Robert F. Kennedy Jr.’s movement has repeatedly been written off as a farce, a stunt, a distraction. Now Donald Trump has nominated him to lead the Department of Health and Human Services, where, if confirmed, he’ll oversee a life-and-death corner of the federal government.

RFK Jr.’s operation had been building toward this moment for months. On August 23, Kennedy suspended his independent presidential bid and endorsed Trump after what he described as “a series of long, intense discussions” that proved the two were ideologically aligned. Almost immediately, the “Make America Healthy Again” (MAHA) movement was born, as was a super PAC of the same name.

The group’s near-term goal was simple: persuade Kennedy’s coalition to vote for Trump. His former national field director, Jeff Hutt, became one of the MAHA PAC’s leaders, and throughout the fall, in his phone calls and meetings with Kennedy supporters, he kept hearing the same message: If RFK Jr. couldn’t become president, he should zero in on health reforms.

[John Hendrickson: The first MAGA Democrat]

“HHS is the place where they wanted Mr. Kennedy to be,” Hutt told me last night. He fully expects Kennedy to be confirmed. Hutt and his team have set up a “war room” and are identifying which senators will support the HHS nomination, and which will need coaxing. Either through standard procedure or via a recess appointment (an idea Trump has teased), Hutt said he was confident that Kennedy will land the job.

Kennedy was offered such a significant position—and will have such a “big rein,” as Hutt put it—because Trump returns favors. In 2016, Trump courted Christian voters by dangling the prospect of appointing conservative judges who would overturn Roe v. Wade. This year, Trump spent the final months of the election wooing the MAHA bros. How many Kennedy supporters actually voted for Trump is unclear, but Hutt and others I spoke with believe that Trump’s victory is partially on account of the RFK Jr. brigade showing up. “He got behind them, and he got elected,” Hutt said of Trump.

Kennedy’s acolytes are elated that he will have such a prominent position in the administration. In my conversations with former Kennedy volunteers and others in his orbit this week, I heard some skepticism as to whether he’ll actually be able to accomplish a revolution inside a sprawling government bureaucracy. But for now, Kennedy’s champions are hopeful that he’ll catalyze policy changes that would lead to a “healthier” society—even if they don’t all agree on what that means.

In late September, at a festival of “free thinkers” in Washington, D.C., where RFK Jr. was the star attraction, Mike Patton, a former campaign volunteer who lives in Florida, told me he was unsure about whether he could bring himself to vote for Trump after all the work he’d done for Kennedy.

This week, Patton told me that, in the end, he and his wife each wrote in Kennedy’s name on their ballot. He is happy that Kennedy is ascending to a place of power, and excited that Trump has promised to give Kennedy authority over health matters, but he’s dismayed that Trump apparently wants to keep him away from areas involving fossil fuels and renewable energy. Patton isn’t sure what Kennedy might be able to accomplish within Trump’s administration. The idea of fighting all manner of chronic diseases with cleaner food and water is a pillar of the MAHA movement. But this will be an uphill battle. “Even when he was campaigning, he was saying he was going to make a drastic reduction in chronic disease in his four years, and I can’t wrap my head around how you can make a measurable difference [that quickly],” Patton told me. “But he seems confident, and Bobby seemed confident before. So, pop some popcorn.”

Another Kennedy supporter, Jennifer Swayne, who served as his campaign’s Florida volunteer coordinator, told me she somewhat reluctantly voted for Trump. Swayne is the mother of a child with autism, and she believes that mothers like herself are searching for answers—that’s partly what drew her to Kennedy. “We want to know what's causing this,” she said of autism. “We want to prevent other moms from having to go through this.” She said she would define success for Kennedy’s HHS tenure as removing “dangerous products off the market” and holding drug manufacturers accountable for adverse effects and chemical dependency.

