During his confirmation hearing on Wednesday, Robert F. Kennedy Jr. was asked about Medicaid, which he’d be tasked with overseeing if confirmed Secretary of Health and Human Services.

Kennedy drew some cackles when he said, “I believe that Medicaid is a critical program but that it is not working as well as it ought to be and President Trump has asked me to make it work better… The premiums are too high, the deductibles are too high, and everybody is getting sicker.”

Many people on X argued that Medicaid is a free program for the poor that doesn’t have premiums and deductibles. This isn’t quite right. Medicaid is a joint federal-state program and there are states that charge premiums to enrollees and there are also instances of co-pays. The charges are all limited — in all but eight states that had been granted waivers, those premiums are only allowed to those making over 150 percent of the poverty line (which eliminates a sizable chunk of enrollees); and premiums cannot be more than 5 percent of income. In terms of co-pays, there are also examples of them existing, but in those cases we’re typically talking about small amounts (Ohio’s program, for instance, charges $3 per non-emergency hospital visit, and $2 for brand name prescription drug refills).

Given the low income level of this population, this still may seem high (an individual earning 150 percent of the federal poverty level makes $23, 475 per year).The Kaiser Family Foundation notes that, “A large body of research shows premiums serve as a barrier to obtaining and maintaining Medicaid coverage…” So, in terms of a “gotcha” allowing critics to show he has no knowledge of Medicaid, this answer isn’t necessarily a killer for RFK Jr., as he can point to examples of premiums and of enrollees dropping coverage due to those costs and argue he wasn’t mistaken.

However, it isn’t a particularly comforting answer to those of us who are skittish about a left-wing activist taking the helm of a department that accounts for one out of every four federal dollars. The idea that the heavily subsidized Medicaid program, which cripples state budgets as it is, isn’t generous enough for enrollees because in limited cases some of them are asked to put some skin in the game, is an odd position for a Republican HHS nominee. Typically, Republican policy has attempted to shrink the Medicaid rolls. In fact, it is worth noting, that the first Trump administration issued waivers that actually enabled some states to charge premiums to more of the population and to lock out enrollees that did not keep up with premiums. Meanwhile, the Biden administration attempted to scale back Medicaid premiums.

This shows that as much as RFK Jr. has tried to navigate the awkward politics of his nomination (for instance, downplaying his lifetime of support for abortion by claiming he would default to administration policy), his instincts are ultimately left-wing.