Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. spent nearly a full day before Congress on Wednesday defending the administration’s FY 2027 HHS budget request and its health policy direction, appearing before both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee.
While the hearings focused formally on funding, the senators used the opportunity to question Kennedy’s broader leadership, including his approach to vaccines, the Centers for Disease Control and Prevention (CDC), Medicaid policy, and a recently launched AI-enabled prior authorization model in Medicare.
The appearances capped a week-long series of budget hearings examining the administration’s proposed $111.1 billion HHS budget for 2027, which represents a 12.5 percent decrease from current-year funding. The proposal reduces funding for some research and public health programs while consolidating functions across the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration, the Office of the Assistant Secretary for Health, and parts of the CDC into a new entity—the Administration for a Healthy America—aligned with Kennedy’s “Make America Healthy Again” agenda and focused on disease prevention.
Budget cuts vs budget restructuring
A central dispute was whether the 2027 budget proposal amounts to cuts to Medicaid and public health programs or reflects a restructuring that preserves overall spending growth.
Kennedy rejected the characterization of the budget as cutting Medicaid, pointing to Congressional Budget Office projections showing Medicaid spending rising from roughly $600 billion to nearly $900 billion by 2036. “Only in Washington is that considered a cut,” he said during the Finance Committee hearing, arguing that the budget shifts resources toward prevention and efficiency rather than reducing total federal support.
Democratic lawmakers countered that long-term projections obscure near-term impacts on states, providers, and patients. They cited budget analyses showing tens of billions of dollars in reduced Medicaid outlays over the next several years and warned that states could respond by tightening eligibility, reducing benefits, or lowering provider payments—changes they said could disproportionately affect rural communities.
Kennedy pointed to a proposed $50 billion Rural Health Transformation Fund, calling it the largest federal rural health investment to date. “We are increasing the influx of federal dollars to rural hospitals by 50 percent,” he said, arguing that the fund would stabilize financially vulnerable facilities and expand access in underserved areas.
Prevention agenda under scrutiny
In his opening statement, Kennedy framed the budget as a reset away from what he described as a profit-driven health care system toward one focused on prevention, nutrition, and lifestyle interventions. He highlighted initiatives such as updated dietary guidelines, expanded nutrition education requirements for medical schools, and efforts to align Medicare, the Supplemental Nutrition Assistance Program (SNAP), and school meals with disease-prevention goals.
“Eighty or 90 percent of our health care costs are chronic disease that are diet-induced,” Kennedy said, arguing that clinicians need tools beyond pharmaceuticals to address conditions such as type 2 diabetes.
Sen. Tina Smith (D-Minn.) challenged Kennedy on what she described as a disconnect between his stated support for preventive health care and specific budget proposals that she argued reduces access to essential preventive services. She cited reductions to the National Breast and Cervical Cancer Early Detection Program, noting that some hospitals have paused screenings as a result, and raised concerns about reduced access to mental health services given Medicaid’s role as the largest payer of behavioral health care.
Smith also criticized the administration’s proposal to eliminate Title X funding, a long-standing program that provides contraception and preventive care to low-income women. She argued that eliminating the program would increase unintended pregnancies and reduce access to cancer screenings, ultimately raising Medicaid costs.
Kennedy disputed the claim that the budget reduces preventive care overall, saying programs are being consolidated and, in some cases, shifted to states through block grants. He argued that states are better positioned to tailor prevention strategies to local needs, while Smith countered that counties and local providers are already absorbing cost shifts and service reductions.
Vaccines and measles outbreak
The hearings also featured repeated exchanges over vaccines amid a growing measles outbreak.
Pressed by Sen. Ben Ray Luján (D-N.M.), Kennedy affirmed his support for measles vaccination. “We promote the measles vaccine. We advise every child to get the MMR,” he said during the HELP Committee hearing.
Other lawmakers, including Sen. Bernie Sanders (I-Vt.), accused Kennedy and the department of undermining public confidence in immunization and weakening CDC authority. Sanders argued that mixed messaging from federal leadership could contribute to declining vaccination rates, particularly during outbreaks.
Kennedy rejected those claims, saying the current measles surge is part of a global trend that predates his tenure and that declining trust in public health institutions largely stems from the COVID-19 era, not current HHS leadership.
WISeR model: AI-driven prior authorization
Senators also raised concerns about the Medicare Wasteful and Inappropriate Service Reduction (WISeR) pilot program, an AI-assisted prior authorization model aimed at reducing fraud, waste, and abuse in high-cost service categories.
Lawmakers said constituents and providers have reported delays and denials for services that were previously routinely approved, including spinal injections and orthopedic procedures. Some senators warned that prolonged delays could worsen patient outcomes.
Kennedy acknowledged problems with the rollout, calling care delays “unacceptable,” but defended the program’s underlying rationale. He said WISeR was developed in response to sharp increases in spending on certain services, citing skin substitute billing that grew from $250 million to $23 billion over three years, along with similar trends in spinal and arthroscopic procedures.
He emphasized that AI tools are intended to support—not replace—human decision-making. “It’s supposed to have a human supervisor,” Kennedy said, adding that denied claims are meant to receive human review as the agency works through what he described as early implementation challenges.