Policy News Roundup: February 6, 2025

RFK Jr.'s contentious HHS nomination hearings

Robert F. Kennedy, Jr., Trump’s nominee to lead the Department of Health and Human Services, had hearings before the Senate Finance and Senate Health, Education, Labor and Pensions Committees this week to consider him for the role.

Hearings highlights:

• On medications for opioid use disorder: Kennedy shed light for the first time on his attitudes towards medications for addiction treatment. When asked by Sen. Kim whether he supported the intervention, he answered, “Yes, I do.” When asked whether the medications represented the “gold standard” of opioid use disorder treatment, however, Kennedy instead said 12-step recovery programs did, claiming support from a Cochrane review. But he misrepresented the findings. The review he cited found that Alcoholics Anonymous is effective for alcohol addiction, but it did not analyze the effectiveness of 12-step programs for opioid use. Kennedy also said, “You need an entire retinue, entire menu of treatments, because many addicts will not respond, immediately at least, to 12-step programs. For many of them, Suboxone and even methadone are critical interventions that save lives, that get addicts off the street, and they should be available as a treatment option.”
• On integrating behavioral health: Sen. Cornyn noted that millions of Americans are experiencing mild to moderate mental health and substance use issues but that many struggle with timely and effective access, making it important that primary care providers are trained. Kennedy said that addiction and substance use services were a priority for him and noted his personal experience. He said he goes to 12-step meetings every day and hears the stories about barriers to accessing care. He highlighted using graduate medical education slots to address the issue and said primary care providers should be able to understand addiction care. He noted the importance of getting people care in the fleeting moments they may be ready for it.
• On recovery farms: Sen. Smith asked Kennedy if he believed Americans who take mental health medications are “addicts who need to be sent to wellness farms to recover,” which he denied saying. He said no one should be compelled to do anything but said the option should be available to them.
• On insurance: Kennedy repeatedly stumbled over basic details of the Medicare and Medicaid programs. His answers on Medicaid focused more on broad principles and buzzwords (e.g., integration, transparency, artificial intelligence, telemedicine, value-based care) than on specific policy proposals.

The first vote: The Senate Finance Committee voted to send Kennedy’s nomination to the full Senate.

What’s coming: The full Senate now has to vote on the nomination.

• Kennedy can afford to lose only three Republican senators, assuming Democrats are united in opposition. The questioning from Republicans at the hearings suggested Kennedy would get approval for a vote on the Senate floor. Sen. Cassidy, who had said he was deeply torn about his vote, ultimately voted to advance Kennedy’s nomination from the Finance Committee.

Sources: Senate Finance with HHS Secretary Nominee Kennedy (Politico); The 7 big topics RFK Jr. addressed during a fiery confirmation hearing (STAT)

The American Lung Association released the 2025 “State of Tobacco Control” report, which evaluates state and federal efforts to eliminate tobacco use and implement proven tobacco control laws and policies.

The findings:

It found that the tobacco industry is taking more aggressive actions at the federal and state levels to stop policies proven to prevent and reduce tobacco use. For example, the industry:

• Worked to stop the Biden administration from finalizing the Food and Drug Administration (FDA) rules to end the sale of menthol cigarettes and flavored cigars (and the Trump administration then withdrew the rule on Trump’s second day in office)
• Worked to stop or weaken state-level tobacco control policies such as restrictions on flavored tobacco products
• Introduced new products that appeal to youth (e.g., e-cigarettes that mimic smartphones, kid-friendly flavors, flavored nicotine pouches marketed by social media influencers)
• Used confusing messaging promoting smoking cessation for products that are not FDA-approved to help people quit smoking

Federal Report Card: The federal government received the following grades:

• Federal regulation of tobacco products: C
• Federal coverage of quit smoking treatments: D
• Level of federal tobacco taxes: F
• Federal mass media campaigns to prevent and reduce tobacco use: A
• Federal minimum age of sale for tobacco products to 21: A

Key actions for the Trump administration and Congress to take in 2025 include:

• At least maintaining current funding for Centers for Disease Control and Prevention’s (CDC) Office of Smoking and Health to ensure dissemination of the “Tips from Former Smokers” campaign and resources for youth prevention
• Protecting Medicaid to ensure people can access tobacco cessation treatments
• Removing illegal tobacco products from the marketplace and passing legislation requiring e-cigarette manufacturers to pay user fees
• Proposing and finalizing regulations to implement “track and trace” technology on all tobacco products
• Improving and expanding options for cessation medications

State Report Cards: The best graded states were California, D.C. and Massachusetts, and the worst were Alabama, Georgia, Mississippi and Texas. Maryland was the most improved state.

• Strength of smoke-free workplace laws: 11 states and D.C. earned an A
• Ending the sale of all flavored tobacco products: 46 states earned an F
• Funding for state tobacco prevention programs: 40 states and D.C. earned an F. Only Maine is funding its anti-tobacco efforts at or above the current CDC-recommended level. Texas, Georgia and Tennessee are at less than 5% of the recommended levels.
• Level of state tobacco taxes: 31 states earned an F
• Coverage and access to services to quit tobacco: 20 states and D.C. earned an A or B

The main point: Tobacco use prevention efforts continue to be vastly insufficient at both the state and federal levels.

