Why This Landed on My Radar
HHS Secretary Robert F. Kennedy Jr. just spent two weeks in front of seven congressional committees, and somewhere between the Kid Rock video questions and the percentage-math gaffes, he said some things that should actually change how Texas PCPs think about the next 12 months. On the record, under oath, with AOC nodding next to him, the Secretary of Health and Human Services called Medicare Advantage upcoding “highway robbery” and floated scrapping risk adjustment and star ratings entirely. That’s not a tweet. That’s a directional signal from the person who runs CMS’s parent agency. If you see MA patients, contract with BCBS Texas or United for commercial lives, or have even thought about a VBC arrangement, this matters.
Here’s What’s Going On
Between April 10 and April 22, Kennedy testified before House Ways & Means, House Appropriations, House Energy & Commerce Health Subcommittee, Senate Finance, Senate HELP, and the Senate Appropriations Labor-HHS subcommittee - his first congressional appearances since September. The stated purpose was defending the White House’s FY 2027 HHS budget. The substance was much broader, and four threads matter for primary care.
First, Medicare Advantage. Kennedy acknowledged to Rep. David Schweikert that upcoding is a significant problem in MA while also conceding enrollees tend to have better outcomes than traditional Medicare. He then argued CMS should “look into a potential model that eschews the existing risk adjustment and star ratings” in favor of rewarding plans that make profit by keeping members healthy. Days later, in a viral exchange with Rep. Ocasio-Cortez at Senate Appropriations, Kennedy agreed - “absolutely” - that insurers are “fleecing the public” and called MA fraud “highway robbery on the American people, on people who are sick, on seniors.” AOC cited MA fraud at roughly $80 billion and an additional $13 billion in projected MA spending in FY 2027 over FY 2026.
Second, 340B. Kennedy publicly criticized certain hospitals’ use of the program at Ways & Means, noted it has grown from its original 100 institutions to 27,000 (100,000 with satellites), and declined to confirm or deny reports that oversight could shift from HRSA to CMS - citing a court order tied to departmental reorganization.
Third, prior authorization and site-neutral payment both came up across multiple hearings, building on the June 2025 insurer pledge Kennedy and Dr. Oz secured, though no new regulatory action was announced in the April window.
Fourth, drug pricing. Sen. Elizabeth Warren produced data suggesting roughly one in four TrumpRx listings are actually priced higher than alternative sources. Kennedy disputed the methodology and defended Trump’s discount math with the now-famous line that a $600 drug reduced to $10 is “a 600% reduction” - which PolitiFact and every math department in the country promptly noted is mathematically impossible.
What This Means for Your Practice
Start with the MA thread, because that’s where the real implications sit for Texas primary care. Medicare Advantage penetration in Texas is above the national average, and Humana, United, and the Blues dominate the MA market here. A sizable chunk of your senior panel - particularly in Houston, San Antonio, and the Valley - is either already in MA or will be at their next annual enrollment. When the Secretary of HHS publicly calls that business model “highway robbery,” two things happen: MA plans get more conservative on risk adjustment review, and your HCC coding and chart documentation come under sharper scrutiny. The MA plans that have been aggressive about sending coders into your practice to “optimize” your documentation are about to dial it back or face regulatory consequences. That changes your leverage.
Second, and more interesting: Kennedy floated scrapping risk adjustment and star ratings in favor of outcome-based rewards. Whether or not that happens in this administration, it’s a public directional signal that matters for contract negotiation. If you’re up for renewal with an MA plan in the next 12 months, the old playbook - accept a modest uplift in exchange for attribution and quality reporting - is the wrong play. The right play is to push for shared savings arrangements tied to actual outcomes, because that’s where this is all heading and the plans know it. Texas practices that move first get better terms. Practices that wait for CMS to rewrite the rules get whatever terms the plans dictate when the new rules drop.
Third, this is the clearest political tailwind for value-based care we’ve seen in this administration. If you’ve been sitting on the fence about joining an ACO, taking on a shared savings contract, or exploring Direct Primary Care, the environment just got more favorable. Not because CMS is about to hand you money, but because the narrative has shifted. MA plans need to demonstrate they’re not just upcoding - they need real outcomes stories, and they need PCPs who can deliver those outcomes. That’s negotiating leverage you didn’t have six months ago.
Fourth, on 340B: if you refer to or have any relationship with a rural hospital, critical access facility, or FQHC that relies on 340B - and in rural Texas that covers most of them - pay attention. The Secretary publicly called 340B “not straightforward” and flagged drugmaker concerns that most-favored-nation pricing would be “existential” for the program. If 340B gets restructured or moves to CMS oversight, the rural hospitals you rely on for referrals and coverage could see real disruption. Your patients’ access to specialty care and affordable drugs runs through that infrastructure.
On prior auth, don’t hold your breath for anything concrete. The June 2025 insurer pledge set deadlines of January 2026 and January 2027 for specific reforms, and Kennedy is pointing to those commitments rather than pushing new regulation. In Texas, where prior auth reform legislation has been bouncing around the capitol for years, state-level action is more likely to move the needle than federal action in the next 12 months.
The uncomfortable reality: there’s real volatility in how MA, 340B, and drug pricing policy shake out from here. Kennedy is increasingly isolated within the administration - not mentioned in this year’s State of the Union, with a challenger endorsed by his own allies’ PAC against Sen. Cassidy in Louisiana, and three cabinet members fired in the last seven weeks. His public positions may or may not translate to policy. But his positions are still the stated positions of HHS, and MA plans, hospital systems, and PBMs are already adjusting their behavior accordingly. Your job is to adjust with them, not wait for certainty that isn’t coming.
Key Takeaways
- The HHS Secretary publicly called MA upcoding “highway robbery” - plans will dial back aggressive coding pressure, which changes your leverage on contract negotiation and documentation practices
- Kennedy floated replacing risk adjustment and star ratings with outcome-based models - whether or not it happens, it’s a directional signal that favors practices positioned for VBC and shared savings arrangements
- Texas MA penetration is above national average - Humana, United, and BCBS dominate, and practices with senior-heavy panels have more to gain or lose from this shift than practices in low-MA states
- 340B restructuring could disrupt rural Texas referral infrastructure - critical access hospitals, FQHCs, and rural specialty access all run through the program Kennedy is publicly questioning
- Prior auth relief is coming through the 2025 insurer pledge timeline, not new federal rules - January 2026 and January 2027 deadlines matter more than anything said in April’s hearings
What Smart Practices Are Doing
The practices positioned to win this shift aren’t waiting for regulatory certainty - they’re using the political moment as negotiating leverage right now. They’re pulling their MA contract renewal dates forward, pushing for shared savings language tied to outcomes rather than coding, and documenting the clinical case for VBC arrangements so they have a credible alternative when plans try to renew at flat rates. They’re also building the infrastructure - care management workflows, risk stratification, chronic disease protocols - that any outcome-based payment model will eventually require, because that infrastructure is the moat that separates practices with pricing power from practices that take what the plans offer.
Source
Highlights from RFK Jr.’s 7 Congressional Hearings This Month, Modern Healthcare; Senators Grill RFK Jr. on Vaccines, Drug Prices and More at Hearing, NPR; RFK Jr. Acknowledges Complexity-and Importance-of 340B, RxTrail; RFK Jr. Kicks Off String of Congressional Hearings, Fierce Healthcare
Primary Care Perspective delivers curated intelligence from trusted healthcare sources.
© 2026 Primary Care Perspective | Texas Edition