WASHINGTON – Today, U.S. Senator Bill Cassidy, M.D. (R-LA) questioned Robert F. Kennedy Jr., nominee for Secretary of the U.S. Department of Health and Human Services (HHS), at his confirmation hearing before the Senate Finance Committee.
Senator Cassidy: Mr. Kennedy, President Trump has sworn to protect Medicare. Republicans are exploring reforms to Medicaid that could help pay for Trump administration priorities. With this context, what will you do about dual eligibles?
Mr. Kennedy: About—
Senator Cassidy: Dual-eligibles.
Mr. Kennedy: Well, dual-eligibles are not right now served very well under the system. Those are people who are eligible for both Medicaid and Medicare. And I, you know, I suppose my answer to that is to make sure that the programs are consolidated, that they are integrated, and that care is integrated. I look forward to working with you, Dr. Cassidy, on making sure that we take good care of people who are dual-eligible.
Senator Cassidy: How would we—how do you propose that we integrate those programs? Does Medicare pay more, Medicare pay less, Medicaid pay more, Medicaid pay less? How do we do that?
Mr. Kennedy: I’m not exactly sure because I’m not in there. I mean, it is difficult to integrate them because Medicaid—Medicare is under fee for service, paid for by employer taxes. Medicaid is fully paid for federal government and it’s not fee for service. So, it’s—I do not know the answer to that. I look forward to exploring options with you.
Senator Cassidy: Republicans again are looking at ways to potentially reform Medicaid to help, you know, pay for President Trump’s priorities, but to improve outcomes. What thoughts do you have regarding Medicaid reform?
Mr. Kennedy: Well, Medicaid is not working for Americans, and it’s specifically not working for the target population. Most Americans like myself, I’m on Medicare Advantage, and I’m very happy with it. Most people who are on Medicaid are not happy. The premiums are too high, the deductibles are too high. The networks are narrow. The best doctors will not accept it at the best hospitals. And particularly, Medicaid was originally designed for a target population, the poorest Americans. It’s now been dramatically expanded. And the irony of the expansion is that the poorest Americans are now being robbed. Their services have dramatically decreased even though we’ve increased the price of Medicare by 60 percent over the last 4 years. The target population is being robbed. We need to figure out other options.
Senator Cassidy: With that said, obviously you’ve thought about that and I appreciate that. What reforms do you recommend, again, that would improve services I suppose, but also make it more cost efficient?
Mr. Kennedy: Well, President Trump has given me the charge of improving quality of care and lowering the price of care for all Americans. There are many things that we can do, I mean, what we want to, the ultimate outcome, I think, is to increase transparency, increase accountability, and to transition to a value-based system rather than a fee-based system—service-based system.
Senator Cassidy. On Medicaid in particular, can you just kind of take those kind of general principles and apply it to the Medicaid program?
Mr. Kennedy: You know I, listen, I think that there are many, many options with telemedicine, with AI right now. And, you know there’s a—including direct primary care systems, we are seeing that movement grow across the country. There’s a—one of the largest providers—
Senator Cassidy: So, so knowing, going back to Medicaid, though. And speaking of these specific advances, how would you, what reforms are you proposing, with these ideas vis a vis Medicaid?
Mr. Kennedy: Well, I don’t have a broad proposal for dismantling the program—
Senator Cassidy: I’m not saying—of course not saying that.
Mr. Kennedy: I think what we need to do is we need to experiment with pilot programs in each state. We need to keep our eye on the ultimate goal, which is value-based care, which is transparency, accountability, access.
Senator Cassidy: And one more thing, going back to Medicare, you mentioned you’re an MA. You mentioned earlier the Medicare fee for service. Do you have any kind of thoughts as to, whether or not patients on fee for service should move into MA or how should we handle that?
Mr. Kennedy: Whether patients—
Senator Cassidy: Who are on Medicare fee for service.
Mr. Kennedy: For traditional Medicare?
Senator Cassidy: Yes.
Mr. Kennedy: That’s their choice right now. I mean, we have I think 32 million Americans, or 30 million Americans on Medicare—on traditional Medicare, and then another 34, or thirty—34 on Medicare Advantage, roughly half and half. And I think more people would rather be on Medicare Advantage because it offers very good services, but people can’t afford it. It’s much more expensive. Oh, and answer to your first question, there, you know, are all kinds of exciting things that we can be doing, including cooperatives, which President Trump has supported, including health savings accounts, which President Trump has supported. All of these things to make people more accountable for their own health.
Senator Cassidy: And so we bring the cooperatives and the health savings accounts into Medicare and Medicaid?
Mr. Kennedy: Exactly. We try to—try to increase those, the use of those and to direct primary care to continue to transition into a value-based program that is private. Americans don’t, by and large, do not like the Affordable Care Act. People are on it. They don’t like Medicaid. They like Medicare. And they like private insurance. We need to listen to what people, they would prefer to be on private insurance. Most Americans, if they can afford to be, will be on private insurance. We need to figure out ways to improve care, particularly for elderly, for veterans, for the poor in this country, and Medicaid, the current model is not doing that. I would ask, you know, any of the Democrats who are chuckling just now. Do you think all that money, the $900 billion that we’re sending to Medicaid every year has made Americans healthy? Do we think it’s working for anybody? Are the premiums low enough?
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