Here’s What RFK Jr. Can and Can’t Do if Confirmed as HHS Chief

President Trump said he would take health agencies in a new direction on the campaign trail and has chosen some controversial nominees to help him achieve his goal, including Robert F. Kennedy Jr., Trump’s pick for HHS secretary.

However, it remains unclear how much could actually change if Kennedy were to be confirmed. To answer that question, MedPage Today spoke with legal experts, former CMS and White House officials, and others who worked alongside health agencies to gauge the potential for substantial reforms across HHS and its sub-agencies.

Can Kennedy Terminate Employees at FDA, Other Agencies?

In October, Kennedy posted on X that “FDA’s war on public health is about to end.” He criticized the agency’s “aggressive suppression” of a number of unproven therapies, including ivermectin and hydroxychloroquine, and warned, “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”

If confirmed as HHS secretary, would Kennedy have the authority to overhaul the FDA and clear out “entire departments,” as he said he planned to do? Lawrence Gostin, JD, a professor at Georgetown Law School in Washington, D.C., said Kennedy has “extensive power” to reorganize the federal workforce, but it isn’t unlimited.

He may get some help from Trump, who issued an executive order to reclassify certain federal employee positions in a way that would make it easier to fire them at will, Gostin said. This order seeks to restore a 2020 executive order, which Biden rescinded in January 2021.

Public servants do have civil service and whistleblower protections, Gostin noted. “They can complain publicly about malevolent intentions,” and would likely have a “valid legal challenge” if they sued that could at least delay the reclassification process.

In April, the Office of Personnel Management under President Biden issued a final rule to prohibit this type of reclassification. If the president was to “follow the letter of the law,” he would need to revoke the prior rule, which includes issuing a notice, holding a hearing, and having “good reasons” for that revocation that could withstand court challenges, Gostin said. “I think [Trump] may succeed, ultimately, if he perseveres,” but he also might drop these efforts if enough civil servants retire or quit on their own.

Steven Balla, PhD, an associate professor of political science at George Washington University in Washington, D.C., told MedPage Today, “I’m convinced that a lot of this is rhetoric that’s designed to demoralize and shrink the federal workforce through ‘voluntary’ resignations.”

Gostin said that the only “real check” on Trump’s authority relates to centers or divisions having statutory functions — meaning their funding or authorities come directly from Congress. In those cases, Trump and Kennedy would need Congress’s help to undo or eliminate those functions. “But if it’s simply a matter of reorganizing how an agency is constituted, [Kennedy] has quite extensive power to do that, and that’s alarming,” he added.

Ashish Jha, MD, dean of the Brown University School of Public Health in Providence, Rhode Island, and former White House COVID-19 Response Coordinator under Biden, agreed with Gostin. “He can definitely reorganize … but it’s going to be hard to shut entire agencies down,” he said.

Tom Scully, JD, who served as CMS administrator under President George W. Bush, noted that it wouldn’t hurt to trim down at least one of the agencies a bit. “I went through the [CMS org chart] and there are offices I never heard of when I was there 20 years ago,” he told MedPage Today.

Scully, who sees himself as a “pretty moderate Republican,” said if he was in government now he would probably eliminate 25% of the offices he saw on the org chart.

On the other hand, the Trump administration’s effort to require all federal employees to go to their offices 5 days a week could have unintended consequences as it potentially forces a lot of early retirements, he added.

“Some people will say, ‘Great.’ I would say, ‘It depends,'” said Scully, who is now a principal at Federal Health Policy Strategies, a Washington consulting firm. “If you lose the good people, you’re in trouble.”

Can Kennedy Pause Research on Infectious Diseases, Direct Half of NIH Funding to Holistic Health?

At an anti-vaccine conference in 2023, Kennedy, who was still running as an independent candidate for president, said he would tell NIH scientists, “Thank you for [your] public service. We’re going to give infectious disease a break for about 8 years.” Later, in a September 2024 editorial for the Wall Street Journal, in which he endorsed Trump for president, Kennedy suggested that half of the NIH’s budget should be directed to “preventative, alternative, and holistic approaches to health.”

Gostin said, as HHS secretary, Kennedy will have “certain flexibility” to allocate where research dollars are spent, but at NIH in particular, Congress funds certain centers and programs. So, “without congressional action to readjust those financial flows, he’s going to have relatively limited ability to make the kind of radical changes that he wants to see,” he noted.

