By Lauren Fox, Sarah Owermohle, CNN
(CNN) — Louisiana Sen. Bill Cassidy in February 2025 weighed possible political peril against a long career in medicine, ultimately casting the critical vote to confirm known vaccine skeptic Robert F. Kennedy as the president’s Health and Human Services secretary.
But the choice hasn’t guaranteed the senator’s political future. Now the incumbent who made a career out of advocating for vaccines is ensnared in a bitter primary election back home — without President Donald Trump’s support. And as he fights for his political life, he must decide whether to confirm a Kennedy ally, Casey Means, to serve as Trump’s surgeon general.
The saga of whether to schedule the vote and push for Means’ nomination despite headwinds is putting Cassidy back in the spotlight as he faces off in a three-way primary against Rep. Julia Letlow, who has been endorsed by the president and embraced by the “Make America Healthy Again” movement, and John Fleming, a state treasurer who has tried to establish himself as a conservative alternative in the race.
Sources close to the process concede that Means’ nomination doesn’t appear to be trending in the right direction and that may be regardless of how Cassidy casts his vote.
Alaska Sen. Lisa Murkowski, a member of Cassidy’s Health, Education, Labor and Pensions Committee, told CNN last week that she’s “not enthusiastic about her” when asked whether she would support Means. And Sen. Susan Collins, a Republican from Maine who is locked in a tough reelection fight of her own, told CNN on Thursday that she was still reviewing written questions Means had submitted.
The loss of just a single GOP vote in the committee could kill Means’ nomination if Democrats are unified against her. And as the chairman of the committee and already a top target of the president’s, it’s just the latest headache for Cassidy.
“The best-case scenario for Cassidy is that she withdraws,” said Robert Hogan, a professor of political science at Louisiana State University. “I don’t think he has much to gain by opposing it or championing it. He has used all his other signals and it hasn’t moved people.”
CNN has reached out to the senator’s office for comment.
In an interview with CNN earlier this month, Cassidy declined to comment on whether Means had been clear enough about her position on vaccines or if he was prepared to back her nomination. “I’m not prepared yet to comment on the hearing yesterday,” he said.
He has not scheduled a committee vote on her nomination.
For the last year, Cassidy has gone out of his way to try to ingratiate himself with the president and his voters. Cassidy said publicly as recently as November that he believed the president was going to stay neutral in the race before Trump ultimately endorsed Letlow.
Cassidy has been a fierce supporter of the president’s top priority, the “SAVE America Act,” a bill that imposes strict voter ID and proof-of-citizenship requirements for US voters. In the last year, he has voted “yes” on all of Trump’s Cabinet nominees and he has been careful when pressed on whether he regrets his vote on RFK Jr.
“Life is lived forward. What I have to do is do my best to reassure the American people that vaccines are safe, that the president believes in vaccines,” Cassidy told Punchbowl News last November.
Cassidy’s task to win over Trump voters has become more essential now that Louisiana has moved from an all-party primary to a more traditional partisan nominating system where voters must be either registered Republican or no party to cast ballots. The primary is scheduled for May 16 and if no candidate gets 50% of the vote, the race will be forced to a June runoff.
Cassidy, who spent his career as a doctor helping vaccinate Louisianans, cast the determining vote in committee to approve Kennedy, who went on to change long-established recommendations for childhood vaccines. But whether Cassidy will now double down and back Means is another question.
Means underwent a tumultuous confirmation hearing that saw Cassidy press on her vaccine efficacy views and left some GOP senators with questions about her fitness for the post.
“I wanted to back up and broadly just reassure you that this is not an issue that I intend to complicate, or bring an agenda on vaccines. This is not the core of my issue,” Means told Cassidy last month.
Following the hearing, Cassidy told CNN that overall his view of vaccines is “there are consequences of having an uncertain message on something which is life-saving.”
A MAHA attack line
Cassidy’s reluctance to come out in support for Means and schedule the vote for her confirmation has become a key attack from Letlow, who has aligned herself closely with the MAHA movement in the state and has earned the backing of the chief political action committee aligned with MAHA.
“Senator Cassidy chairs the committee overseeing her nomination, yet he refuses to say where he stands on President Trump’s nominee. Louisiana deserves a senator who stands with President Trump and who helps move his nominees forward,” Letlow said in a statement. “A vote against Casey Means is a vote against Making American Health Again.”
Letlow has brought on vaccine skeptic and Kennedy ally, former Louisiana surgeon general Ralph Abraham to be her campaign chair this month.
While the issue of Means’ nomination may be top of mind in Washington, Fleming, the other GOP candidate in the race, told CNN in a phone interview that the issue isn’t yet playing a major role in the campaign back home.
“It is definitely a movement. I have not seen any polling to see how big of an impact it has, to be honest with you. You see a fair amount on social media discussions and so forth. But to be honest with you in terms of discussions between candidates and in ads, you don’t really see anything mentioned about MAHA,” Fleming told CNN.
Still, Cassidy’s is one of several midterm races that the MAHA movement has promised to sway.
MAHA Action, which holds weekly rallying calls for its supporters, has regularly promised that the movement can be the decisive votes in midterms races. And with the Means vote hanging in the balance, MAHA Action president Tony Lyons and other MAHA leaders are urging voters to press Murkowski and Collins.
“The establishment says she’s too radical. Elements of the right say she’s not radical enough,” Robert Malone, a Kennedy-appointed vaccine adviser and frequent speaker on the weekly MAHA Action meetings, said during a call last week. “That’s the signature of someone who cannot be captured by any faction. That is exactly what this moment calls for.”
For Cassidy, the Means nomination may be a blip on the political radar that does little to help him even if he muscled it through or came out in support of her. He already lost Trump’s endorsement after he voted to impeach the president over the January 6, 2021, Capitol attack and later suggested he should drop his reelection bid.
“Cassidy is flying all the flags and sending any signals he can in hopes he can be forgiven for committing the cardinal sin and crossing the president,” Hogan, the LSU professor, said. “At this point, I don’t think it is going to matter very much.”
The-CNN-Wire™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.
CNN’s Alison Main contributed to this report.
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