Rural hospitals painted as bright spot in tense RFK Jr. Senate hearing: 3 takeaways

HHS Secretary Robert F. Kennedy Jr. appeared before the Senate Finance Committee on Sept. 4 to explain his ‘Make America Healthy Again’ agenda and defend sweeping changes to the CDC, vaccine policy and other federal health programs. 

Here are three of the central takeaways from the nearly three-hour hearing. 

1. Mr. Kennedy’s testimony drew bipartisan criticism for his position on vaccines. Sen. Bill Cassidy, MD, R-La., had secured a commitment from Kennedy during his February confirmation that he would not limit Americans’ access to vaccines — a commitment the senator says Mr. Kennedy has broken. In June, Mr. Kennedy dismissed all 17 members of the CDC’s Advisory Panel on Immunization Practices, replacing them with individuals Dr. Cassidy, a gastroenterologist, claims are mostly unscientific vaccine skeptics with financial ties to lawsuits against vaccine manufacturers.

The hearing also intensified Democrats’ calls for his resignation. “Robert Kennedy was unfit to serve as the Secretary of the Department of Health and Human Services before he was on the job, which is why every Democratic member of the Senate Finance Committee opposed his nomination,” 12 Democratic members of the committee said in a Sept. 4 statement. 

“The actions Robert Kennedy has taken since he was sworn in reinforce the danger he poses to the health of America,” the statement continues. “By discarding well-established science related to vaccines, elevating conspiracy theorists and self-interested charlatans to positions of public trust, and presiding over the largest cut to American healthcare in history, Robert Kennedy has reinforced every fear families had about him.”

Although three Republicans sided with Senate Democrats on Thursday to criticize Mr. Kennedy over vaccines, it remains uncertain whether Congress will take further action.

2. Rural hospitals positioned as a bright spot. Although much of Mr. Kennedy’s hearing with lawmakers was focused on vaccine policy and the state of public health agencies, several Republican lawmakers also discussed federal funding for rural hospitals included in the One Big Beautiful Bill Act. The legislation allocates $50 billion over five years through the Rural Health Transformation Program to support financially struggling rural hospitals.

Committee Chair Sen. Mike Crapo, R-Idaho, noted “a lot of attacks going on publicly about ‘hospitals are in trouble,’ and the blame for that is placed on the bill, even though the bill hasn’t even been implemented yet.” In response to questions about the program, Mr. Kennedy noted that the investment should stem the “hemorrhage” of financial problems and closures among rural hospitals across the U.S. Since 2015, 109 rural hospitals have closed, with 20 hospitals in rural and urban locations closing so far this year.

Independent analysis suggests the program would offset only part of the anticipated funding reductions. KFF’s analysis of Congressional Budget Office estimates found that the $50 billion would cover about 37% of the projected $137 billion in reduced federal Medicaid spending to rural areas over the next decade.

Unlike past federal relief efforts, the program does not provide direct payments to rural hospitals. Instead, CMS will issue grants to states, which must seek the agency’s approval to access and spend the funds. States are not legally required to direct any of the money to rural hospitals specifically.

CMS Administrator Mehmet Oz, MD, has broad authority to approve or deny state applications and decide how funding from the program’s discretionary pool is allocated. The law gives him the ability to define eligible activities, including uses that may have little to no direct connection to rural hospitals.

An Aug. 19 Bloomberg editorial said the rural fund risks becoming a “slush fund” due to vague criteria and limited transparency. Half the funds are awarded to states with rural transformation plans; the rest are distributed at HHS’ discretion. Critics warn that funds could be diverted to vendors or loosely defined health technology projects rather than directly aiding struggling hospitals. 

3. Questions linger over CDC leadership. Mr. Kennedy’s appearance before the Senate Finance Committee came amid several turbulent months at the CDC. He fired CDC Director Susan Monarez, PhD, Aug. 27, although the leaders’ accounts of the dismissal differ. Dr. Monarez wrote an op-ed in The Wall Street Journal Sept. 4 claiming she was “fired after 29 days because I held the line and insisted on rigorous scientific review.” Mr. Kennedy said he fired her because she was not “trustworthy” — a claim her lawyers have dismissed as “patently ridiculous,” according to Reuters. On Aug. 28, the Trump administration selected Jim O’Neill — HHS’ deputy secretary — to serve as acting CDC director. 

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