President Trump's new push for sweeping changes to childhood immunizations feeds off of a divide — narrow but growing — over who should have the final say over whether and when kids get their shots.

The big picture: Trump and Health Secretary Robert F. Kennedy Jr. think they've hit a nerve with their emphasis on personal choice in contrast to blanket recommendations, which they say discouraged discussions about the risks and benefits of vaccination.

• The question is how much are parents willing to trust their instincts — and what happens if the policy changes make it harder to access care in a timely way for those who want to vaccinate their kids.

Late Friday, Trump ordered federal health officials to review the decades-old U.S. childhood immunization schedule and consider reducing the number of recommended vaccinations to align with developed nations like Denmark and Japan.

• The directive came the same day that a panel of Kennedy-appointed vaccine advisers voted to drop the decades-old federal recommendation that all infants receive the hepatitis B vaccine at birth.

Between the lines: The administration's moves come as more Americans are turning to the internet with questions about their health, and as suspicion and partisan cues are driving a wedge between the public and the medical establishment.

• Childhood vaccines are a particular friction point. Strong majorities believe they're safe and effective, but there has been a noticeable shift in some Americans' opinions over whether they should be required for kids to attend public schools.

By the numbers: The Pew Research Center last month found 63% of Americans have high confidence in the effectiveness of childhood vaccines, but that just over half trust their safety testing (53%) and are confident in the schedule (51%).

• The drop-off is especially visible among Republicans, whose support for MMR vaccine school requirements has slipped from 79% in 2019 to 52% today.

An Axios-Ipsos poll in October found that skepticism over child vaccination requirements has ticked up since Trump took office in January.

• 74% of Americans said parents should follow the recommended child immunization schedules, down from 81% in February.

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Senate Majority Leader John Thune and House Speaker Mike Johnson are both considering votes on GOP health care priorities this week — if they can figure out what those priorities are.

Why it matters: Democrats are unified in their demand for a three-year extension of the Affordable Care Act's enhanced subsidies, which expire Dec. 31. Republicans are still divided and debating their counter offers.

• Johnson (R-La.) has said he hopes to reveal a House GOP health care package early this week, though some sources are skeptical that will happen.
• Thune (R-S.D.) has promised Democrats a vote on their health care bill this week. But his conference is still in the idea stage on their counters, which are more likely to come as amendment or unanimous consent votes rather than a single broader GOP package.

Between the lines: Don't expect any health care package to pass next week.

• The real question is whether the voting exercise in the Senate and maybe the House fuels ongoing bipartisan dealmaking — or hampers it.

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MAHA Action, a political advocacy group dedicated to advancing Kennedy's agenda, made its first state-level election endorsement last week by wading into a key farm state's gubernatorial race.

Why it matters: The group is branching out to state politics while top Republicans rally the wide-ranging MAHA coalition to prevent control of the House from flipping in the midterms.

Driving the news: MAHA Action is endorsing Republican candidate Zach Lahn in the crowded 2026 Iowa gubernatorial race.

• Lahn is positioning himself as a Trump-aligned populist and socially conservative candidate. He runs a firm that invests in agriculture, real estate and technology, per the Des Moines Register.

What they're saying: "Zach has seen the harms of pesticides up close like many in the [Make America Healthy Again] family, with his own father facing those consequences," MAHA Action wrote on X.

• Lahn is one of five candidates gunning for the Republican nomination.

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A new Medicare payment trial will determine whether the federal government can promote digital health applications like remote monitoring to manage chronic illnesses.

Why it matters: It's viewed as the clearest sign the Trump administration has given about its plans for health tech.

• Traditional Medicare currently pays care providers based on the volume of individually billable services they deliver, which makes digital health adoption difficult.

How it works: The new model, dubbed ACCESS, would pay participating Medicare providers and suppliers a fixed amount to manage chronic issues including hypertension, diabetes and depression.

• It sets specified patient outcomes for receiving full payments for the services.
• The program would widen the reach of tools for chronic-disease management, such as remote monitoring, and is slated to run for 10 years.

The initiative could provide an incentive for hospitals and health systems to invest more in digital care infrastructure.

• Obama administration health official Andy Slavitt's investment firm, Town Hall Ventures, collaborated with CMS on the model.

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💰 Republicans left tribes out of their $50 billion rural health fund. Now, it's up to states to share. (KFF Health News)

🇨🇳 Biotech contracting giant WuXi AppTec faces new concerns that its extensive business ties to the U.S. could be imperiled. (Fierce Pharma)

🐖 Spain is probing whether a swine fever outbreak was set off by a lab leak. (Reuters)