Trump Transition: Ensuring Alignment with Health Department Goals

Just months after Donald Trump promised to let Robert F. Kennedy Jr. “go wild” on health care as a member of his Cabinet, some of the president-elect’s advisers are quietly trying to box him in.

Transition officials plan to install several longtime GOP allies in senior roles across the health department, filling out key parts of Kennedy’s leadership team well before he could be confirmed as Health and Human Services secretary.

Strategic Staffing for Alignment

The push aims to surround Kennedy with conservative policymakers who can compensate for his lack of government experience and MAGA credentials — while also ensuring the White House can keep close tabs on an HHS nominee who many Trump aides still don’t fully trust, said a half-dozen Republicans familiar with the transition’s activities, who were granted anonymity to discuss private deliberations.

“There’s a fear that they’ve put a Kennedy as health secretary — so not only a Democrat but a Democrat that happens to be a Kennedy,” said one former senior Trump health official involved in the transition discussions, granted anonymity to discuss internal matters. “The White House absolutely wants to make sure they have their people around him.”

Key Appointments and Implications

The transition has tapped veteran GOP lawyer Heather Flick to be Kennedy’s chief of staff, a role from which she could broadly influence the department’s day-to-day priorities. Flick, who was a senior HHS official during the first Trump term, is regarded as a committed conservative who can keep the department focused on executing the White House’s agenda.

Hannah Anderson, a health expert at the Trump-aligned America First Policy Institute, is also expected to take a role on Kennedy’s senior team, according to three Republicans familiar with the matter granted anonymity to describe the situation.

Future Directions and Challenges

The early hires mean the department may look more traditional than it first appeared when Trump tapped Kennedy to lead it, putting a prominent anti-vaccine activist in charge of the sprawling bureaucracy responsible for Americans’ health. And they raise questions about how much leeway the White House will grant Kennedy to pursue his own agenda, including greater scrutiny of vaccines and efforts to reshape chronic health and food policies, should they conflict with broader administration plans to pursue more traditional conservative priorities.

Kennedy and his allies have heralded his nomination as a major political realignment and validation of his “Make America Healthy Again” movement, which is grounded in deep skepticism of the health care establishment. Yet since then, an intense tug-of-war has played out over personnel decisions, the Republicans familiar with the transition discussions said, with different factions vying for influence over the shape of the department.

Ensuring Alignment and Loyalties

“They’ve given him some flexibility in who he can hire, but there are certainly limits to that,” said one of the Republicans close to the transition, adding that Trump’s senior aides have scrutinized candidates’ allegiances. “They’re looking for people who understand the agencies and the departments really well — and then have the necessary loyalties.”

The Trump transition did not respond to a request for comment, and a spokesperson for Kennedy declined to comment.

At the Centers for Medicare and Medicaid Services, a policymaking hub that represents 22 percent of federal spending, aides have made a series of high-level appointments. John Brooks, a former first-term Trump health official running the transition’s HHS landing team, is returning as CMS’ chief operating officer, according to two people familiar with the matter who were granted anonymity to disclose the previously unreported hire. Another first-term alum, Abe Sutton, is in line to run the Innovation Center charged with improving patient care.

Chris Klomp, an entrepreneur who aided some of the Trump White House’s early Covid response efforts in 2020, will helm the Medicare program. His deputy is expected to be Alec Aramanda, who served at HHS during the first Trump administration.

Drew Snyder, a former longtime Mississippi state Medicaid director, is expected to run CMS’ Medicaid division, two of the Republicans familiar with the transition said. And former Republican Capitol Hill staffer Stephanie Carlton is set to be CMS chief of staff. The Washington Post first reported Klomp and Carlton’s hiring, and STAT News first reported Sutton’s return.

Kennedy, who remains close with Trump, is still expected to bring in a handful of his longtime allies. Stefanie Spear, who was press secretary on his 2024 campaign, is slated to be Kennedy’s deputy chief of staff at HHS, two of the Republicans said.

Strategic Alliances and Future Prospects

But three of Kennedy’s closest confidants — wellness entrepreneurs and influencers Calley and Casey Means and vaccine injury lawyer Aaron Siri — are unlikely to join the department. They are expected to retain broad influence with Kennedy from the outside, mirroring the direct involvement they’ve had during the transition in helping vet candidates and plot policy priorities.

Kennedy’s orbit has also focused on determining who they don’t want at HHS and its various agencies, pushing back hard against candidates who have worked with major drug companies.

Trump advisers involved in the personnel process have tried to balance the demands from competing factions, the Republicans familiar with the transition said, wary of touching off an internal war that could derail the president-elect’s health agenda before he’s even inaugurated.

In particular, transition officials have worked with Kennedy to reach agreements on key appointees like Flick, rather than thrusting their favored picks on him. And while there have been occasional fissures, one person familiar with the Kennedy team’s thinking acknowledged, they stressed that Kennedy has won perhaps the most important victories: Getting like-minded allies nominated to run CMS, the Food and Drug Administration and the National Institutes of Health.

Building Consensus and Direction

“No one wants to start a war right now. They don’t want a repeat of issues that they had during Trump 1.0,” the former senior health official said, referring to the vicious infighting among top health officials throughout the first Trump term that disrupted key policy goals. “Right now, everyone’s trying to play nice.”

Transition officials are hoping that Flick in particular will serve as a steadying force, capable of tamping down divisions and keeping Kennedy and his department on track.

“With Heather, there’s a lot of opportunity to bridge the kind of idealism of the Kennedy secretaryship with some pragmatism for how the agency actually works,” said David Mansdoerfer, a senior first-term Trump official, warning that it will be critical to avoid “long-term relationship issues, even between the different divisions of HHS.”

Still, Trump allies characterized the first round of staffing as a friendly, if not-so-subtle reminder that regardless of his own ambitions, Kennedy works for Trump now. And Trump’s top aides plan to make sure it stays that way.