Trump’s surgeon general nominee caught in GOP crossfire over MAHA

President Trump’s nominee for U.S. surgeon general appears stuck in the Senate, the latest sign that some Republicans in Congress have reached their limit on the more divisive aspects of the “Make America Healthy Again” (MAHA) agenda.  

While the surgeon ​general wields no direct regulatory powers, the nation’s top doctor has a powerful bully pulpit — one that some in the GOP seem hesitant to hand over to Casey Means, a healthy living influencer with an expired medical license and no plans to renew it. 

Trump indicated he was open to withdrawing her nomination over the weekend, before the White House swiftly reaffirmed its support for Means, the sister of White House senior adviser Calley Means, an influential figure in Health and Human Services Secretary Robert F. Kennedy Jr.’s orbit.  

Mark Brewer, professor and chair of the department of political science at the University of Maine, said lawmakers might be getting “gun shy” following poor performances by Trump nominees, but he argued the apparent reluctance to confirm Casey Means likely has more to do with her specific background. 

“She doesn’t have the appropriate qualifications. She doesn’t really have kind of any public health experience, per se,” said Brewer, echoing criticism from Jerome Adams, a physician who served as surgeon general during Trump’s first term. 

“If she were to be installed as the surgeon general, I think it would send a message,” he added. “And at least some senators are not interested, it appears, in the message that that would send.” 

More than a month after her confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions (HELP), there has been no movement on her nomination. And there do not seem to be any immediate plans to bring her nomination up for a vote.

Brewer noted that Republican Sens. Bill Cassidy (La.), the HELP Committee chair; Lisa Murkowski (Alaska); and Susan Collins (Maine) — the latter two being the sole GOP holdouts on Means’s confirmation — are uniquely immune from Trump’s ire, to a certain degree.

“He’s got less leverage over those three senators than maybe he would have over some other members of the Senate,” Brewer said. 

“He’s already kind of threatened Cassidy, right? And so, he’s already done what he can do there. Collins, he’s got to be careful with if he wants the Republicans to control the Senate,” he added. “Murkowski has already proven that, you know, she’s got her own brand in Alaska, and that she isn’t necessarily reliant on even a party’s endorsement, right? I mean, she ran without that and won.” 

Trump has endorsed Rep. Julia Letlow (La.) in the Republican primary against Cassidy, a career gastroenterologist who voted to impeach Trump following the Jan. 6, 2021, insurrection. Collins is anticipated to face a tough challenge from Democratic candidate Graham Platner, who is holding a healthy lead over Maine Gov. Janet Mills in the state’s Senate primary race. Murkowski, who has flirted with leaving the Republican Party entirely, will next face reelection in 2028. 

Following Means’s confirmation hearing, Murkowski and Collins said they walked away with unanswered questions about the nominee. In the weeks since, they have not said whether they’ll vote to confirm her. 

Murkowski, an ardent proponent of vaccinations, took issue with Means’s seeming skepticism of hepatitis B vaccines for newborns. Means said she believed the shot to be effective, calling past characterizations of her views “incomplete.” Collins, meanwhile, expressed concerns about Means’s self-professed use of hallucinogenic psilocybin mushrooms. 

“I still have reservations,” Murkowski told The Hill last month. The Alaska senator said at the time she did not plan on having another meeting with Means. 

With no Democrats on the HELP Committee expected to support Means, two opposing votes on the Republican side would effectively end any hope of confirmation. 

The Hill has reached out to the offices of Cassidy, Collins and Murkowski for comment. 

The White House defended Means’s credentials in its statement supporting her after Trump’s remarks earlier this week. 

“An alumna of Stanford University and the Stanford School of Medicine, there is no one better suited to advance President Trump’s agenda to Make America Healthy Again,” White House press secretary Karoline Leavitt said in a statement. “The President stands by her and the Senate should move to quickly confirm Dr. Means as our next surgeon general without further delay.”

MAHA Action, the PAC backing Kennedy’s movement, has also been lobbying senators to advance her nomination. 

“The MAHA movement deserves a Surgeon General who will tell the truth — not a mouthpiece for the broken status quo,” the group said in a social media campaign earlier this month.  “Senator Susan Collins and Senator Lisa Murkowski appear to be the two Republican holdouts during this confirmation process. It’s time for MAHA to get loud.”

Yet there are also MAHA proponents who are not standing behind Means.

“The Surgeon General is one of the most powerful healthcare influencers in America,” Ryan Cole, head of medical and scientific affairs for the Independent Medical Alliance, told The Hill in a statement. “Going into the midterms, Republicans want a Surgeon General who can articulate with credibility the health benefits of cleaner food and healthier lifestyles.”

Cole added, “The current nominee didn’t convince Senators they could credibly carry that message.”

As with several of Trump’s nominees, there’s also a concerted push opposing Means from communities outside Congress.

The political action organization Stand Up For Science has been mobilizing doctors and scientists to speak out against her confirmation.  

“Bill Cassidy is in this situation where, at this point, he kind of has nothing to lose by saying no,” Colette Delawalla, the organization’s president and CEO, told The Hill. “We know him, Collins and Murkowski and Tillis — they’re all getting a lot of calls from our folks.” 

Sen. Thom Tillis (R-N.C.), who does not sit on the HELP Committee, told The Washington Post he’s a likely no if Means’s nomination makes it to a floor vote. 

The timing of Means’s confirmation process is also less than ideal. When saying he was open to withdrawing her nomination, Trump told reporters, “I’m more focused on Iran.” 

“This is coming at a moment when certainly President Trump and the administration are feeling most embattled, just because of the war, because of the oil prices, because of the midterms, and so I think there’s less tolerance in the GOP right now to do absolutely everything he wants,” Julian Zelizer, a professor of history and public affairs at Princeton University, told The Hill. 

“And there’s more willingness to find points where they can maybe, at lower-level issues, separate themselves a little bit.” 

Means’s confirmation push comes on the heels of former Homeland Security Secretary Kristi Noem being fired — the first Cabinet member, but not the only Senate-confirmed official, to be let go. Former Centers for Disease Control and Prevention Director Susan Monarez was fired less than a month after she was officially confirmed for the role.

Cassidy indicated that Monarez’s firing was a poor use of Republican time and support. 

“If someone is fired 29 days after every Republican votes for her, the Senate confirms her, the secretary said at her swearing-in that she has ‘unimpeachable scientific credentials’ and the president called her ‘an incredible mother and dedicated public servant,’ like what happened? Did we fail? Was there something we should have done differently?” Cassidy said in a hearing after Monarez’s termination. 

This track record may be informing how senators are handling Means, Zelizer said. 

“Letting go of people, people leaving — it doesn’t create the incentive to invest everything if you’re a Republican. And the big timing is the midterms keep getting closer and closer,” he said. “And so, if they’re going to be unstable, the administration, I think on certain picks, some Republicans will be more willing to vote no and figure it’ll be OK.” 

Updated at 9:19 a.m. EDT.