[Yasmin Tayag: ‘Make America healthy again’ sounds good until you start asking questions]

When I asked Hutt how he’d gauge Kennedy’s success, he had a range of ideas. “The amount of money flowing through government into corporations would be dramatically reduced. Government would be out of a lot of things, like health care. We would take the middleman out of a lot of things. We would have government agencies whose sole purpose is to publish and report facts and numbers in ways that educate the American people, not to convince them one way or the other of something,” he said. He envisioned Kennedy ushering in an era of more family farms, of citizens gardening and growing their own food. “I guess that's really what it looks like: sort of a health revolution, in a sense,” he said. “Nobody’s ever asked me that question before.”

In announcing the nomination, Trump echoed Kennedy’s core campaign messaging: “Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.” Kevin Roberts, the president of the Heritage Foundation and one of the key people behind Project 2025, said in a statement that Kennedy’s nomination “sends a clear message to our failed public health establishment,” and that under Trump and Kennedy, “Americans will be in control of their health, not the commissars of three-letter health agencies.”

Many questions surround the HHS nomination, none more significant than whether Kennedy would use his authority to block or recall certain vaccines. Kennedy has spent years sowing doubt about their safety. In the early 2000s, he helped popularize the unproven theory of a link between vaccines and autism. More recently, he was an influential opponent of the COVID vaccines and accompanying mandates. Now he’s poised to inform drug policy at the highest level.

Kennedy’s spokesperson did not respond to my request for comment last night as to whether, as HHS secretary, RFK Jr. would move to outlaw any existing vaccines, and referred me to his victory-lap post on X, which did not mention the topic. Tony Lyons, who founded a different Kennedy super PAC, American Values 2024, said in a text message: “Bobby has said very clearly that he’s not going to take away anyone’s vaccines.” If, hypothetically, we faced another pandemic during Trump’s second term, I asked Lyons, would Kennedy stand in the way of a vaccine-development project such as Operation Warp Speed? Lyons didn’t offer a clear answer. “[Kennedy] believes in robust, transparent and independent science, rather than corporate science propped up by censorship and propaganda,” he wrote.

In my conversations with Kennedy’s supporters, I heard a lot about “medical freedom” and “personal choice,” but no one mentioned the word ban. Kennedy stiff-arms the “anti-vax” label, and his allies steadfastly maintain that he’ll use his position to scrutinize vaccine science—but not to institute a vaccine moratorium for the greater population.

[Benjamin Mazer: The sanewashing of RFK Jr.]

Perhaps the clearest way to understand Kennedy’s HHS aim is to listen to his musings on “corporate capture”: the idea that government agencies are overly influenced by the companies within the industries they’re supposed to be regulating. This is a long-standing liberal complaint, which Kennedy has built up to the status of a conspiracy theory. (Anthony Fauci, for instance, has not personally profited off of vaccines, as Kennedy has claimed.) His top-line goal is to sever the relationships between corporations and the federal government, but he has yet to explicitly state how he’ll do that. Reforming fast food may be his biggest source of tension with Trump. The future 47th president didn’t just serve fries at a (closed) McDonald’s as a campaign stunt; he seems to genuinely love Mickey D’s, while Kennedy sees it as a scourge—the antithesis of MAHA. But that’s just one company. Hutt conceded that his team faces a challenge in persuading senators from agricultural-heavy states to support the sort of reforms Kennedy is promising: fewer food chemicals, an emphasis on regenerative soil.

And some of what Kennedy speaks of accomplishing is well beyond his reach. For instance, he has called for removing fluoride from our drinking water—something even Republican dentists oppose. But such a change could occur only at the local level, not the federal level. In New York City, for example, Mayor Eric Adams has said he will follow the fluoridation recommendations of city and state health departments.

As Trump prepares to take office again, Kennedy remains a confounding presence: He’s a dreamer, but he’s destructive. Kennedy was never going to win the White House, but he’s now, at last, on his way to Washington. And we all have to live with it.

Robert F Kennedy Jr has been nominated to be the next US health secretary, but some of his views are not backed by science.

Robert F Kennedy Jr has a history of spreading health information scientists say is false.

Donald Trump will begin his second term as president the same way he began his first—with Republicans controlling both the House and Senate.

