President Trump’s second choice to serve as surgeon general has pitted some members of the Make America Great Again (MAGA) movement against allies of the Make America Healthy Again (MAHA) movement.
Trump’s decision to nominate Casey Means to serve as the nation’s top physician — a choice he attributed to the advice of Health and Human Services Secretary Robert F. Kennedy Jr. — has caused backlash among some outspoken MAGA allies, sparking a fight among two factions of the president’s base.
It has also underscored the extent to which Trump has brought Kennedy and his views into the fold of his administration.
“Bobby really thought she was great. I don’t know her,” Trump said matter-of-factly when asked last week why he went with Means after withdrawing his first nominee, Janette Nesheiwat. “I listened to the recommendation of Bobby. I met her yesterday and once before. She’s a very outstanding person. A great academic, actually. So I think she’ll be great.”
Some outspoken Trump allies are less sure.
Laura Loomer, a far-right activist and staunch Trump supporter, has spent days attacking Means on social media. She has questioned Means’s qualifications, suggested she should be “nowhere near the Trump admin,” and has compared her to Elizabeth Holmes, who founded the biomedical company Theranos and was later convicted of fraud.
Loomer is considered a fringe figure, but one who has Trump’s ear. Several weeks ago, she met with Trump in the Oval Office to raise concerns about members of the National Security Council, who then were fired shortly after their talk.
Other Trump allies have raised concerns about Means’s background and whether she is qualified for the job. While the surgeon general has little power to make policy, the office carries a significant platform for messaging and providing public health guidance.
Means dropped out of her surgical residency and doesn’t have an active medical license, something that has been standard for previous surgeons general. She is the co-founder of Levels, a health technology company that focuses on tracking health information through devices such as continuous glucose monitors. She co-authored a book and has spoken at length about healthier living and expressed skepticism about vaccines, aligning with the MAHA movement’s ethos.
MAHA leaders, including Kennedy and Means’s brother, Calley, who serves as a top adviser to Kennedy, have aggressively defended the new surgeon general pick.
“The attacks that Casey is unqualified because she left the medical system completely miss the point of what we are trying to accomplish with MAHA. Casey is the perfect choice for Surgeon General precisely because she left the traditional medical system–not in spite of it,” Kennedy wrote in a post on the social platform X, calling the criticisms of Means “absurd.”
Calley Means has sparred on social media with Loomer and suggested the pro-Trump activist was being paid by “industry” to “scuttle President Trump’s agenda.” Loomer replied that Calley Means was “full of s‑‑‑.”
The fight over the surgeon general pick reflects how Trump has embraced Kennedy and his MAHA compatriots to create an even bigger tent, one that threatens to be unwieldy and prone to infighting.
One Trump ally told The Hill that Trump is a big fan of Kennedy, viewing him as a valuable asset who provided a major boost by dropping out of the 2024 campaign and endorsing Trump. The White House has hosted MAHA roundtables, and Kennedy has appeared alongside the president at major policy announcements.
The ally argued that Trump’s deference to Kennedy over the surgeon general pick is the latest evidence that the MAHA movement is here to stay as part of the president’s political brand.
Trump’s public vs. private approach to reconciliation
To look at Trump’s Truth Social account and listen to his public remarks about the specifics of the massive reconciliation bill containing much of his agenda is to see a president largely reluctant to make the final call on complicated legislation.
Trump was initially fine with one bill or breaking his agenda up into two separate bills, even if he preferred the sound of “one big, beautiful bill.”
More recently, Trump has waffled over the concept of increasing taxes on the wealthiest Americans to help pay for the legislation and satisfy conservatives worried about adding to the debt. Trump has repeatedly said he would personally be OK with it, while simultaneously cautioning against the political risks.
His rhetoric and lack of clarity has, at times, made life more difficult for Republican leaders in Congress working to get members in line and assuage concerns from moderates and more conservative lawmakers alike.
But Trump’s public murkiness is, in some ways, at odds with his behind-the-scenes efforts to coordinate with GOP leaders and get uncertain members on board.
White House officials said Trump is in regular communication with Speaker Mike Johnson (R-La.) and Senate Majority Leader John Thune (R-S.D.). He has hosted members of the House Freedom Caucus and other Republicans at the White House and speaks regularly with other members on the phone.
Sources told The Hill that Trump’s engagement will ramp up further as lawmakers push the legislation toward the finish line in the coming weeks.
“His outreach to Congress and involvement on [Capitol] Hill will increase as the package draws near,” a White House official told The Hill.
It is a critical week for the reconciliation package, with markups happening on Capitol Hill while Trump is traveling to the Middle East. There are still disagreements among Republicans on the state and local tax deduction and Medicaid cuts.
“When I return from the Middle East, where great things will happen for America, we will work together on any and all outstanding issues, but there shouldn’t be many — The Bill is GREAT,” Trump posted.
