Trump’s Pick to Quiet the Chaos at HHS

Robert Kennedy Jr.: I want to thank President Trump for entrusting me to deliver on his promise to make America healthy again.

Dan Gorenstein (DG): When President Trump returned to office, he tapped Robert F. Kennedy Jr. to serve as Secretary of Health and Human Services. 

He picked a person revered by some, reviled by others for his controversial views, particularly on vaccines. 

Kennedy: In my advocacy, I’ve often disturbed the status quo by asking uncomfortable questions. Well, I’m not going to apologize for that.

DG: Now, a year into the President’s second term, Kennedy’s vaccine changes are unpopular and his department is in turmoil.

So the White House has tapped a very different type of leader to help Kennedy right the ship.

Dan Diamond (DD): You would not get the sense if you encountered him in the wild that he was working for the Trump administration in this high powered role. And he’s basically running HHS on a day to day basis.

DG: Today, how a virtual unknown has risen to the top of Trump’s health department, and what that could mean for the nation’s health policy.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

*****

DG: To learn more about the guy President Trump has tasked with cleaning up the mess at the Department of Health and Human Services, I called up an old friend.

How are you doing Dan? Good to see you, man.

DD: Hey, buddy. How are you? How are you doing, better Dan, original Dan?

DG: Dan Diamond is a longtime health care reporter and currently a White House reporter for the Washington Post. 

So you wrote a profile recently of Chris Klomp. Klomp was originally Trump’s pick to oversee Medicare, the federal health insurance program that covers some 70 million older Americans and people with disabilities.

Now, Dan, he’s been promoted to chief counselor of HHS. HHS is a $2.6 trillion agency that includes health insurance programs like Medicare and Medicaid, research programs at NIH, vaccine policies at FDA and CDC. You write that in Klomp’s new role, he’s overseeing all of that that everyone in all of those agencies report to him.

What does this actually mean, though, Dan? Like, what’s this guy’s new job?

DD: His new job is being the day to day manager of HHS. 

In some ways, he’s the secretary in all but name. So Chris Klomp, still running the Medicare program, by the way, is now also overseeing, to some extent, hiring. He’s signing off on all their big announcements and decisions. He’s trying to be the manager of this sweeping department, really, that has caused a lot of political headaches for the Trump administration

DG: And so. Right. I mean, can you go into a little bit greater detail, Dan, what has happened at HHS that made the White House feel like they needed to bring in someone new?

DD: As your listeners know, the secretary of HHS, Robert F Kennedy Jr., very controversial figure, not someone who necessarily had all the HHS skill set qualities. If you looked back at past secretaries of this sweeping department, they were usually, government officials.

Xavier Becerra, he had been the attorney general of California.  Kathleen Sebelius had been, I think, governor and the insurance commissioner. Robert F Kennedy Jr. had not had one of these big government jobs running a big organization. He hadn’t been a university president like Tommy Thompson, another past HHS secretary.

So when Kennedy came in and brought a lot of his allies, there really was this culture clash in some ways intentional because Kennedy decried the government, said how much HHS was in trouble, how much he wanted to fire people at NIH and CDC.

But it also just meant operationally, there were things from the White House perspective that weren’t getting done, or if they were getting done, they weren’t getting done. Right. The White House felt like it was getting surprised, even when the good news was coming out.

DG: Vaccines, Dan, have obviously been a focus of Kennedy’s HHS. And you write that part of why Trump brought Klomp in is to, quote, keep the health department focused on the message that the White House wants to see and away from abrupt vaccine policy shifts that cause political headaches.

Based on your reporting, is Klopp’s appointment a signal that the MAHA vaccine agenda is in trouble?

DD: I don’t know if HHS would agree with me, but I think so. I think this is a guardrail around some of what MAHA wants to do on vaccines. President Trump has empowered Kennedy to make some of these vaccine changes. But I think what Republican pollsters and advisers to the White House have increasingly realized and warned the president is that these are unpopular changes.

The White House is trying to shift away. They’re focused more on things like Kennedy’s changes to the food pyramid, the health department’s work on fighting fraud, things that are more bipartisan.

And Klomp himself got the mandate. And I know this because I interviewed him on record, that the White House wants him to focus on affordability, this buzzword in a midterm election year about how much Americans are spending. And is the Trump administration helping Americans have a better experience of navigating the economy and not feeling like they’re being stretched thin?

DG: So the White House is unhappy with Kennedy’s HHS. Here comes this virtual unknown who’s been running Medicare. What is it about Klomp, like why Klomp?

DD: Why Klomp? Chris Klomp was a guy that I maybe had vaguely heard of about a year ago, when. When I broke the news that he was going to get the Medicare job. He’d worked as a health care businessman and what I found in talking to him and talking to people around him is that Chris Klomp is a data driven guy who talks like a health care businessman.