The GOP scored its 218th House-race victory—enough to clinch a majority of the chamber’s 435 seats—today when CNN and NBC News declared Republicans the winner of two close elections in Arizona. How many more seats the Republicans will win depends on the outcome of a few contests, in California and elsewhere, where ballots are still being counted. But the GOP’s final margin is likely to be similar to the four-seat advantage it held for most of the past two years, when internal division and leadership battles prevented the party from accomplishing much of anything.

Such a slim majority means that the legislation most prized on the right and feared by the left—a national abortion ban, dramatic cuts to federal spending, the repeal of Barack Obama’s Affordable Care Act and Joe Biden’s largest domestic-policy achievements—is unlikely to pass Congress. “I don’t think they’re even going to try on any of those things,” Brendan Buck, who served as a top aide to former Speaker Paul Ryan during Trump’s first term, told me.

[Daniel Block: The Democrats’ Senate nightmare is only beginning]

Trump’s biggest opportunity for a legacy-defining law may be extending his 2017 tax cuts, which are due to expire next year and won’t need to overcome a Senate filibuster to pass. He could also find bipartisan support for new immigration restrictions, including funding for his promised southern wall, after an election in which voters rewarded candidates with a more hawkish stance on the border.

In 2017, Trump took office with a 51–49 Republican majority in the Senate and a slightly wider advantage in the House—both ultimately too narrow for him to fulfill his core campaign promise of axing the ACA. Next year, the dynamic will be reversed, and he’ll have a bit more of a cushion in the Senate. Republicans gained four seats to recapture the majority from Democrats; they now hold a 53–47 advantage, which should be enough to confirm Trump’s Cabinet picks and judicial nominees. The impact on the Supreme Court could be profound: Trump named three of its nine members during his first term, and should Justices Clarence Thomas and Samuel Alito, who are both in their 70s, retire in the next two years, he would be responsible for nominating a majority of the Court.

Yet on legislation, Republicans will be constrained by both the Senate’s rules and the party’s thin margin in the House. Republicans have said they won’t try to curtail the Senate’s 60-vote threshold for circumventing a filibuster. “The filibuster will stand,” the outgoing Senate minority leader, Mitch McConnell, declared on the day after the election. But he’ll be only a rank-and-file member in the next Congress. McConnell’s newly elected successor as party leader, Senator John Thune of South Dakota, reiterated his commitment to the legislative filibuster after winning a secret-ballot election for the role.

How many votes are needed to pass bills in the Senate won’t mean much if Trump can’t get legislation through the House, and that could be a far more difficult proposition. The two speakers during the current Congress, Kevin McCarthy and Mike Johnson, each had to rely on Democrats to get major bills passed, because the GOP’s majority proved too thin to govern. With Trump’s backing, Johnson should have the votes to stay on as speaker when the new Congress convenes in January. (When Trump addressed House Republicans today in Washington, the speaker hailed him as “the comeback king” and, NBC News reported, the president-elect assured Johnson he would back him “all the way.”)

But the Republican edge could be even narrower next year if Democrats win a few more of the final uncalled races. Trump’s selection of Representative Elise Stefanik of New York to serve as United Nations ambassador and Representative Mike Waltz of Florida to serve as national security adviser could deprive Republicans of two additional seats for several months until voters elect their replacements. (Senator Marco Rubio’s expected nomination as secretary of state won’t cost the GOP his Florida seat, because Governor Ron DeSantis can appoint an immediate replacement.)

[Read: Elise Stefanik’s Trump audition]

Still, the GOP has reason to hope for a fruitful session. During Biden’s first two years in office, House Democrats demonstrated that even a small majority could produce major legislation. They passed most of Biden’s agenda—though the Senate blocked or watered down some of it—despite having few votes to spare. And Trump exerts a much tighter grip on his party than Biden did on congressional Democrats. Unlike during Trump’s first term, few if any Republicans hostile to his agenda remain in the House. His decisive victory last week, which includes a likely popular-vote win, should also help ensure greater Republican unity.

“I think we will have a much easier time in terms of getting major things passed,” predicts Representative Mike Lawler of New York, whose victory in one of the nation’s most closely watched races helped Republicans keep their majority. “The country was very clear in the direction it wants Congress and the presidency to go.”

