MAHA's messy marriage

• But its attempt to integrate with the federal health apparatus — and the MAGA purists who comprise the backbone of Trump's base — has so far proven deeply dysfunctional.

The big picture: The anti-establishment takeover of Health and Human Services — a sprawling agency that accounts for the largest share of domestic federal spending — has become one of the most chaotic experiments of Trump's second term.

• Trump has already been forced to pull two major health nominations — former Rep. Dave Weldon for Centers for Disease Control and Prevention director and Fox News contributor Janette Nesheiwat for surgeon general — after scrutiny of their records.
• The Food and Drug Administration's top vaccine regulator, Peter Marks, abruptly resigned in March in protest of Kennedy's "misinformation and lies" about vaccines.
• As a measles outbreak spread in Texas, the White House became so frustrated by the lack of clear and fast communications by HHS that it set up a parallel press shop, as Axios scooped last month.

Between the lines: Kennedy's top health picks include contrarians who are critical of the medical establishment — but unwilling to fully embrace the MAHA movement's more conspiratorial views on vaccines.

• National Institutes of Health director Jay Bhattacharya and FDA commissioner Marty Makary were brought in as high-profile critics of COVID-era orthodoxy who boast mainstream academic credentials.
• But neither man fully endorses Kennedy's most controversial positions, particularly on childhood vaccines and autism — making them targets for the anti-vaccine purists who view them as insufficiently radical.

Zoom in: Trump's nomination of nutrition influencer Casey Means to be surgeon general last week has become the latest flashpoint in the unraveling of the MAHA coalition.

• Means and her brother, White House adviser Calley Means, became key faces of Kennedy's movement after authoring a New York Times best-seller that railed against the food and pharmaceutical industries.
• Their message — that metabolic dysfunction and chronic illness stem from institutional corruption — helped popularize the MAHA brand among wellness influencers and libertarian-minded reformers.

But Casey Means' nomination to be the face of public health messaging has drawn fire from all sides.

• Anti-vaccine activists argue she isn't sufficiently committed to Kennedy's views on vaccine safety, especially the more fringe beliefs he espoused before leading HHS.

• Kennedy's running mate, Nicole Shanahan, claimed she was promised that the Means siblings wouldn't get jobs inside HHS — and that "someone" is "controlling" Kennedy's decisions.

The intrigue: Far-right conspiracy theorist Laura Loomer, who successfully lobbied Trump to fire national security adviser Mike Waltz and much of his team, has trained her eyes on the Means siblings.

• Loomer has openly mocked Casey Means as a "woo woo woman" who "literally talks to trees and spiritual mediums" — drawing backlash from Calley Means, who suggested Loomer was taking money from the medical industry.
• Kennedy has vigorously defended Means' qualifications, arguing that her popularity among "MAHA moms" poses "an existential threat to the status quo interests, which profit from sickness."

The other side: Other top MAGA influencers, including Charlie Kirk, Donald Trump Jr. and Megyn Kelly, have praised Casey Means' appointment and emphasized the need for coalition harmony.

• "If you merge MAHA and MAGA, it's like 1932," former Trump chief strategist Steve Bannon said on his "War Room" podcast, predicting a political realignment on par with FDR's New Deal coalition.
• "You govern forever."

The bottom line: HHS will be at the center of major policy debates over Medicaid cuts, abortion access, vaccine policy, medical research and the future of public health infrastructure.

• But the deep divisions within its Frankenstein coalition are threatening to tear MAHA apart before those battles can even begin.