He talks like a guy who’s run organizations, and he talks like someone who, to be frank, is not Robert F Kennedy Jr. He’s not going to go off book and start quoting something that he saw on YouTube or on Twitter or X, like RFK Jr might. He’s going to talk in pretty deep, wonky detail about his thoughts around, say, prior authorization or, you know, coding in Medicare.

DG: You spend a minute in your piece, Dan, and I like that your editors gave you this latitude — that you quoted the president who has nicknamed Klomp his either “favorite Mormon” or the “killer Mormon.”

But really, this guy Klomp, whatever his nickname may or may not be, he is the adult in the room.

DD: Dan, someone said that basically to me that Susie Wiles wanted an adult in the room at HHS. And Chris Klomp, who emerged on the scene last year as part of the team, in some ways, the chief negotiator negotiating with drug companies on President Trump’s drug price program. 

Newsclip: President Trump announced a new agreement with nine pharmaceutical companies that are aimed at making certain prescription drugs cheaper.

DD: That really impressed the White House. And Klomp, speaking in the Oval Office last year.

Chris Klomp: Today, we’re announcing another truly great deal. I love this deal.

DD: Further wowed the president.

Chris Klomp: This is about unlocking the full potential of every American, the grandmother, the grandfather, the father, the son, by unlocking access to affordable lifesaving medications that make a meaningful difference in their lives when they need them most. 

DD: The White House and others who dealt with him in the administration, they felt like this guy is a problem solver. He’s someone who’s reliable, who can talk the talk and help run things more efficiently at a department that really needs it.

DG: As you’ve gotten to better understand Klomp and this role of his, Dan, does this tell us anything about RFK Jr? Not his agenda and not how the White House feels about his agenda, but about RFK Jr. as someone who’s learning the ropes of running a massive organization like HHS.

DD: I think it says two things. First, he did recognize, as so many people would agree, that Chris Klomp has this expertise and these capabilities that could help him. This was late last year, but my colleague Rachel Roubein and I had a story about all the chaos linked to FDA and how the White House and HHS was worried about FDA problems.

And my understanding then was Kennedy was leaning a lot on Klomp. This was months before Klomp got elevated. But basically saying, look, you’re a management expert, you run companies, you’ve been on boards. Help me fix the problems at FDA.

I think second, it reflects how quickly people can rise in this orbit, where Kennedy has alienated so many normal wonks and other people who don’t want to work with him, that if you’re competent and get into this world, you might get a very big job very fast.

DG: I know we’re a policy show, but I have to ask a political question here, Dan, is this an election year move? Like let’s bring somebody in who’s going to be sort of like quiet the critics a little bit here?

DD: Totally. I would not be surprised if we get past the midterms and Chris is still in this big job, that we would see more things coming from this HHS and maybe even from him that would be more politically controversial.

He’s a registered Republican. I believe his politics skew conservative, but he is not a culture warrior. And in my reporting on him or my personal dealings with him, he didn’t bring up things like the need to constrain the vaccine schedule, the need to overhaul abortion access. Those may be personal priorities. But they did not come up in my reporting, and they have not, in his early days in this big HHS job shaped his perspective.

DG: When we come back, Dan explains how Chris Klomp is already shaking up HHS, and what we could expect in the months to come.

BREAK

DG: Welcome back. We’re talking with Washington Post White House reporter Dan Diamond about his recent profile of Chris Klomp. 

Klomp is a former Bain Capital consultant with an MBA from Stanford who built and ran a major health tech company. 

He’s overseen Medicare for the last year and the Trump administration has tasked him with cleaning up the troubled Department of Health and Human Services.

Okay so, Dan, Klomp’s been in this new role for a little over a month. What’s he been up to?

DD: I think Klomp has been looking across the agencies for the trouble spots and the people who might have been behind some of those trouble spots. So at FDA, the Food and Drug Administration, there was a senior official, Vinay Prasad, who has overseen vaccine policy, who has been linked to some number of headaches for this administration. Vinay Prasad, since Klopp took over, is finding his way out of the administration.

At CDC, Centers for Disease Control and Prevention, senior official named Ralph Abraham, who had said some controversial things about vaccines. Ralph Abraham leaving the administration. And I’ve asked directly, you know, is this Chris Klomp pushing people out or is he just kind of encouraging it? And HHS has said, you know, Klomp had nothing to do with this.

But based on my reporting, I think Klomp made it pretty clear that he does not want to deal with any unnecessary headaches and he’s been hunting for a new CDC director. And based on when this episode gets published, there may well be a new CDC director.

DG: Klomp spoke to STAT news at an event a few weeks ago in New York, and they asked him about what he’s looking for in this new CDC director. His comments really struck me, Dan. He said, “I grew up hearing stories about the CDC and you’d hear about an outbreak somewhere. And they were the first ones on site. They were the Ninja assassin squad that bravely went forward to ensure that whatever this thing was discovered didn’t metastasize across the planet.” I cannot underscore how different that sounds than RFK Jr.

