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Robert F. Kennedy Jr. is not yet the nation's top health official. But as his Senate confirmation vote looms Thursday, leaders inside the Department of Health and Human Services are already scheduling meetings for Secretary Kennedy, as some political appointees now call him, according to two HHS officials who spoke on the condition of anonymity because they were not authorized to speak with the media.
"It's being treated as a done deal," said one.
How Kennedy - a former liberal, pro-abortion rights, anti-vaccine activist once perceived to be a long shot for a Cabinet position - arrived at the precipice of confirmation is indicative of the arc of the modern Republican Party, according to conversations with about two dozen lawmakers, staffers and others involved with Kennedy's confirmation process, many of whom spoke on the condition of anonymity to be candid about private deliberations.
Kennedy forged an alliance last year with then-candidate Donald Trump, then benefited from the GOP Senate's acquiescence to President Trump's demands. Kennedy avoided attacks from antiabortion groups, which were already bruised from their previous battles with Trump and backed away from further fights. He said just enough to convince a pivotal GOP physician, Sen. Bill Cassidy (Louisiana), that he wouldn't threaten vaccines. And he was buoyed throughout by a powerful constituency of supporters, who rallied behind his "Make America Healthy Again" message and argued that politicians have ignored the burden of chronic disease.
Now Kennedy has arrived at the finish line: The Senate voted 53-47 along party lines Wednesday to advance his nomination to a final vote, which is expected to be as soon as early Thursday.
The three-month confirmation fight has drawn millions of dollars of lobbying, with more than $1.5 million spent by a pair of Democratic-led advocacy groups trying to stop Kennedy's confirmation, as well as hundreds of thousands of dollars spent by an anti-Kennedy group run by former vice president Mike Pence. Two Senate hearings last month drew figures such as Megyn Kelly, who used her popular podcast to celebrate Kennedy and was stationed behind him in his first confirmation hearing, and Hawaii Gov. Josh Green (D), who repeatedly flew to Washington to share his personal concerns about a nominee whom Green blamed for contributing to a measles outbreak in Samoa. Vice President JD Vance even intervened to make personal commitments to Cassidy that locked up his vote.
Senate Democrats gave themselves only a 1-in-5 chance of stopping Kennedy's nomination, according to one Democratic staffer involved in the process. But it continues to mystify many doctors, liberal lawmakers and even some conservatives that Kennedy's confirmation is on the verge of reality.
"It's blind loyalty to Trump," said Rep. Raul Ruiz (D-California), a physician, insisting that Kennedy is not fit to serve. "I'm very worried. His anti-vaccine beliefs, which have been scientifically debunked, jeopardize people's trust in vaccines."
Kennedy denied to senators that he is anti-vaccine and dismissed any connection to the measles outbreak in Samoa. But he refused to rule out the debunked link between vaccines and autism, and sent other signals to Congress that he was uncertain of vaccines' value.
The full Senate must still approve Kennedy's nomination. But with Democrats expected to vote against Kennedy in lockstep, four Republicans would have to join them to block him - and the path to stopping him has disappeared. Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) this week said they will support him; Sens. John Curtis (R-Utah) and Mitch McConnell (R-Kentucky) have signaled concerns over Kennedy but voted to advance his nomination Wednesday.
One point where his critics and admirers agree: Kennedy's confirmation would be historic.
Kennedy founded one of the nation's most prominent anti-vaccine groups; if confirmed, he'd oversee the nation's vaccine supply. Kennedy fought efforts by U.S. health agencies to roll out coronavirus vaccines during the pandemic four years ago; now public health leaders fear he'd do the same if another outbreak, such as avian flu, unfolded as he sat atop HHS.
"Physicians like myself feel duty bound to speak out, especially when it is an issue where science is so heavily on one side of the debate," said Pradheep J. Shanker, a physician and conservative pundit, who was part of a group of doctors lobbying Cassidy and others.
But Kennedy's supporters see a reformer who isn't beholden to the establishment - and who is finally giving voice to public health problems, such as Americans' relatively poor life expectancy, that can be overlooked.
"I think that you are the person to lead HHS to make America healthy again," Sen. Roger Marshall (R-Kansas), a physician who launched a MAHA caucus in the Senate, told Kennedy in a confirmation hearing last month. "… G od has a divine purpose for you."
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A year ago, Kennedy's purpose was difficult to divine. His independent campaign for president was polling at about 15 percent support - meaning that he was a long shot to unseat President Joe Biden or Trump but could be a spoiler if he stayed in the race.
Trump, worried that Kennedy would siphon some of his conservative support, hammered him as a "radical" who was even more liberal than Biden - a message amplified by his campaign and allies.
Then Kennedy threw his support to Trump in August and became a top surrogate, drawing crowds and independent voters to the GOP campaign. He also made something clear: He wanted a senior role overseeing food and health in Trump's future administration.
Trump was game, pledging that Kennedy would "go wild on health" if he was elected.