Trump might even hold sway over a few Democrats on some issues. Because Trump improved his standing almost everywhere last week, the House in January will include many Democrats who represent districts that he carried. Two House Democrats who outran their party by wide margins, Representatives Jared Golden of Maine and Marie Gluesenkamp Perez of Washington State, refused to endorse Kamala Harris, while several candidates who more fully embraced the party’s national message underperformed. Nearly all Democratic candidates in close races echoed Trump’s calls for more aggressive action to limit border crossings, which could yield the new president additional support in Congress for restrictive immigration legislation.

[Mike Pesca: The HR-ification of the Democratic Party]

Like most House Republicans, Lawler endorsed Trump, but he ran on a record of bipartisanship and told me he’d be unafraid to defy the president when he disagreed. As a potential swing vote in a narrow majority, he could have more influence over the next two years. Lawler told me Monday that the GOP should heed the voters’ call to focus on issues such as the economy, border security, tax cuts, and energy production. Pursuing a national abortion ban, he said, would be “a mistake.” And Lawler serves as a reminder that enacting legislation even in an area where Republicans are relatively unified, like tax cuts, could be difficult: He reiterated his vow to oppose any proposal that does not restore a costly deduction for residents of high-tax states such as New York and California—a change that Trump supports but many other Republicans do not.

Trump showed little patience for the hard work of wrangling votes during his first term. Now he’s testing his might on Capitol Hill—and displaying his disdain for Congress’s authority—even before he takes office. Though he didn’t endorse a candidate to succeed McConnell, he urged all of the contenders to allow him to circumvent the Senate by making key appointments when Congress is in recess. After he won, Thune wouldn’t say whether he’d agree. Trump apparently wants the ability to install nominees—Robert F. Kennedy Jr. as secretary of health and human services?—who can’t win confirmation by the Senate.

“The Trump world does not give a damn about normal processes and procedures and traditions and principles of the prerogatives of certain chambers,” Buck, the former GOP aide, said. “They just want to do stuff.” The fight could be instructive, an early indication that no matter how much deference the new Republican majority is prepared to give Trump, he’ll surely still want more.

The reelection of Donald Trump might seem like doomsday for America’s public-health agencies. The president-elect has vowed to dismantle the federal bureaucracy.Robert F. Kennedy Jr., potentially his next health czar, wants to go even further. As part of his effort to “Make America healthy again,” Kennedy has recently promised to tear up the FDA and its regulations, including those governing vaccines and raw milk. But that effort is going to run into a major roadblock: the “deep state.”

The phrase deep state might trigger images of tinfoil hats. After all, Trump has spent much of the past eight years falsely claiming that Democratic bureaucrats are unfairly persecuting him. But operating within the federal health agencies is an actual deep state, albeit a much more benign and rational one than what Trump has talked about. And he might not be able to easily tear it down.

Whether you know it or not, you’ve likely seen this deep state in action. It was the reason Trump’s preferred treatment for COVID during the early phases of the pandemic, hydroxychloroquine, was not flooding pharmacies. And it was why COVID vaccines were not rushed out before the 2020 presidential election. Both of those efforts were stopped by civil servants, despite overt pressure from Trump and officials in his administration.

Public-health officials didn’t buck Trump to sabotage him. They did so because both measures were scientifically unsolid. Vaccines weren’t authorized before the election because FDA officials knew that they had to wait at least two months after the clinical trials were completed to make sure the vaccines didn’t cause dangerous side effects. And the FDA blocked use of hydroxychloroquine for treating COVID because of the drug’s unproven efficacy and spotty safety record.

If they really wanted to, health officials could have caved to Trump’s requests. But in general, they don’t easily renounce their empirically grounded views on science—regardless of who is president. The FDA’s top vaccine regulator vowed to resign in 2020 if the agency relented to Trump’s pressure to approve vaccines early. Two other vaccine regulators resigned in the first year of the Biden administration after the FDA announced the rollout of COVID boosters. Following their resignations, the ex-officials publicly argued that “the data simply does not show that every healthy adult should get a booster,” and that public-health efforts should have been entirely focused on “vaccinating the unvaccinated, wherever they live.”

