With the midterm elections looming, the Department of Health and Human Services has become a key political battleground. In a significant move, Secretary Robert F. Kennedy Jr. recently appointed four senior officials to his inner circle, a decision aimed at accelerating the administration’s “Make America Healthy Again” agenda. To unpack the implications of this leadership shuffle, we’re joined by James Maitland, a distinguished expert in U.S. healthcare policy and politics. We’ll explore the strategic thinking behind these appointments, the operational challenges they present, and the high-stakes gamble of building a midterm campaign around a controversial secretary and his policies.
Let’s start with the new appointments. We have four senior officials—Chris Klomp, John Brooks, Kyle Diamantas, and Grace Graham—taking on advisory roles while keeping their day jobs. Could you break down what this move signals about the department’s priorities and the potential operational hurdles of having these key leaders essentially wearing two hats?
This is a classic move to centralize power and ensure message discipline, especially with an election on the horizon. By bringing in Chris Klomp, the Medicare director, as a de facto chief of staff, and top people from CMS and the FDA, Kennedy is surrounding himself with “battle-tested” individuals who know the inner workings of the most critical agencies. The signal is clear: the focus is on executing high-profile policies that can be touted on the campaign trail. However, the operational strain is immense. These are not trivial day jobs. Running Medicare or overseeing crucial FDA matters requires undivided attention. Asking them to also serve as senior counselors risks creating bottlenecks, slowing down the very agencies they’re supposed to be leading, and causing significant burnout among some of the department’s most important figures.
The timing of this shake-up, right before the midterms, seems anything but coincidental. How do you see this new team being deployed to shape public opinion on signature policies like “most favored nation” drug pricing and new nutrition guidelines?
Their primary mission will be to transform complex, often bureaucratic, policy initiatives into sharp, repeatable campaign messages. For a policy like “most favored nation” drug pricing, this team’s job is to boil it down to a simple, powerful narrative: “We’re fighting to stop drug companies from ripping you off.” They’ll coordinate a media blitz, ensuring that every statement from HHS, CMS, and the FDA echoes this theme. John Brooks from CMS will be crucial in defending the policy with data, while the FDA counselors, Diamantas and Graham, can speak to the safety and efficacy side. It’s about creating a unified front that presents these policies not as complicated regulations but as direct, tangible benefits for the American family, perfectly packaged for a 30-second campaign ad.
There are reports the White House is seeking to tighten its grip on HHS. From a practical standpoint, how does bringing these four officials into a new inner circle help the administration achieve that top-down control, especially given Secretary Kennedy’s reputation for abrupt leadership changes?
This new structure acts as a direct conduit between the White House’s political objectives and the department’s day-to-day operations. Instead of messages getting filtered or lost in the massive HHS bureaucracy, this inner circle can receive directives and immediately translate them into action within their respective agencies. For a White House concerned about a department going off-script, this is invaluable. It also helps stabilize things. Kennedy’s history of firings and re-hirings creates chaos and unpredictability. By formalizing an advisory team of established internal leaders, the White House can create a more reliable and consistent command structure, ensuring the department’s messaging is locked in step with the broader administration’s goals heading into November.
Given that recent polling shows significant public disapproval of the Secretary—with 59% of Americans disapproving of his performance and 62% disapproving of his vaccine policy—how much of a political gamble is it for the administration to center its midterm health messaging around his agenda?
It’s an enormous gamble, and the stakes couldn’t be higher. On one hand, you have a base that is energized by Kennedy’s populist, anti-establishment approach, particularly his overhaul of the U.S. vaccine system. For them, he is a fighter, and campaigning on his agenda could mobilize those voters. On the other hand, those polling numbers are stark. A majority of Americans, a significant one at that, are not on board. By making him the face of the party’s health platform, they risk alienating the moderate and independent voters who will ultimately decide control of Congress. They are essentially betting that the enthusiasm of their base will outweigh the widespread disapproval from the rest of the electorate, and that is a very risky bet in a midterm year where the president’s own popularity is already sinking.
Secretary Kennedy said these appointments will help his team “move faster and go further.” Beyond just refining the talking points for the campaign, what tangible policy or operational changes could this new advisory group realistically push through before the November elections?
Time is short, so they’ll have to focus on actions that generate headlines and create a perception of momentum. I would expect to see an acceleration of rule-making and executive actions related to drug pricing, things that don’t require congressional approval. For example, they might fast-track a list of drugs subject to the “most favored nation” model or issue bold new nutrition guidance that grabs public attention. Operationally, Klomp’s role as chief counselor could be used to slash red tape on specific projects Kennedy wants to champion, clearing bureaucratic hurdles to announce a new initiative or a pilot program. The goal isn’t necessarily to implement massive, long-term change before November; it’s to produce a series of visible “wins” that they can point to on the campaign trail as proof that they are actively working to “Make America Healthy Again.”
What is your forecast for the role of HHS as a political asset or liability for the incumbent party in the upcoming midterm elections?
HHS is shaping up to be a high-risk, high-reward political tool, but I suspect it will ultimately be more of a liability. The strategy to double down on Secretary Kennedy and his controversial agenda is a base-mobilization tactic, not a persuasion campaign for the broader electorate. While his supporters will be energized, the negative polling—especially the 62% disapproval on vaccine policy—provides a massive target for opponents. Democrats will likely frame the election as a referendum on Kennedy’s leadership, using those numbers to portray the administration as extreme and out of touch with mainstream American concerns about healthcare. The administration is hoping to ride a wave of populist energy, but they may instead find themselves drowned by a blue wave of public disapproval.
