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Robert F. Kennedy Jr. is facing a bruising fight in his quest to become HHS secretary, regardless of whether he wins Senate confirmation.

Why it matters: The process will test how willing GOP senators are to let his disproven vaccine claims and pro-abortion stance go unchallenged, either in the belief it's important to get an outsider-provocateur running federal health care or in deference to President-elect Trump.

The big picture: There's a lot of early confidence that Kennedy could have a hard skate but will ultimately get confirmed, especially because members have larger concerns with other controversial nominees — like former Rep. Matt Gaetz for attorney general — and may have to pick their battles.

Where it stands: Kennedy's liabilities start with his views on vaccines, pharma and the medical establishment and extend to reproductive health and food policy.

• The nation's most prominent vaccine critic says he doesn't want to take away anyone's vaccines. While Republicans have questioned the safety and effectiveness of COVID-19 shots, they've never before made vaccination a defining issue — and the public skepticism in GOP circles is quite new.
• The GOP has traditionally been a reliable defender of the pharmaceutical industry and policies that help bring more new therapies to market faster. Kennedy, on the other hand, has insinuated that there's a link between Big Pharma and the rise of chronic disease.

Kennedy's past support of abortion rights is also emerging as a sleeper issue.

• "There's no question that we need a pro-life HHS secretary, and of course, we have concerns about Robert F. Kennedy Jr.," SBA Pro-Life America President Marjorie Dannenfelser said in a statement.
• Senate Republicans by and large haven't raised this as a red flag, although some will undoubtedly press Kennedy about his views.

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Sen. Susan Collins (R-Maine) called Wednesday for President-elect Trump's health administration appointees to face "extensive committee investigations" as part of the Senate's confirmation process.

Why it matters: Her comments echo concerns from some in Congress that Trump may forgo the traditional confirmation process in favor of recess appointments, and skip several vetting steps for appointed candidates.

What she's saying: Opting to allow recess appointments without congressional approval, would "avoid and evade the Senate's constitutional duty to do advice and consent," Collins said at an Axios event on cognitive care.

• To her, "that means a background check, it means extensive committee investigations and questionnaires and public hearings," she said.

Collins, who called for additional federal funding for Alzheimer's and other cognitive care research, said there "could be" an upheaval at the NIH, FDA and other key divisions due to Trump's health agency picks.

• She touted her work on a law requiring NIH to submit a budget specifically for Alzheimer's research, which she said has helped increase funding.
• "Back in 2011 we were only spending $500 million on Alzheimer's and other dementias," she said. "Now we are spending $3.8 billion, and if the appropriations bill passes, we will cross the $4 billion threshold."

Roughly a quarter of Americans say they suffer from chronic pain, and nearly 1 in 10 say it's bad enough to regularly limit their life or work, according to new data from the CDC.

Why it matters: Chronic pain is the most common reason people seek medical care and beyond causing physical limitations can lead to increased anxiety and depression as well as opioid misuse.

What they found: Researchers asked more than 87,000 people how often they experienced pain in the last three months and found 24.3% reported "most days" or "every day."

• 8.5% said it limited their life or work activities most or all days.
• The risk for chronic pain rose as people aged and was highest in rural areas.
• American Indian and Alaska Native adults were more likely to have chronic pain in the past three months (30.7%) compared with white (28%), Black (21.7%), Hispanic (17.1%) and Asian (11.8%) adults.

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Hospitals provide essential care in rural America where access to physicians is limited. In 2021 alone, rural patients turned to hospital EDs 18 million times for care.

Get the facts on how hospitals care for patients in rural America 24 hours a day, 7 days a week, 365 days a year.

Three out of four U.S. adults want their primary care provider to discuss their mental health during routine checkups, but roughly a third say they've never been asked about it, according to a new Gallup survey.

Why it matters: The poll shows a disconnect between patient expectations and provider behavior at a time when the country is in the midst of a mental health crisis and more health officials are looking at integrating behavioral health into primary care settings.

Driving the news: 74% of those polled said they were very or somewhat comfortable bringing up mental health issues with a primary care provider.

• Women were more likely to report being asked by a provider about their mental health.
• Half of those responding said it's "very important" for primary care providers to screen patients for anxiety and depression, while 57% said it was important for primary care providers to treat patients themselves for these conditions.

Between the lines: An estimated 59 million people were living with a mental illness in 2022, and just over half received treatment in the prior year.

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