RFK Jr. is forcing doctors to make a tough choice

The most powerful lobbying group for America’s doctors has a big decision to make: Go to war with Health Secretary Robert F. Kennedy Jr. or try to work with him.

For many members of the American Medical Association, publicly opposing Kennedy feels right. It means defending public health against policies — from changes to vaccine guidance to cuts to Medicaid — they see as dire threats. But it could come at a big cost if Republicans decide to overhaul how doctors are paid, as Kennedy has said he wants to do.

It's up to AMA leaders, like its new president, Dr. Bobby Mukkamala, to strike the balance between rebuffing the administration and building relationships within it.

“On Monday, we might have something to say, ‘We disagree. They shouldn't be doing this,’ and on Tuesday, ‘We love this and congratulations,’” Mukkamala said in an interview with POLITICO. “That's what I think the year is going to be like.”

After member doctors gave AMA staff a tongue-lashing for inaction at a June summit, the group has criticized Kennedy and President Donald Trump more vocally. But that could imperil the AMA’s longstanding relationships on Capitol Hill with GOP lawmakers and stall efforts to net policy wins. At stake: billions in Medicare reimbursements, the doc vote in the midterms and physicians’ clout in Washington.

Mukkamala said the AMA is negotiating to reverse a 3 percent Medicare pay cut that took effect in January. Congressional Republicans floated the fix earlier this year, but haven’t been able to push it over the line.

Mukkamala is an ear, nose and throat doctor who grew up in Flint, Michigan, and became AMA president in June. He loves to talk about his town’s blue-collar bona fides, forgets the name of the “fancy grocery store” — Whole Foods — and boasts a car collection with 86 vehicles. His ascension to the AMA presidency was nearly derailed in November when his doctor discovered a 3-inch cancerous lump in his brain. He had the tumor removed and has since cracked jokes about the hole in his head.

Dr. Mario Motta, a former AMA board member, described Mukkamala as a storyteller and “natural-born activist.”

When Mukkamala discusses the pills he takes to manage his cancer, he notes the cuts to the National Institutes of Health that helped develop them. In the past he has taken attention-grabbing steps — like purchasing an AR-15 — to spotlight public health issues.

“A large majority of the AMA, including those on the left, do feel like he is representative of our views and has our concerns at heart,” said Dr. Ray Lorenzoni, an AMA delegate.

Dr. Laurie Lapp, who served on an AMA committee that responds to federal legislation, said she supports Mukkamala’s efforts to build bridges with the Trump administration, but she hopes the AMA will focus on fighting it.

“Is it going to work? I don’t know,” Lapp said. “I do not envy him and the line he has to tow.”

Mukkamala, as chief communicator, helms the AMA alongside a new CEO, Dr. John Whyte. Whyte, who has held posts at the FDA and HHS, leads the group’s advocacy efforts.

Mukkamala told POLITICO that neither of them has spoken yet with Kennedy. Mukkamala wrote letters to Kennedy introducing himself and suggested the two work together to improve preventive care since Mukkamala is certified in lifestyle medicine. He said Kennedy hasn’t responded.

“I don't know if I'd ever get a hug from the HHS secretary. I'd take it if I got it,” he said of Kennedy, who has repeatedly criticized doctors, accusing them of failing to treat the root causes of disease and being in league with pharma. Kennedy has also said he wants to change the way the government sets rates for medical services, reducing the AMA’s role in the process. Still Mukkamala thinks there may be common ground on some issues. “The point is that we could get along well on the things we agree on.”

A political shift

The AMA was once a dominant force in GOP politics and influential with Republican officials.

The AMA shot down President Harry Truman’s national health care proposal, opposed the creation of Medicare and helped sink President Bill Clinton’s 1993 health plan. But the group started moving left when Democrats sided with doctors in their battles with insurers’ health maintenance organizations in the 1990s. That shift accelerated after Trump came to office and Americans’ political allegiances resorted based on education levels. Since 2018, the AMA has given more of its campaign contributions to Democrats.

For the better part of 2025, the group was rankled by infighting. Its physician members rallied against its leaders, accusing them of listlessly standing by as Trump sowed doubt in the medical establishment.

The group did not speak out when Trump nominated Kennedy to lead HHS and when it became clear that Medicaid cuts would fund the GOP’s tax cuts. What kicked off much of the internal disgruntlement, some members said, began with a March letter from concerned physicians asking the AMA board of trustees to publicly oppose the Medicaid cuts.

“I understand, having been on the board, why they might be hesitant,” Motta, the former AMA board member, said in an interview, describing the board’s response as “tepid.”

“At the same time, if you’re the leading health care organization, and you don’t speak up when there are major transgressions, then what are we here for?” he added.

Dr. Michael Suk, then chair of the AMA board, replied to the letter saying, “Reactive activism can be risky — it can divert attention from larger, long-term goals,” STAT reported.

In June, the doctors’ discontent burst into rancor at the AMA’s annual summit in Chicago. Physicians queued up to voice support for resolutions against various Trump policies. While the conference was going on, Kennedy dismissed an outside panel of experts on vaccine safety. The physician delegates united to take an emergency vote rebuking the move.

Suk changed his tone.

“Let us be honest; we recognize that at times, we could have been more forceful,” he told the delegates. “We could have spoken louder, earlier, and more publicly.”

The AMA has since released a flurry of pronouncements against Trump and Kennedy.

Even so, on July 4, Trump signed into law nearly $1 trillion in Medicaid cuts.

The AMA’s new tone appears to be sticking. On Wednesday when the White House ousted Dr. Susan Monarez, the director of the Centers for Disease Control and Prevention, the AMA quickly alerted that “this turmoil leaves us highly susceptible to public health threats.”

But three AMA physicians in leadership roles, granted anonymity to speak candidly, said the group still wasn’t doing enough to counter the Trump administration’s assault on public health. They added that the AMA board is still discouraging members from speaking out.

“They're trying to make us more unified, but we have fighting people who want to see more public action,” one of the physicians said.

An AMA representative did not respond to a request for comment.

It’s unclear how the AMA plans to handle the midterm elections. Mukkamala said he doesn’t necessarily believe a Democratic majority in Congress would be friendlier to doctors.

The AMA also faces a generational split. Several members said that the old guard hopes the AMA will keep on with its biggest battle: fighting to reverse declining Medicare payments for doctors. But younger physicians are pushing the AMA to speak out on public health.

“The power of the AMA is that we are a group of America’s physicians and our job is to advocate for our patients,” said Lapp, an OB/GYN resident. “The older ones are very set in that mindset that we have to take care of the physicians. I could not care less about Medicare payment reform.”

Mukkamala defended the AMA’s “quiet advocacy” strategy from earlier in the year, saying that it was the right choice for the group to forgo organizing against Kennedy’s nomination as secretary.

If the group rallied against Kennedy, he said, the AMA would be “looking through a window as opposed to being in the room.”

But the AMA may be outside the room anyway, said Lorenzoni, the AMA delegate.

He called the Trump administration’s apparent disinterest in the AMA’s views “a failure from us that we haven't been able to engage — our message hasn't been as emphatic and influential as it needs to have been to really sway public opinion.”