be nonstarters for Democrats and even some Republicans. Medicaid insures more than 70 million Americans, and any legislation that might reduce coverage in the program would be fiercely opposed by Democrats and could be a tough vote for Republicans in swing districts.
The proposed ACA changes involve enhanced premium tax credits that expire at the end of the year, setting up a major policy battle.
Democrats broadly support extending the enhanced subsidies, which have lowered premium costs for many Americans and led to record ACA marketplace enrollment. Many Republicans support letting them expire, arguing they’re raising health care costs, but moderate Sen. Lisa Murkowski (R-Alaska) recently said she supports extending them. Either way, Republicans will have a difficult choice: spend hundreds of billions to buoy Obamacare enrollment or raise premium costs significantly heading into an election year in 2026.
Are there any proposals that could get bipartisan agreement?
Site-neutral payments are a more bipartisan option under consideration. Limiting eligibility for ACA plans based on citizenship status could receive more bipartisan interest than it might have previously, given Democrats’ pivot on immigration after a tough election cycle. But most of the options are not expected to receive much, if any, Democratic support…
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