Source: Tobacco Industry Escalates Efforts to Block Proven Policies, Damaging Nation’s Health (American Lung Association)

Early last week, the White House Office of Management and Budget (OMB) ordered a total freeze on “all federal financial assistance” that could be targeted under Trump’s previous executive orders pausing funding for a wide range of priorities.

The initial memo:

• In a memo, OMB announced all federal agencies should be forced to suspend payments, with the exception of Social Security and Medicare. This threatened to affect billions of dollars in grants to state and local governments while causing disruptions to programs that benefit many households.
• The memo instructed each agency to analyze their financial assistance programs and assess which ones fall afoul of the executive orders Trump issued. In particular, programs related to foreign financial aid, nongovernmental organizations, diversity and inclusion and “woke gender ideology,” were ordered paused for review.
• The memo said the pause did not include assistance “provided directly to individuals,” but it did not clarify whether that includes money sent first to states or organizations and then provided to households. It also did not detail all payments to be halted.
• The broad language threatened to ensnare federal health and assistance programs beyond those explicitly targeted. Experts said the memo could be interpreted to halt programs including medical research, food assistance, federally qualified health centers, Head Start and even Medicaid.

A follow-up memo: OMB later issued a follow-up memo instructing agencies to answer 14 questions by February 7 “for any program that has funding or activities planned through March 15.”

• The memo listed out the programs for which agencies must answer these questions. There are 434 Department of Health and Human Services programs identified in the document, including ones related to tobacco control and prevention, state opioid response grants, the substance use block grant, harm reduction technical assistance, Drug-Free Communities, Certified Community Behavioral Health Clinics, behavioral health workforce programs, mental health and addiction research, Office of National Drug Control Policy programs, mental health services, injury prevention and control research, support for health centers, etc.
• The follow-up memo said that the Supplemental Nutrition Assistance Program (SNAP) and Medicaid, as well as funds for Head Start, rental assistance and other similar programs would not be paused.
• The questions ask agencies about whether the programs provide services to undocumented immigrants, promote gender ideology or support abortion or diversity, equity and inclusion policies.

However: Despite the follow-up memo indicating that Medicaid payments should not be affected, states reported difficulties accessing Medicaid payment portals.

• States regained access the next day, but some reported that the site still wasn’t functioning “correctly.”

Then a pause from a judge: A federal judge temporarily blocked the order minutes before it was scheduled to take effect, with an administrative stay to expire Monday.

• The judge’s order is in response to a complaint filed by the National Council of Nonprofits, American Public Health Association, the Main Street Alliance and SAGE.

Then a rescind: The next day, OMB rescinded the memo that had ordered the pause on federal funding.

• But: White House Press Secretary Karoline Leavitt wrote on social media that, “This is NOT a rescission of the federal funding freeze.” She said the president’s executive orders on federal funding “remain in full force and effect, and will be rigorously implemented.” She appeared to be referring to the fact that the executive orders Trump signed the prior week, which directed government agencies to review and eliminate spending on so-called woke ideologies, remain in force.
• She said rescinding the memo should effectively end the court cases and “allow the government to focus on enforcing the President’s orders on controlling federal spending.”

The responses:

• There has been widespread confusion over how the memo would be implemented and whether it could face legal challenges. States, local governments and companies counting on grants and loans, including in the health industry, sounded the alarm.
• The Trump administration defended the order, with Leavitt calling the freeze “a very responsible measure.” She dismissed reports of widespread confusion.

The larger context:

• The freeze threatens to permanently alter the balance of power between the White House and Congress, with OMB declaring that “financial assistance should be dedicated to advancing Administration priorities.” Russell Vought, Trump’s nominee to lead OMB, has vowed to try to move power over spending from Congress to the executive branch, a battle experts said could be foreshadowed by this pause.
• The decision to rescind the directive was a significant reversal and the first major capitulation by Trump, who has not hesitated to use his executive power.

What’s coming:

• The alarm and confusion has remained even after the judge blocked the freeze and the White House rescinded the memo.
• Despite the fact that the memo was rescinded, the underlying intentions remain, and the administration is expected to find other ways to execute them. OMB may issue a new memo on another spending freeze, with administration officials arguing that such an action falls within the power of the executive branch.
• Trump has repeatedly contended that he has the authority to withhold congressionally approved spending that he considers wasteful, a practice known as impoundment that Congress prohibited in a 1974 law. The actions taken over the past week could open the door to an eventual court ruling granting that power.
• The actions also raise the prospect that Trump is attempting to interrupt spending that agencies have contractually obligated. Many expect Trump’s actions to play out in court, but that itself could stall or complicate pending dollars and programs. Already, the uncertainty is forcing some grant recipients, especially small nonprofits, to consider drastic measures as they remain unsure whether they can rely on finalized grants.
• A second federal judge said he intends to issue a new block on the effort to freeze federal spending, in response to a lawsuit from Democratic attorneys general. He said a bid by the White House to rescind a “hugely ambiguous” order implementing the freeze appeared to be undercut by Leavitt’s subsequent statement that the freeze was still in effect. The judge said that confusion suggested the harm caused by the original memo was still likely to occur.