For more than a month, President Donald Trump’s pick for surgeon general, Casey Means, has sought private meetings with the two Republican senators threatening to sink her nomination.
But those meetings haven’t happened, two people familiar with the matter said, with Sens. Lisa Murkowski and Susan Collins remaining noncommittal about their votes.
Murkowski told CNN in mid-March she’s “not enthusiastic about her.”
The senators’ skepticism has effectively stalled Means’ candidacy, dealing a major blow to the man who championed her rise, Health and Human Services Secretary Robert F. Kennedy Jr., and his “Make America Healthy Again” agenda.
It’s the latest rebuke for Kennedy, who over the last several months has suffered a series of setbacks that have sapped his influence among Republicans and left him diminished within an administration where some officials view him — and his vaccine actions — as a potential liability in the upcoming midterm elections.
A federal judge recently reversed Kennedy’s most significant childhood vaccine changes, and the administration’s search for a new director of the Centers for Disease Control and Prevention has dragged past deadline amid questions about who can navigate Senate confirmation and the CDC’s challenges in this environment. Longtime MAHA advocates, meanwhile, are lamenting that the administration has abandoned their top goals — and are promising their own retribution with midterm votes.
The current environment is a far cry from Kennedy’s first months on the job, when he was seen as a powerful Trump ally who enjoyed broad latitude to carry out his priorities, touting a supposed cause of autism and promising to reverse rising chronic illnesses in children.
Increasingly, the Means vote looks like a proxy battle over Kennedy himself, who over the past year has plunged ahead on vaccine policy changes that have rankled some Republicans across the spectrum.
“Their only leverage [against him] is trying to stop these nominees, or at least slow them down,” said one person familiar with the internal discussions.
The seeming deadlock has also fueled speculation that Trump would pull his nomination of the wellness author and longtime Kennedy ally. The president told reporters Sunday that step “would be possible.” He added, “We certainly have a lot of great candidates for the job.”
In a statement Monday, White House spokesperson Karoline Leavitt reiterated support for the nominee and said the Senate should move quickly to confirm Means “without further delay.”
An HHS spokesperson said that Means “has communicated a vital public health message that people voted for” and that “we look forward to her swift confirmation.”
Inside HHS, Kennedy and his inner circle are struggling to strike a balance between a White House increasingly tightening its grip on policy and messaging, and MAHA advocates pressing for Kennedy to keep his campaign promises.
The tension has tipped into public view, with some MAHA allies openly venting about dysfunction at the federal health agency.
A Massachusetts judge in March effectively blocked Kennedy’s narrowed list of childhood vaccine recommendations and suspended most of the people the secretary had appointed to the Advisory Committee on Immunization Practices, a federal panel advising those decisions.
Dr. Robert Malone, a biochemist and Covid-19 vaccine critic, resigned from the panel following the judge’s ruling, which the government has yet to appeal.
“The truth is that I have been looking for an exit for months. This thing is a hot mess,” Malone said in late March on “The Highwire,” a weekly show hosted by Del Bigtree, a longtime Kennedy ally who has advocated against vaccination.
“All you can say for sure is the government did a horrid job” defending Kennedy’s vaccine actions, Malone said.
Malone also said Kennedy called him and asked him to stay on at the vaccine advisory panel. An HHS spokesperson declined to comment.
Kennedy, when appointing Malone and others to the committee last June called them a group of “highly credentialed scientists, leading public-health experts, and some of America’s most accomplished physicians.”
The White House has tried in recent months to assert more influence over HHS, this February installing four senior officials with experience in drug pricing and access.
Administration officials are keen to emphasize the president’s wins in that arena, such as “Most Favored Nation” pricing for prescription drugs and the direct-to-consumer drug platform TrumpRx, rather than vaccine policies in the upcoming midterm election.
The strategy is tied to mounting concern that Kennedy’s controversial vaccine actions are alienating average voters. Kennedy, once polling as Trump’s most popular Cabinet secretary, has seen his broader popularity slip: By October, eight months into Kennedy’s tenure, nearly 6 in 10 Americans said they disapproved of the health secretary, according to a KFF poll.
But on the other side, MAHA advocates warn they represent a pivotal voting base that is being sidelined by traditional Republicans.
“Casey Means and her — not just her health experience, but she’s a new mom — represents a demographic that is absolutely essential to successful Republican midterms: MAHA moms,” said Michael Caputo, a biotech founder and former assistant HHS secretary for public affairs during the first Trump administration.
That cohort has been further aggravated by recent Trump action to support pesticide manufacturers and a looming Supreme Court battle over whether those chemical makers can be sued for health damages.
Kennedy and his allies, including Means, have long argued that commonly used pesticides such as glyphosate, or Roundup, can fuel cancer and other health problems. Manufacturers and several prominent agricultural groups have said there is no evidence of this link and that restricting pesticide use could destabilize the American food supply.
For now, the latter camp has won the messaging: A Kennedy-led strategy to address chronic disease skipped calls for pesticide bans and restrictions. And the health secretary this year echoed the argument about a stable food supply when defending Trump’s decision to order more domestic production of glyphosate.
But he also publicly admitted frustration with the moves.
“It’s not something that I was particularly happy with. Let me put it that way, mildly,” he told podcast host Joe Rogan in February.
Surgeons general — public health messengers with no policymaking authority — are rarely mired in voting controversy. Most are waved into their role as the nation’s top doctor with a chorus of “ayes” on the Senate floor.
But Means’ tense confirmation hearing before the Senate Health, Education, Labor and Pensions Committee in February exposed fault lines between moderate Republicans and MAHA advocates.
Committee Chairman Bill Cassidy of Louisiana almost immediately brought up vaccine policy, pressing Means on her views. He was followed by Murkowski expressing alarm about HHS efforts to delay hepatitis B vaccination, and Democrats questioning the Stanford-trained physician’s personal stance.
Means told Cassidy that “this is not an issue that I intend to complicate.”
Cassidy, a physician himself, has not signaled how he will vote on Means’ nomination — or when he intends to hold the committee vote. But he has been one of the most vocal GOP critics of Kennedy’s vaccine actions, concerns he nodded to when he kicked off Means’ hearing in February.
“The surgeon general needs to be an effective and truthful communicator, a calming voice of reason, a steady-handed experience at a time when so many, for whatever reason, sow distrust and confusion,” Cassidy said. “Dr. Means, it should be your mission — and the mission of every HHS official — to restore stability and assure Americans that protecting health is the top priority.”
