Rfk Jr.’s Latest Overhaul Aims To Boost Preventive Care. It Could Get Expensive.

Robert F. Kennedy Jr.’s about to remake another government panel with power over Americans’ access to health care.

This time around, unlike his push to downsize the vaccine schedule, the health secretary is eager to expand the care Americans get.

Kennedy’s denunciation of the U.S. Preventive Services Task Force for not requiring insurers to cover testing for Alzheimer’s disease has sparked lobbying by manufacturers of tests who’d benefit if Kennedy were to also encourage the task force to recommend coverage of more testing for colon cancer. A patient advocacy group whose members include drug companies has also reached out to Kennedy, hoping he can expand testing for kidney disease. More copay-free tests could appeal to patients if it doesn’t cause their already burdensome insurance premiums to spike some more.

“We think they've been asleep at the switch to the cost of patients, innocent lives and taxpayers,” Paul Conway, the chair of policy and global affairs at the American Association of Kidney Patients, told POLITICO of the task force. Conway’s group favors universal screening for kidney disease that it believes would catch early signs of disease that’s expensive to treat and deadly.

The task force previously rejected expanded kidney screening, saying there wasn’t enough evidence about its benefits, but is reevaluating now. 

The Reagan administration set up the Preventive Services Task Force in 1984 to help health care providers know what screenings were effective. It’s long been comprised of a group of primary care doctors appointed by the health secretary. Congress in the Affordable Care Act required screenings the task force says have strong evidence of at least moderate health benefits be covered in full. The list includes colonoscopies, mammograms, counseling and preventive medication. 

Kennedy this spring told lawmakers the task force had been “lackadaisical and negligent,” faulting it in several congressional hearings for not recommending screening for Alzheimer’s.

The Department of Health and Human Services has canceled most meetings of the group and Kennedy fired its leaders in May, citing legal issues that weren’t fully explained to the leaders and the public. HHS is expected to announce new members soon, and a first meeting of the reconstituted panel is planned for late August.

But Kennedy’s plan to overhaul the task force has triggered alarm among some doctors’ and patients’ groups that he would follow the same playbook he did with the Advisory Committee on Immunization Practices, an external group advising the Centers for Disease Control and Prevention on which vaccines to recommend for children.

Last year, Kennedy fired all the members of that committee, saying they had conflicts of interest, and replaced them with new people, some of whom shared Kennedy’s skepticism of vaccine safety. ACIP then recommended reducing the number of vaccines the federal government advises children receive, but a federal judge in March temporarily threw out its guidance after finding Kennedy hadn’t followed his department’s own rules in naming the new members. The Trump administration appealed the ruling and has now changed the ACIP’s charter to allow Kennedy to appoint people who are not vaccine experts. The work of the panel remains blocked as the legal challenge plays out.

“There’s the potential that they could reform [the preventive services task force] in a way that is no longer evidence-based or scientific, in which case they can force insurance to cover things with no out-of-pocket costs, but things that might not be evidence-based or potentially could cause more harm than good,” said Aaron Carroll, the president and CEO of AcademyHealth, a nonprofit representing health policy researchers who follows the task force’s work closely.

Two former task force chairs, including one Kennedy fired in May, expressed concerns in a New York Times opinion piece that the health secretary could call for “recommendations that bolster the financial interests of the myriad individuals in his circle who profit from fitness and nutrition products.” HHS did not respond to a request for comment on that criticism.

Beyond his statement about Alzheimer’s testing, Kennedy hasn’t said what he thinks the task force should do. Without mentioning the task force, he has suggested he’d like to see Americans receive more preventive care aimed at encouraging healthier eating and exercise. He’s also said he wants everyone using a wearable device over the next few years. He expects the data they see will prompt them to adopt healthier lifestyles.

HHS did not respond to a list of questions about how the secretary plans to revamp the task force. Emily Hilliard, senior HHS press secretary, said the department received “an unprecedented number of nominations” for new members, which made HHS “postpone briefly” a task force meeting initially planned for July.

An administration official granted anonymity to discuss internal thinking said changes to the task force “aren’t about fringe science or political ideology.”

Kennedy feels the task force has been too slow and too conservative in its recommendations guiding preventive care, “which is well understood to be one of the best investments we can make in the health of the country,” the official said.

Some companies could see a windfall if the task force recommends their products. The American Association of Kidney Patients counts several drugmakers among its corporate members, including Novartis, which manufacture drugs that help fight kidney disease. But Conway rejected “the premise that our policy positions benefit industry — they benefit patients, families and taxpayers."

Test makers, such as Guardant Health, which makes a blood test for colorectal cancer that it says can be an alternative for people who want to avoid the more-invasive colonoscopy, are also lobbying to expand coverage. “They haven’t started looking [at the test] two years after FDA approval,” complained AmirAli Talasaz, the Guardant CEO at a U.S. Chamber of Commerce event in April. He argued his company’s test could increase screening rates for colorectal cancer, which is becoming more common in younger people.

HHS’s cancellation of most task force meetings has stalled much of its work developing recommendations during President Donald Trump’s presidency.