DG: For example, here’s an exchange between Kennedy and Georgia Senator Raphael Warnock from last year.

Raphael Warnock: Did you say that the CDC was quote the most corrupt federal agency in the history of the world?

Kennedy: Not the history of the world, but definitely within HHS. I did not say that, but I did say it’s the most corrupt agency at HHS and maybe the government. 

Warnock: So you called the CDC corrupt.

DG: Based on your reporting, do you expect a CDC with a director picked by Klomp to act differently than what we’ve seen so far?

DD: I think Klomp is operating in an environment where he will have a major say, but he doesn’t have the final say. So Chris Klomp wants someone who will command the respect of scientists of the general public.

My understanding is he wants someone who’s pro-vaccine, and he may well recommend a person who fits all those criteria. And RFK Jr will say, I’m not interested. And President Trump ultimately has to make the decision. So I think this is an early test in many respects of Chris Klomp and how much power and say he has will he get to put his stamp on CDC or will it ultimately be someone that RFK Jr prefers, and Klomp might have to hold his nose a bit?

DG: If you had to guess, what would you guess?

DD: I think it will be a compromise pick, but I think it will lean toward Klomp more than Kennedy.

DG: Right. The point is to minimize those headaches. Klomp is like the big bottle of ibuprofen.

DD: And given that I think he’s a pretty tall guy, it would be a big bottle, yeah. I mean, look, maybe maybe I’m wrong and maybe your listeners will be hearing this at a moment where my, my instinct is wrong, but I don’t think they would have put him in this job if he didn’t get the power to do some of these things. And since we’ve seen Vinay Prasad and some others leave the department in the past couple of weeks, I have to believe that Klomp is going to get his shot to not just push people out, but to bring them in.

DG: Something we’ve been hearing for over a year now is how demoralized rank and file folks are within the agency, within HHS. You wrote something that I was really sort of my eyebrows went up when you said that according to two career civil servants, Klomp, “regularly invites federal workers feedback and respects their expertise.”

We know this administration has shown impatience, some would say hostility, if not contempt, for federal workers. This description of Klomp is obviously in contrast to that. What impact, if any, Dan, do you think this might have on policy at HHS? This sort of respect for the federal workforce?

DD: Well, again, it’s parallel to the personnel argument because Klomp can listen to every career staffer in the building and make a recommendation, and RFK Jr. could still go a different direction.

Klomp has talked about the need to bring in more people who want to make a positive change. And I think Klomp is seeing as his mission not just to help Republicans win at the midterms, but build back up this agency that has been through a really rough patch.

But RFK Jr and Donald Trump are two people who have for decades listened to their guts, not to their lieutenants. And I think Klomp has tried to create an environment in Medicare where people can be open and they can talk through these policies. A little TBD, whether he can sway the president, sway the health secretary.

DG: I mean, on that point, you know, it’s one thing to notch some wins running Medicare, right? I mean, it’s an entirely different thing to try to keep President Trump happy.

DD: Exactly. Chris Klomp, successful in the health care business world, talked to people who worked with him there. Every single person had praise with the exception of people who said, look, he’s never really been in politics before. This is a different animal than the health care business world.

And I think we don’t know what will happen when there is that explosive issue, when we’re a couple months out from the midterm elections and some big issue emerges around abortion, drugs or something that he’s never really had to grapple with, and he’ll be navigating political pressures, lobbyists, an angry president, like who knows TBD. But inevitably some moment like that will come and that will be a big test for him.

DG: Final question, Dan, you cover the White House and public health. There’s so many things you can and do write about. You ultimately decided you wanted to do a 1,500 word profile on Klomp, because you see him rising up through the administration into this role, and he’s going to have some real power and influence. What do you expect to see two years out from an HHS that has all but been run by Klomp?

DD: So this question is assuming that Klomp is basically empowered to do what he wants and is still there.

DG: Right. Which are big, which are huge, right? We’ve entered the part of the podcast where I’m asking you to wildly speculate. I freely admit that.

DD: Which I think is incredibly dangerous for reporters. But because you’re my buddy, I’ll do it for you. I think Chris Klomp really does want to make change on some of the back end things in health care that RFK Jr. probably never really contemplated things like changing the role of prior authorization, things like interoperability, 

DG: Interoperability being making it easier for health medical records to talk to each other.

DD: Exactly, headaches for health care leaders that go well beyond the explosive things like vaccines. So I think that’s where he wants to go. I don’t know if he’ll be successful, but these jobs, Dan, have a way of changing people and creating new priorities.

So I’m giving you my best guess in the spring of 2026, but we may come to spring 2028 and it’s a completely different ball game.

DG: Dan, thanks so much for taking the time to talk to us on Tradeoffs.

DD: You’re the real Dan, and it is great to be here, so thanks for having me.

DG: I’m Dan Gorenstein, this is Tradeoffs.