Also, given the number of Republicans in Congress with a vested interest in research on childhood cancers, heart disease, diabetes, and even infectious diseases, it would be “very, very difficult,” although “not impossible” to change that, he added.

Can Kennedy Reverse Vaccine Approvals, Overhaul Vaccine Advisory Committees?

FDA approvals are granted at the center director level, which is not currently a political appointment, but the HHS secretary does make the final decision, Gostin said.

Paul Offit, MD, a former member of the Advisory Committee on Immunization Practices (ACIP) at CDC and a current member of the FDA’s Vaccines and Related Biological Products Advisory Committee, noted that if the FDA’s vaccine advisory committee recommends a vaccine be licensed and the FDA agrees, the HHS secretary could disagree. “He can say, ‘I think this vaccine hasn’t been tested well enough,'” or even that existing vaccines have not been tested enough.

Kennedy has previously made such arguments. In 2021, he lobbied the FDA to revoke the authorization of the COVID vaccines, even while thousands of people were dying weekly from the virus. In recent months, however, Kennedy has appeared to moderate his stance, telling Republican senators that he won’t take away vaccines and that he just wants to make safety and efficacy data more readily available.

But Offit noted that Kennedy still believes vaccines cause autism despite “abundant evidence” that they do not. “When he says … ‘I just care about vaccine safety,’ what he really means is he wants to see studies done to confirm his immutable, fixed, science-resistant beliefs,” he said.

Donald Berwick, MD, president emeritus of the nonprofit Institute for Healthcare Improvement in Boston and a former CMS administrator under President Obama, noted that to change vaccination policies reflected in CDC regulations, an HHS secretary would have to follow the rule-making process and provide a 30- or 60-day comment period under the Administrative Procedure Act.

“You can always ignore the law, but when you’re a public official … you’ve taken an oath, and violating that oath has consequences,” Berwick said, adding that there needs to be enforcement of those consequences.

Jha noted that as HHS secretary, Kennedy would yield “soft power” over the heads of other agencies, including CMS, FDA, NIH, and CDC. “They’re not going to want to make decisions that are going to upset him,” he said.

Gostin argued that making vaccine bans the “holy grail” of an anti-vaccine agenda is flawed, given the many ways Kennedy, as HHS secretary, could potentially undermine trust in immunizations. Although he has the power to reverse an approval, Kennedy might hesitate to do so given the “enormous” backlash he could face, and likely would instead undermine vaccines in other ways — such as by appointing vaccine skeptics to advisory committees such as ACIP, he said.

Balla pointed out that there are stipulations in the Federal Advisory Committee Act (FACA) that govern how these committees are constituted and operate. When there’s an opening, usually a call is issued in the Federal Register and an open application process follows. Balla also noted that a share of seats are reserved for certain stakeholders to ensure committees are balanced.

In the “bad old days” before FACA, Balla said, committees would hold non-public meetings and be stacked with certain types of stakeholders. The balance and solicitation requirements seek to prevent that. “So, that makes it harder to, just by fiat, change the composition of the advisory committee,” he noted.

Still, as Gostin pointed out, the CDC director makes nominations for the advisory committees, and appointments are ultimately determined by the HHS secretary. And Kennedy, by leveraging anti-vaccine allies on these committees, could ensure that even approved vaccines would not receive coverage under the Affordable Care Act.

“Even more insidiously,” he added, “he could cherry-pick data, [and] use misleading health communications to foment doubt and distrust in certain vaccines,” and “a number of red states” would likely change their school immunization requirements as a result.

Additional Checks and Balances

Other forces could limit Kennedy’s plans, but for Offit, Congress is unlikely to be one of them. “The mere fact that they might confirm him tells you that you should worry about them ever pushing back” on his actions, he said.

Kennedy’s confirmation hearing with the Senate Finance Committee is scheduled for Wednesday, and he has a hearing with the Senate Committee on Health, Education, Labor, and Pensions on Thursday.

For Jha, one check on Kennedy’s power is the sheer number of rules that government officials have to follow. “It’s hard to make reform inside government … You can do window dressing, but substantive reform is very, very hard, and I don’t know that [Kennedy has] got the team or the capability or the patience to do it,” he said. Plus, if he’s not careful, lawsuits will inevitably follow, he added.

“The truth is that I think the biggest bulwark against really egregious behavior is likely to come from the courts,” Jha said. “I think at least for the next 2 years … if anybody is doing anything, it’s going to be the courts.”

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