Sen. Bill Cassidy (R), a physician-turned-politician from deep-red Louisiana, has emerged as a central figure in the confirmation fight over Robert F. Kennedy Jr. to lead the Department of Health and Human Services.
Over the course of six hours in two hearings, Cassidy indicated he holds serious doubts about whether Kennedy is qualified to lead the agency, casting a cloud of uncertainty over Kennedy’s path to confirmation.
“I have been struggling with your nomination,” Cassidy told Kennedy at the end of Thursday’s Senate Health, Education, Labor and Pensions (HELP) Committee hearing.
He said the pivotal question is if Kennedy will use his massive following and national prominence to support public health or undermine it.
“And I got to figure that out for my vote,” Cassidy said.
Cassidy gave Kennedy numerous opportunities Thursday to renounce his prior false claims that vaccines cause autism, at times practically pleading with Kennedy to disavow the link.
“Man, if you come out unequivocally, ‘Vaccines are safe, it does not cause autism,’ that would have an incredible impact,” Cassidy said.
But Kennedy, who has renounced his previous views on abortion to align with President Trump, refused to do so.
“If you show me data,” Kennedy said, “I will be the first person to assure the American people that they need to take those vaccines.”
While the HELP Committee that Cassidy chairs won’t vote on Kennedy, he also sits on the Finance Committee, where he could be a pivotal vote. Republicans hold a one-seat advantage, so if all Democrats vote against Kennedy, Cassidy will have the power to deny him a favorable recommendation.
If Kennedy clears the Finance Committee, he can afford to lose three Republican votes on the Senate floor. The three GOP senators who voted against Defense Secretary Pete Hegseth — Sens. Mitch McConnell (Ky.), Lisa Murkowski (Alaska) and Susan Collins (Maine) — are all seen as potential wildcards on Kennedy as well.
How Cassidy handles the Kennedy situation will have serious political consequences for the second-term senator, who is being squeezed by his loyalty to Trump and his commitment to sound medicine, having spent three decades as a practicing gastroenterologist.
Robert Hogan, department chair and political science professor at Louisiana State University, said Cassidy has spent years trying to cultivate an image of himself as a reasonable conservative.
“The physician part of his biography is highlighted prominently in everything that he does. He wants to be viewed as an expert in that area,” Hogan said. “This vote, he recognizes is something that may damage his brand that he has spent so long trying to hone over the years.”
There is enormous pressure on Cassidy from Kennedy allies as well as Republicans at home.
Earlier this week, the Louisiana Freedom Caucus sent Cassidy a letter urging him to confirm Kennedy.
Louisiana Gov. Jeff Landry (R) in a separate letter also called on Cassidy to confirm Kennedy.
Echoing the Freedom Caucus, Landry indicated Kennedy would help to bring back the trust to physicians and public health that was lost due to Biden administration policies during the COVID-19 pandemic
“Kennedy proved to be an asset to the state as we navigated the edicts of the federal government,” Landry wrote in the letter, which was posted to social media.
But Cassidy is already at odds with Republicans over his vote to convict Trump in his 2021 impeachment, for which he was formally censured by the state GOP.
“The linchpin, you know, on RFK is going to be Cassidy and he’s got a very very difficult choice,” a source close to the Trump team said. “He is very likely to have a very difficult primary and he already… carries the weight on how he voted to impeach Trump.”
That sentiment is apparent to other conservatives.
After Kennedy’s hearing on Thursday, Rep. Clay Higgins (R-La.) taunted Cassidy on social media.
“RFK is going to run HHS whether you like it or not. The Senate is ours, and the moment Trump decides he’s had enough of random Senators delaying our mission, [Vice President JD Vance] is walking in and taking the gavel as President of the Senate. There’s zero you can do about that,” Higgins wrote. “So, vote your conscience Senator, or don’t. Either way, We’re watching.”
Cassidy is up for reelection in 2026 and while he hasn’t formally announced, he has said he plans to run.
Cassidy won his 2020 election in a landslide, but after his vote against Trump, state Republicans changed the rules to create a closed primary, where only Republicans and people who aren’t registered in any other party can vote.
State Treasurer John Fleming (R), a former House member, has already launched his primary campaign against Cassidy.
Hogan said Cassidy’s reelection bid is already an uphill battle.
“Even if he votes [for] Kennedy, I think he’s going to be viewed as a little bit too late,” Hogan said.
A Senate GOP aide said the Kennedy confirmation will be a “pivotal moment” in whether Cassidy runs for reelection or retires.
“If he’s a no on RFK, they think he’s going to retire. And if that becomes the case, then he very much becomes an undecided vote on much of the Trump agenda moving forward,” the aide said.
Cassidy himself seemed to acknowledge the tension when he questioned whether Kennedy could harm Trump’s legacy.
“I’m a Republican … I want President Trump’s policies to succeed,” he said.
But if someone doesn’t get vaccinated because of Kennedy’s “policies or attitudes” and later dies of a vaccine-preventable disease, Cassidy said the blame would fall on Kennedy, and by extension, Trump.
“The greatest tragedy will be her death. But I can also tell you an associated tragedy … that will cast a shadow over President Trump’s legacy, which I want to be the absolute best legacy,” Cassidy said.
Alex Gangitano contributed.
