Former Independent-candidate Robert F. Kennedy Jr.’s ambitious agenda to “Make America Healthy Again” is already facing significant legal and bureaucratic fights as he prepares to reshape national health policy under the President-elect Donald Trump’s second administration.
While Kennedy has pledged transparency in vaccine policy, experts say his authority would be limited by state control over public health decisions — and they expect pushback by Democrat-controlled states.
“Under the Constitution, states hold the authority to make public health decisions such as school vaccine requirements, which could be an important guardrail,” said Lawrence O. Gostin, health law expert at Georgetown University, warned.
Kennedy, under attack by the media, has defended his stances recently, telling NBC, “If vaccines are working for somebody, I’m not going to take them away. People ought to have choice, and that choice ought to be informed by the best information.”
His greatest influence could come through Health and Human Services agency restructuring and appointments.
“There is a lot of leeway that an administration has, that they don’t need support from Congress to change how things are organized, to change the emphasis,” explained Jennifer Kates, senior vice president at KFF.
Kennedy has also specifically targeted FDA reform, suggesting elimination of certain departments.
“In some categories there are entire departments, like the nutrition departments at FDA, that have to go, that are not doing their job. They’re not protecting our kids,” he said.
Some experts have defended Kennedy’s concerns about industry influence, even while taking parting shots at the longtime Democratic environmentalist lawyer.
Ezekiel Emanuel, vice provost at the University of Pennsylvania, said, “The conflict of interest of people making recommendations, those things are correct. But I think he’s put this in a whole worldview of conspiracy theories, experts are always trying to deceive people, that is just totally wrong.”
Key fights coming for Kennedy include civil service protections for career scientists and congressional oversight, who have promised to “fight like hell” against reforms.
“Another guardrail is the fact that we have an enormous well of career scientific professionals who have civil service protection, whistleblower protection, and would fight like hell,” Gostin added.
Kennedy’s plans to redirect NIH funding toward alternative medicine and preventive care, along with potential changes to Medicare’s payment formula, signal broader systemic changes.
However, these goals require navigating complex regulatory, bureaucratic, and legislative processes.
The FDA’s reliance on industry user fees, which fund about half its budget, presents another challenge to Kennedy’s reform agenda. No clear alternative funding source has been identified if these fees were eliminated.