In this edition of the Situation Report, we explore major disruptions in U.S. health policy and governance. RFK Jr.’s contentious Senate testimony has intensified debates over vaccine policy and leadership. Meanwhile, several states are independently revising vaccine mandates, diverging from CDC guidance amid growing public health uncertainty. Additionally, CMS has launched investigations into Medicaid spending on immigrant care, raising concerns about access and program stability. AcademyHealth is actively monitoring these developments, advocating for evidence-based decision-making, supporting researchers navigating these challenges, and amplifying the critical role of rigorous health services research in informing policy.
In today’s issue:
- RFK Senate Hearing & Implications for Health Research
- Florida Calls for End to Vaccine Mandates, Omits Data Review
- CMS to Investigate Medicaid Spending on Care for Immigrants
- States Forge Independent Vaccine Policies Amid Federal Policy Changes
RFK Jr. Senate Hearing & Implications for Health Research
Health secretary Robert F. Kennedy (RFK) Jr. responded to questions about vaccines, health policy, and leadership during an oversight hearing in the Senate Finance Commitee last Thursday. The three-hour hearing proved contentious, with both democrats and republicans posing numerous pointed questions including why Kennedy limited parents’ freedom to choose vaccination for their children and about his discrediting comments about CDC employees prior to the recent shooting at the headquarters.
On Sunday, President Trump ultimately defended RFK Jr., however, continued to communicate conflicting messaging including some supporting vaccines. Trump described Kennedy as an “outside-the-box thinker,” and praised his unique ideas for progress on understanding autism, however, also called some vaccines “incredible” and warned against guidance that recommends some people do not need to be vaccinated.
The Senate and presidential reactions illustrate the ongoing debate over CDC leadership and vaccine policy, highlighting challenges for clear public health communication. AcademyHealth’s President and CEO Aaron Carroll recently noted in a New York Times op-ed that while the U.S. health system faces challenges such as high costs, complexity, and inequality, it also includes many institutions and programs that have driven significant improvements in health outcomes. Vaccination programs, advances in cancer treatment, and the work of agencies like the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Agency for Healthcare Research and Quality (AHRQ) have contributed to measurable improvements in child survival, disease prevention, and medical innovation.
Carroll writes: “Americans are right to demand more from their health care system. But if we tear down the parts that work — the research, prevention, regulation and education that have driven decades of progress — we won’t be left with something stronger. We don’t need to burn down the house. We need to fix the plumbing.”
Florida Calls for End to Vaccine Mandates, Omits Data Review
Florida Surgeon General Joseph Ladapo confirmed that no data projections were conducted prior to the decision to lift vaccine mandates, highlighting a policy choice not driven by empirical evidence. Indeed, according to Ladapo, “there’s this conflation of the science... and what is the right or wrong thing to do.” This move raises concerns about the potential rise in preventable disease cases, especially for children who rely on herd immunity due to being immunocompromised. Ladapo defended the decision by framing it as an issue of parental rights, underscoring his stance that government intervention should not extend to vaccine mandates. This situation sets a precedent for the field of health services research as it demonstrates that policymakers are taking approaches that differ from standard evidence-based guidance, highlighting the importance of research-informed decision-making. Policymakers, researchers, and parents are urged to consider the implications of this policy shift, especially for vulnerable populations who rely on herd immunization.
States Forge Independent Vaccine Policies Amid Federal Policy Changes
Amid sweeping changes in vaccine policy at the federal level, a growing number of states are asserting greater autonomy is developing immunization guidelines. Notably, California, Oregon, Washington, and Hawaii have banded together to launch the new West Coast Health Alliance. This collaborative aims to protect scientific expertise and develop immunization guidelines that would be informed by national medical organization expertise. Similar state-based action is being recognized in the Northeast as well. New York declared a statewide disaster emergency in order to preserve access to COVID vaccines, and Massachusetts is requiring insurers to pay for vaccines recommended by the state. This shift exemplifies how state health leaders are turning away from the CDC who has been the longstanding source of immunization guidance to alternate scientific bodies to inform policy.
CMS to Investigate Medicaid Spending on Care for Immigrants
The Centers for Medicare and Medicaid Services (CMS) has launched Medicaid spending probes in at least six states that provide comprehensive health coverage to poor and disabled immigrants without permanent legal status. Even though states are allowed to bill the federal Medicaid program for emergency and pregnancy care for individuals without legal status, CMS is reviewing claims paying for these individuals’ health care, ostensibly looking for waste, fraud, or abuse. Federal officials have sent letters notifying state health agencies in California, Colorado, Illinois, Minnesota, Oregon, and Washington of their review of federal and state payments for medical services. These investigations are following the Trump administration’s reconciliation bill which cuts funding for Emergency Medicaid, reduces immigrant eligibility for Medicaid, and implements work reporting requirements for the broader Medicaid expansion population. Experts note these steps could impede access to care and leave safety net hospitals, clinics, and other providers financially vulnerable. While some states area already looking to cut costs of their Medicaid programs for immigrants, 20 states are suing the Trump administration for handing over Medicaid data on millions of enrollees to deportation officials, a move which a federal judge temporarily halted. Experts note that the examples the administration points to as fraud, such as California erroneously billing the federal government for some care, is due to the complexity of the Medicaid program, which involves overlapping federal and state funds, as well as rules. Health services researchers should continue to educate policymakers about the impacts these rulings will have on different populations and how federal and state policymakers can work together to address payment issues as they occur.
Previous Updates
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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