Trump's next health nominee in the hot seat

Politico

2 days ago

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With help from Simon Levien
Driving the Day
CHRISTINE FACES QUESTIONING — President Donald Trump's choice for a top post at HHS, Dr. Brian Christine, goes before senators today for a confirmation hearing.
Christine will face questioning from the Senate Health, Education, Labor and Pensions Committee as lawmakers consider his nomination to be assistant secretary for health — one of the highest-ranking jobs at HHS and a position often held by admirals in the Commissioned Corps of the U.S. Public Health Service.
Why it matters: If he advances through the committee and is eventually confirmed by the full Senate, Christine, a men's sexual health doctor and GOP donor, would oversee thousands of uniformed public-health service members and be charged with carrying out Health Secretary Robert F. Kennedy Jr.'s public health agenda, Simon reports. One of the highest-ranking positions at the agency, the assistant secretary for health advises the HHS secretary and recommends policy related to public health matters like disease prevention, vaccine programs and health disparities.
He would also help lead a new HHS office called the Administration for a Healthy America, which consolidates existing agency offices to focus on primary care, maternal and child health, mental health, environmental health, HIV/AIDS and workforce development.
Background: Christine, a urologic surgeon at Urology Centers of Alabama, has previously criticized the acceptance of transgender health care and the federal government's response to the Covid-19 pandemic. He's expressed opposition to trans athletes competing in women's sports and has said on his podcast — called 'Common Sense,' and last airing two years ago — that children experiencing gender dysphoria should seek counseling or 'pastoral care,' not gender-affirming treatments.
He's also come under scrutiny after The Wall Street Journal reported in March that his Alabama urology practice advertised its work treating transgender men with erectile dysfunction. Christine has denied treating trans patients.
Since taking office, Trump has directed HHS to restrict access to gender-affirming care treatments for children and teens.
The Alabama GOP has praised Christine's nomination, calling him 'a longtime Conservative grassroots activist and dedicated supporter of the Alabama Republican Party.' In 2024, Christine contributed more than $8,500 to Trump's campaign.
Key context: Dr. Rachel Levine, a pediatrician and the highest-ranking openly trans person to serve at the federal level, held the job during the Biden administration. Levine, who used the post to advocate gender-affirming care, was frequently the target of anti-trans attacks from Trump and his allies.
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HAWLEY'S ABOUT-FACE — Just weeks after voting for massive cuts to Medicaid in the GOP's 'big, beautiful bill,' Missouri Republican Sen. Josh Hawley introduced a bill Tuesday that would walk back those cuts.
Hawley repeatedly voiced his opposition to deep Medicaid cuts throughout the megabill negotiation process, specifically provisions that would hit rural hospitals. But he ultimately voted 'yes' on the recently enacted legislation, which contains more than $1 trillion in health care cuts and a provision that would cap state provider taxes — a move that hospitals have said could deeply reduce their revenue and limit access to health care for millions of Medicaid enrollees.
Hawley said he voted for the bill's passage after negotiating for the inclusion of a $50 billion rural hospital fund but said at the time that he would 'continue to do everything in my power to reverse future cuts to Medicaid.'
His new legislation, the Protect Medicaid and Rural Hospitals Act, would repeal the megabill's moratorium on taxes that states impose on providers to generate more Medicaid funding, which helps boost payments to hospitals. Hawley's bill would repeal megabill provisions that reduce state-directed payments — which enable states to increase the rates that privately run Medicaid managed care plans reimburse providers.
His legislation would also double the megabill's investment in the rural hospital fund to $100 billion and extend the fund from five to 10 years.
'President Trump has always said we have to protect Medicaid for working people. Now is the time to prevent any future cuts to Medicaid from going into effect,' Hawley said in a news release.
Global Health
PEPFAR U-TURN — Senate Republicans on Tuesday stripped cuts to global AIDs funding from the White House's $9.4 billion spending clawback request, POLITICO's Jordain Carney and Cassandra Dumay report.
Republicans will remove a $400 million cut to the global AIDS program known as PEPFAR, reducing the amount of cuts in the package to $9 billion, said Sen. Eric Schmitt (R-Mo.), who's leading the rescissions effort in concert with the White House.
Senate Majority Leader John Thune said he expects the removal to be the only change made to the rescissions package, adding that there was a 'lot of interest' among Senate Republicans to address the cut to the program created under then-President George W. Bush and credited with saving tens of millions of lives.
News of the change came after White House Budget Director Russ Vought briefed senators during a closed-door lunch Tuesday. Schmitt said the White House is on board with the change.
'We're fine with adjustments,' Vought told reporters. 'This is still a great package, $9 billion, substantially the same package. The Senate has to work its will, and we've appreciated the work along the way to get to a place where they think they've got the votes.'
Background: Several GOP senators, including Appropriations Chair Susan Collins of Maine, had raised concerns about the AIDS funding cuts. It's unclear whether the $400 million rollback will be enough to secure her vote, but it might placate enough Republicans to advance the package through the Senate. Other Republicans being watched closely are Alaska Sen. Lisa Murkowski, Kentucky Sen. Mitch McConnell and Kansas Sen. Jerry Moran.
At the Agencies
HOSPITAL PAY CUT — The Trump administration is proposing cutting $280 million in payments to certain hospital clinics for administering drugs to patients, POLITICO's Robert King reports.
The Centers for Medicare and Medicaid Services said the cut would ensure that Medicare beneficiaries aren't charged more for the same service at a hospital than at an independent clinic. The proposed rule is likely to generate fierce pushback from the hospital industry, which has successfully fought similar congressional efforts.
The rule also outlines 2026 Medicare payment rates for hospital outpatient services and ambulatory surgical centers and includes new changes to boost price transparency.
'These reforms expand options and enforce the transparency Americans deserve to ensure they receive high-quality care without hidden costs,' CMS Administrator Mehmet Oz said in a statement.
Background: The first Trump administration adopted a policy in 2019 to lower payments for outpatient hospital clinics to align them with those of independent clinics. Now, CMS wants to expand that policy to include services for storing or administering pharmaceuticals to patients.
The agency estimates the change will reduce Medicare spending by $280 million, with $210 million allocated to Medicare and $70 million to Medicare beneficiaries thanks to lower co-insurance rates, according to a fact sheet on the rule.
Key context: Site-neutral payments — when Medicare pays the same amount for the same service regardless of where it's provided — have gotten bipartisan support on Capitol Hill. But packages have never made it across the finish line partly due to fervent lobbying from the hospital industry, which argues the payment cuts would imperil the finances of vulnerable hospitals.
What's next: The rule has a 60-day comment period before final approval.
WHAT WE'RE READING
POLITICO's Lauren Gardner reports on Democratic Sen. Richard Blumenthal suggesting he's open to changing the federal vaccine injury program.
KFF Health News' Darius Tahir reports in NPR that researchers fear a program that collects DNA data from millions of retired military service members could be in limbo.
Endpoints News' Jared Whitlock reports on the Trump administration's disbanding of a newborn screening panel for rare conditions.