RFK Jr. Wrong on Medicare, Medicaid During Senate Confirmation Hearing

MedPage today story.

Robert F. Kennedy Jr.'s statements before the Senate Finance Committee on Wednesday revealed a troubling lack of knowledge about the major health care programs he would oversee if confirmed as HHS secretary.

Several times during the 3.5-hour hearing, Kennedy appeared to confuse Medicare, Medicaid and Medicare Advantage and appeared to erroneously refer to health care exchanges under the Affordable Care Act.

“Medicaid is not working for Americans, and it especially is not working for the target population,” he said in response to questions from Sen. Bill Cassidy, M.D. (R-La.), a physician who asked him how he would improve the health care delivery system.

“I get Medicare Advantage and I’m very happy about it,” Kennedy responded. “Most people on Medicaid are unhappy. Insurance premiums are too high, deductibles are too high, networks are narrow.”

In fact, Medicaid plans typically do not have premiums, and if they do, federal law requires them to be kept low based on income.

Asked by Cassidy what reforms he would propose, Kennedy replied, “Well, I don't have a proposal to curtail the program.” He later gave vague answers to Cassidy's question about how he would improve programs for dual eligibles: about 12 million beneficiaries – often with complex health problems – who qualify for Medicare but, because of their low income, also qualify for Medicaid.

“Well, the system doesn't currently account for dual eligibles very well,” Kennedy responded. “And you know, I guess my answer to that is to make sure that programs are consolidated, they're integrated, and care is integrated. I look forward to working with you, Dr. Cassidy, to make sure we take good care of people.”

Cassidy then asked how he proposed integrating the programs. “Does Medicare pay more? Does Medicare pay less? Does Medicaid pay more? Does Medicaid pay less? How can we do this?

“I'm not really sure because I'm not there. I mean, they're hard to integrate…” he responded, eventually saying, “I don't know the answer to that question. I look forward to exploring my options.”

Kennedy also said that Medicare beneficiaries “would prefer to use the Medicare Advantage program because it offers very good services. People can't afford it. It's much more expensive.”

In fact, beneficiaries of MA plans typically pay no or very low premiums and choose their plans because of low or non-existent upfront costs. However, it is true that MA plans typically cost the trust much more than if the same beneficiaries were in traditional Medicare – $82 billion even more in 2023, according to the Medicare Payment Advisory Commission.

At another point, Kennedy stated that Medicaid is “paid entirely by the federal government,” when in fact it is paid through mixing This is an important concept to understand because coverage and eligibility requirements for each Medicaid program can vary greatly depending on the complex federal waiver programs administered by HHS agencies.

The American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) held a joint media briefing Wednesday after the hearing, questioning Kennedy's suitability to lead an agency that has 13 separate and important divisions, thousands of programs and 80,000 employees.

“… [H]He demonstrated that he did not have much experience in the health care field, and in many of his responses we saw that he had … a lack of management experience,” said Georges Benjamin, MD, executive director of APHA.

Benjamin noted that it is important for someone in this position to be “rigorous with the scientific evidence and not cherry picking, and understand things like health care financing, which he really didn't know the difference between Medicaid and the health care exchanges.”

“He talked about copays and premiums that were too high for Medicaid, even though Medicaid didn't have premiums to begin with,” Benjamin said. Also, “he made a statement that the NIH (National Institutes of Health) doesn't spend a lot of money on chronic diseases, which is completely untrue.”

Benjamin was asked, given the number of Kennedy's misrepresentations, whether he should be better informed at this point in the process about the Medicare and Medicaid programs and the problems with the programs for double right.

“He didn’t understand any of it,” Benjamin replied. “And you know, this is not rocket science…. [HHS] does a lot of things, but I said earlier that the country is spending 5 trillion dollars [on healthcare] and we rank near the bottom among other industrialized countries in terms of health indicators. There are many reasons for this, but he is not the guy who can fix it because he really doesn't know. He doesn't even understand the basics of what the department does.”

Julie Sweetland, Ph.D., a senior adviser at the Framework Institute, which conducts research on social issues and language, said during the briefing that Kennedy reported “quite a lot of misinformation.”

He has repeatedly stated that “most Americans are unhappy with Medicaid, although some of his comments suggest that he may not have fully understood what Medicaid is. … In fact, we know that more than 8 in 10 Medicaid enrollees rate Medicaid's overall performance positively, according to 2023 KFF data. vote“

Susan Kressley, MD, president of the AAP, was asked about Kennedy's statement to the committee that “most experts today agree, even the people who did it then, that COVID vaccines are not appropriate for 6-year-old children, who have virtually no risk of contracting COVID.”

Such remarks, along with Kennedy's oft-repeated opposition to other vaccines, which he now denies, raise concerns that he will find ways to discourage immunizations, perhaps by not requiring them to be covered as a basic benefit by Medicare or health insurance plans.

Kressley said Kennedy was wrong because children can experience complications from COVID months after recovery, she said. They also “tend to be spreaders of infectious diseases because they're not very good at blowing their noses and keeping their germs to themselves,” which could impact their families, schools and communities, she said.

“COVID doesn’t affect kids at all,” she said. “It actually has a huge impact.”