Many scientists, lawyers, and doctors are involved in each and every decision that federal-health agencies make, because the decisions must be evidence-based. Arbitrary decisions based on conspiracy theories or political whims can, and will, be challenged in court. “A new administration absolutely can come in and set new policies,” Lowell Schiller, who led the FDA’s office of policy during part of Trump’s first term, told me. But, he added, “there is a lot of law that they need to follow, and things have to be done through proper process.”

Some changes that may seem relatively insignificant require reams of paperwork. When the FDA wanted to revoke the standardized federal definition of frozen cherry pie (yes, one existed until earlier this year), it had to go through a formal procedure that forced the agency to defend its legal authority to make the move as well as the costs and benefits of a more laissez-faire cherry-pie policy. The process took more than three years. Few things are harder than approving or revoking approval for a drug: In 2020, the FDA tried to pull an unproven drug meant to prevent preterm births. Despite lots of evidence that the drug was ineffective, the process took nearly three years. Now imagine how things would go if RFK Jr. pressured the FDA to pull a vaccine off the market because he is convinced, incorrectly, that it causes autism.

A Trump administration could do a few things more easily. It could, for example, direct the FDA to stop enforcing the agency’s restrictions on some of the products that Kennedy touts, such as raw milk and certain vitamins. The FDA often declines to go after various products in the name of “enforcement discretion.” A downturn in enforcement actions might anger some within the agency, but Trump could bring that about with little red tape.

Kennedy has promised mass firings at the FDA, presumably to install loyalists who would enact the agenda. That threat should be taken seriously. The president has sweeping power to hinder officials who muck up his agenda. The Trump administration allegedly demoted one top federal official who pushed back against authorizing hydroxychloroquine.

But there are major checks, too, on what a president can do to turn the screws on civil servants. Unlike many workers, federal employees can be fired only for cause or misconduct, and civil servants are entitled to appeals in both cases. “It’s a tangled process that makes it hard to be able to get rid of people,” Donald Kettl, an emeritus public-policy professor at the University of Maryland, told me. Trump was famous for firing people during his first term, but the people who got the axe were political appointees who did not have the same protections as civil servants. In short, few federal employees last just one Scaramucci.

However, one major threat still looms over federal workers. In his first term, Trump pursued an effort to reclassify federal workers in a way that would strip many of them of their protections, and he has said that in his second term he will “immediately” pursue that action. Trump would have to go through an arduous process to make good on that threat, and it would likely be challenged in court. But if implemented, the policy could give Trump massive leverage to fire workers.

Still, Trump takes those actions at the peril of his own agenda. The reality is that the same members of the so-called deep state that Trump and Kennedy are threatening to fire are also essential to making anything the administration wants to do happen. Seminal parts of the “Make America healthy again” agenda would have to run through this deep state. If Kennedy, a champion of psychedelics, wants the FDA to approve a new psilocybin-based treatment, the medicine must be reviewed by the scientists and doctors who review other drugs for safety and efficacy. If he wants a national ban on fluoride in water, that must go through the EPA. There is no way around this: Even if Trump appointed Kennedy as the unilateral king of every single federal health agency, Kennedy cannot make these decisions on his own.

A central tenet of the “Make America healthy again” agenda is removing potentially dangerous chemicals from food. Although the FDA has been slow to ban certain chemical additives, the agency seems to have recently seen the light. Earlier this year it set up a new initiative for reassessing the safety of these substances. But if Kennedy guts the FDA, no one might be there to do that review.

The Trump administration could hypothetically hold a massive job fair to get cronies into all of those roles—especially if the president-elect makes good on his promise to make hiring and firing bureaucrats easier—but few people can successfully perform these highly technical jobs, not to mention that hiring in the federal government typically takes forever. (The average hiring time in 2023 was 101 days.)

Still, Trump’s second term will be one of the biggest challenges facing our federal health system. No president in modern history has been so intent on bending health agencies to his will, and he seems even more emboldened to do so now than in his first go-around. Trump will likely have some successes—some people may be fired, and some important policies may be scrapped. America is about to find out just how resilient the deep state really is.