In the days after the election, the president-elect, Kennedy and advisers huddled at Mar-a-Lago, Trump's estate in Palm Beach, Florida, to discuss whether he could be confirmed by the Senate; whether Kennedy had the appetite to go through what was expected to be a grueling confirmation battle; and whether it made sense to attempt a recess appointment that would allow Kennedy to avoid a Senate confirmation fight, according to people familiar with those conversations.
Kennedy opted for the Cabinet nomination. The pick was immediately greeted as one of Trump's most controversial selections.
Kennedy began a tour of dozens of Senate offices - although to unclear effects, with Republicans consistently supporting him and Democrats remaining solidly opposed. Some senators described a nominee with limited grasp of the powers he would inherit as HHS secretary; he privately told some Democrats that he supported seizing drug patents, an idea embraced by progressives, before publicly rejecting the idea.
But as Trump's nominees faced pressure - and former Florida congressman Matt Gaetz's nomination to be attorney general collapsed - the president and the White House made clear that they would fight to preserve the rest. The GOP Senate quickly fell in line.
"It's incredibly difficult to go against any of the president's nominees," said Ryan Ellis, president of the Center for a Free Economy, a conservative nonprofit. "People takes notes. People have memories. You don't want to go whole hog and then cut off your ability to work with an administration, an HHS, a White House for the next four years."
• Staving off abortion pressure
Another threat to Kennedy's nomination still lurked: his history of advocating for abortion access, which had prompted attacks from Trump and Republicans last year.
Stephen Miller, a top Trump adviser, highlighted Kennedy's abortion support as "unfathomable" in May - just three months before Kennedy and Trump would team up.
Kennedy allies worried that antiabortion groups would seize on his comments, too. The groups frequently wade into legislative debates and had scored the nomination of Biden's health secretary, Xavier Becerra - meaning that they tracked senators' votes on their legislative scorecards, a powerful tool to ensure alignment among GOP lawmakers.
But while Pence's group, Advancing American Freedom, said that Kennedy's abortion views disqualified him from the role, other organizations backed down after raising initial concerns.
Others in the antiabortion movement said they were thrilled with how Kennedy responded to questions about abortion during his confirmation hearings and in meetings with senators.
For instance, Kennedy said he was open to revisiting existing regulations around abortion pills, according to an antiabortion advocate - and was open to the idea that mifepristone could be risky to a woman's health. (Leading medical associations agree that the abortion pills are safe, even when taken without first having an ultrasound or meeting with a doctor in person.)
The groups' relative silence helped give GOP senators cover to vote for a longtime liberal who, less than six months earlier, had called for "unrestricted abortion" until fetal viability.
"I heard people express their concerns about his pro-choice position, and yet I haven't seen any pro-life organizations score this vote or recommend that we should vote against it," Sen. Thom Tillis (R-North Carolina), who had been viewed as a potential swing vote, said after voting for Kennedy in the Finance Committee last week.
• Securing Cassidy
Kennedy's allies were also worried that the 71-year-old former environmental lawyer, who has never held a senior government role, would say something disqualifying during his pair of confirmation hearings.
The HHS nominee received briefings from conservative policy wonks such as Hannah Anderson and Brian Blase. But he still stumbled through explanations about core health programs, such as Medicaid and Medicare, in his hearings with the Senate's finance and health panels, and even some of Kennedy's supporters worried about his performance.
Kennedy "was not very well prepared, in my judgment, on Medicaid issues," said Mark Kapengut, who traveled from New Jersey to watch Kennedy's testimony, wearing a button from his ill-fated presidential campaign.
Some Democrats wished that they'd dwelled on Kennedy's qualifications to lead a nearly $2 trillion agency, rather than focusing so heavily on his vaccine stance. Sen. Peter Welch (D-Vermont), a member of the Senate's finance panel, worried that Democrats had blown an opportunity in the hearing to expose Kennedy's lack of health-policy expertise.
But the key senator whom Kennedy needed to win over was Cassidy, who held the swing vote on whether Kennedy's nomination would make it out of committee to the Senate floor. The politically endangered Louisiana senator fretted about whether Kennedy could be trusted to protect access to vaccines and privately spoke with Vance for reassurance.
Cassidy also secured a series of guarantees, such as Kennedy's commitment to testify as frequently as every three months in front of the Senate health panel that Cassidy leads, and a promise that Cassidy could provide input on top jobs at the federal health department, such as the still-open assistant secretary of health position.
As lawmakers filed into the Senate Finance Committee room Feb. 4 to learn whether Kennedy's nomination would advance to the Senate floor, a pair of Kennedy's close allies sat side by side in the front row: Stefanie Spear, a longtime liberal activist who has worked for Kennedy for years, and Ken Nahigian, a GOP strategist now advising Kennedy on how to navigate the Senate.
After Cassidy announced his vote for Kennedy - a decision that allies said he reached only that morning - and the committee advanced the nomination to the Senate floor, Spear stood up to return to HHS, where she is already serving as a top official and beginning to lay the groundwork for Kennedy's agenda. Nahigian remained behind in the hearing room, with Kennedy's confirmation incomplete; one major vote still loomed.