PRO-TWINKIE — He flip-flopped on vaccines. His answers on the health care system, particularly Medicare, Medicaid and the Affordable Care Act, were sloppy. He got the programs mixed up. He got the numbers mixed up. He got the financing mixed up. To put it mildly, Robert F. Kennedy Jr.’s confirmation hearing today to become Health and Human Services secretary didn’t exactly inspire confidence. Many of us who write about or work in health care occasionally say Medicare when we mean Medicaid — but we catch ourselves and fix it. We don’t get it wrong again and again through a three-plus hour hearing when we’re shooting for the top health job in the country. Between them, Medicare, Medicaid and the ACA cover somewhere around 170 million Americans — that’s roughly a third of the U.S. population. Oversight and regulation of those government health systems is under the Centers for Medicare and Medicaid Services, and Trump wants Dr. Mehmet Oz to run that. But CMS is part of HHS. As secretary, Kennedy would be atop it all. Yet he got them all jumbled up — and said they don’t work. And that everyone hates them. In one rambling answer, Kennedy said Medicare is paid for by employer taxes (in fact, it’s employer taxes, employee taxes, premiums, deductibles and tax dollars). He said Medicaid is “fully-paid for by the federal government” (no, it’s split with the states.). “Medicaid is not working for Americans,” he continued. “It is specifically not working for the target population. Most Americans like myself are — I’m on Medicare Advantage and I’m very happy with it. For most people, Medicaid is not working. The premiums are too high. The deductibles are too high. The networks are narrow. The best doctors will not accept it. The best hospitals will not accept it. The poorest Americans are being robbed.” Medicare Advantage has nothing to do with Medicaid. States cannot charge the poorest people Medicaid premiums, and they can impose only very modest costs on people a little further up the income chain. Kennedy is right, though, that a lot of doctors won’t take it because payment is low. Cutting it, as Republicans hope to do, won’t fix that. The nominee wouldn’t weigh in on whether the expanded subsidies for the ACA should be extended. Without congressional action, they’d expire at the end of this year. A lot of people would end up uninsured. The man who aspires to oversee and transform American health care replied, “Congress has to make its own decisions.” And so it went on. Confusing Medicare for Medicaid and misrepresenting public attitudes is bad enough. But Kennedy’s bigger problem might be his answers to questions about the U.S. health care system posed by the Louisiana Republican who might have the single biggest influence over whether he is confirmed as HHS secretary — Sen. Bill Cassidy (R-La.). Cassidy is a doctor. He knows a lot about health care. He’s more moderate than most Senate Republicans. And, as a member of the Finance Committee and the chair of the Senate HELP committee, which will hold its own confirmation hearing tomorrow, Cassidy could potentially sink the nomination. In response to Cassidy’s questions, Kennedy looked and sounded exactly like someone in a cold sweat nightmare trying to take an exam for a course he didn’t know he was enrolled in. He did, however, slip in a reassurance that even though he believes in healthier diets as the key to conquering chronic disease, he isn’t going to take away anyone’s Twinkies. Cassidy didn’t make his views about Kennedy known today — and the rest of the Finance Republicans, including North Carolina Sen. Thom Tillis who had been seen as a possible RFK opponent — all seemed supportive. As expected, the Senate Finance hearing today mostly split along party lines, and it centered largely on RFK Jr’s history of challenging vaccine safety and on his pledge to support President Donald Trump’s anti-abortion stance, even though he personally has long backed abortion rights. Kennedy insisted that wasn’t “anti-vax” and that he’d support the Trump administration on abortion, calling them “tragedies.” If nothing else, while he may have gotten the policy details wrong, Kennedy did a really good job throwing around the favorite jargony Capitol Hill catchwords – some of which Cassidy is particularly prone to use — about “transparency” “accountability” and “value-based care.” Plus, he nailed that Twinkies question — even though nobody actually had asked. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author on X (formerly known as Twitter) at @JoanneKenen.
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