By Gabriella Borter and Stephanie Kelly
WASHINGTON (Reuters) – Robert F. Kennedy Jr.’s confirmation as the top U.S. health official – one of President Donald Trump’s most contentious nominations – may hinge on Louisiana Republican Senator Bill Cassidy, a doctor with a history of bucking political pressure who has expressed wariness over Kennedy’s anti-vaccine views.
Cassidy sits on the Senate Finance Committee, which has a vote scheduled for Tuesday on whether to send the nomination to the full Senate for a final confirmation vote. All of the Democrats on the committee are expected to oppose Kennedy. If Cassidy joins them, he could stop the nomination in its tracks.
The Senate’s Republican leadership could maneuver to try to hold a confirmation vote on the Senate floor despite the committee action, though such moves have been rare in the past.
A vote by Cassidy against Kennedy would defy Trump’s demand for Republican loyalty and could present a political risk for the senator should he seek election to a third six-year term in 2026.
Cassidy chairs the Senate Health, Education, Labor and Pensions Committee. During a hearing before that committee last week, Cassidy said he was troubled by Kennedy’s long record of casting doubt on vaccine safety, and cited his own ethical duties as a physician.
A gastroenterologist and former medical school professor, Cassidy’s 30-year medical career highlights include co-founding a community clinic and launching a public-private program to vaccinate thousands of children against Hepatitis B in Baton Rouge, Louisiana. His wife, Dr. Laura Cassidy, is a retired general surgeon who specialized in breast cancer cases.
“Does a 70-year-old man,” Cassidy asked Kennedy at Thursday’s hearing, “who spent decades criticizing vaccines and was financially vested in finding fault with vaccines – can he change his attitudes and approach now that he’ll have the most important position influencing vaccine policy in the United States?”
If confirmed, Kennedy would serve as secretary of the sprawling U.S. Department of Health and Human Services. It oversees more than $3 trillion in healthcare spending, including agencies such as the Food and Drug Administration and the one in charge of the Medicare and Medicaid health insurance programs covering more than 100 million Americans.
Cassidy’s office did not respond to requests for comment on how he will vote on Kennedy’s confirmation.
If Kennedy’s nomination advances to the Senate floor, he could not afford to lose more than three Republican votes if Democrats all vote no.
Groups that oppose Kennedy’s confirmation see a handful of Republican senators as potential swing votes against Kennedy in the full Senate, including Mitch McConnell, Susan Collins and Lisa Murkowski. Their offices did not respond to requests for comment.
That Republican trio also voted against confirming former Fox News personality Pete Hegseth as defense secretary. Vice President JD Vance voted to break a 50-50 tie, clinching confirmation.
Senator John Barrasso, a Finance Committee member who practiced as an orthopedic surgeon for 24 years in Wyoming, expressed support for Kennedy, saying the nominee would be good for rural healthcare.
‘MAKE THINGS MORE DIFFICULT’
Cassidy has a record of sometimes crossing party lines, most notably when he joined six other Republicans in voting to convict Trump in his Senate impeachment trial on charges relating to the Jan. 6, 2021, attack on the U.S. Capitol by Trump supporters. Trump ultimately was not convicted thanks to other Republican senators. Cassidy for that vote was censured by the Louisiana Republican Party and labeled “disloyal” by Trump. In last year’s election, Trump won in Louisiana with more than 60% of the vote.
“If he starts voting against the president’s nominees, it wouldn’t put him in an advantageous position to receive the president’s support. I think it would make things more difficult for him,” said Lionel Rainey III, a Republican strategist in Louisiana.
Adding to Cassidy’s vulnerability in the 2026 election is Louisiana’s implementation of single-party primaries, a system that likely rewards party loyalty over moderate positions. Billionaire Trump supporter Elon Musk and right-wing activists including from the group Turning Point USA have threatened to support Republican primary opponents of U.S. lawmakers who oppose the president’s cabinet picks.
Fellow Louisiana Republicans have joined the pressure campaign targeting Cassidy. The state’s popular Republican governor, Jeff Landry, appealed to the senator to back Kennedy in a letter posted to social media last month. Representative Clay Higgins posted a photo of Cassidy to the social media site X, saying Kennedy would be confirmed with or without his support: “Either way, we’re watching.”
At Kennedy’s hearing last week, Cassidy seemed to tease a case for obstructing the confirmation in order to help Trump avoid a blemish on his legacy, citing a hypothetical death of a person from a vaccine-preventable ailment that gets “blown up in the press.”
“That will cast a shadow over President Trump’s legacy, which I want to be the absolute best legacy it can be,” Cassidy said.
(Reporting by Gabriella Borter and Stephanie Kelly; Editing by Scott Malone and Will Dunham)
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