While health insurers must cover screenings and other services the task force has determined to be beneficial at no cost to patients, the cost of those services is typically built into the premiums people pay.

AHIP, the lobby group for the health insurance industry, said it’s “premature to speculate any cost impact of potential changes” to the task force recommendations, but noted in an emailed statement that “health plans value the evidence-based framework that the task force has historically provided and believe coverage decisions should remain grounded in clinical evidence.”

The administration official said there have been calls to add health economists to the task force to consider whether preventive care could be done more cost effectively.

Some fear task force members selected by Kennedy won’t be so careful in evaluating the evidence around health benefits and will be susceptible to industry and patient pressure campaigns.

“There’s big business in prevention,” said Alex Krist, a Virginia doctor and teacher who was a member of the task force between 2014 and 2021 and a former chair.

“If it improves health, that's OK, but if it's selling a product to people without improving health, that's not a good use of our national resources,” he said, adding that the task force has recommended tests, screening and counseling for conditions where there’s an existing intervention that can prevent disease.

The task force hasn’t found that to be the case with Alzheimer’s disease testing. As more treatments for Alzheimer’s are approved, the task force recommendations on screening for the disease could change, Carroll said.

Anyone can propose topics for the task force to assess. Once it decides which to focus on, academic and research institutions designated by the Agency for Healthcare Research and Quality, which is part of HHS, develop research plans and evaluate the evidence. The task force then develops draft recommendations, puts them up for public comment and has the option to make changes before finalizing them.

That ensures the task force’s recommendations are based on solid evidence and not opinions, Krist said.

But some of the recommendations have sparked debate, such as the one about routinely screening for chronic kidney disease or for cognitive impairment.

Conway, of the American Association of Kidney Patients, said patient advocates thought there was enough evidence in 2012 to recommend routine kidney screening.

Conway is a chronic kidney disease patient himself, who went through dialysis and received a kidney transplant. He also worked in several government departments during Republican administrations, starting with Ronald Reagan and ending with George W. Bush. He was also a Virginia deputy health secretary under Republican Gov. George Allen.

Kidney disease in the U.S. costs over $130 billion a year, and people who are on dialysis to treat it have one of the highest mortality rates, Conway said.

“And here we are, 14 years after 2012, and they’re still trying to figure it out,” he said of the task force assessment of chronic kidney disease screening.

Conway said he expected the task force to at least recommend screening for the disease in people who are at higher risk of developing it, such as those who have hypertension or diabetes, or those in certain predisposed communities, such as African Americans.

But the task force says its recommendations are only for people with no symptoms, and testing for chronic kidney disease in people already diagnosed with another condition is part of chronic disease management.

When the task force doesn’t find enough evidence to recommend a preventive service be covered, the National Institutes of Health typically funds studies to generate it, former task force chair Krist said.

Instead of criticizing the task force, Kennedy should support more funding for the research that undergirds its recommendations, AcademyHealth’s Carroll said.

“You want more screenings for Alzheimer’s? Fund more studies,” he said.

The Trump administration’s cuts to funding and staff at the Agency for Healthcare Research and Quality, which supports the work of the task force, is contrary to what the health secretary wants to achieve, Carroll argued.

The agency has lost most of its workforce since Kennedy took over, going from nearly 300 employees in 2024 to 87 now, according to data from the Office of Personnel Management. House Republicans have proposed eliminating the agency in the bill funding HHS for the 2027 fiscal year, calling it “duplicative.”

Defunding the agency that supports the task force and deprioritizing its meetings is contrary to ending the chronic disease epidemic — which is Kennedy’s stated goal — said Michael Sapienza, the CEO of the Colorectal Cancer Alliance, a patient advocacy group.

“It’s been 16 months and there hasn’t been one recommendation put forward,” he said. His group was among 60 cancer organizations that sent a letter to Kennedy in May highlighting the need for the recommendations the task force has been working on, including testing for cervical and prostate cancer, to move forward.

The Colorectal Cancer Alliance has recommended the same tests as the task force “because of their exhaustive scientific database research,” Sapienza said.

The Guardant Health blood test, which the task force has not yet evaluated, could be a useful alternative for people who refuse a colonoscopy, but it’s less likely to detect precancerous lesions or early-stage cancer, he said.

Other groups are worried that Kennedy could push the new task force members to curtail access to some preventive services insurers are currently required to cover, such as drugs to prevent HIV in people at higher risk of getting the virus.

“We are deeply concerned, given that the secretary has in the past made comments saying that he did not believe that HIV causes AIDS, that this may be one of the areas that he is seeking to meddle in and defy a wide body of scientific and community evidence that this intervention is wanted, essential, and effective,” said Jeremiah Johnson, the executive director of PrEP4All, an advocacy group focused on universal access to HIV prevention and treatment.

Johnson stressed that his group doesn’t take any pharma funding and said that it shares Kennedy’s concerns about pharmaceutical companies’ “undue influence in the entire system.” But he argued that the pushback must be done through a proper process.

“Introducing new bias, without guardrails, without any sort of rigor, that's just the wild, wild west and chaos. It’s not the way to correct whatever problems we perceive in terms of pharmaceutical bias.”

Kelly Hooper contributed to this report.