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The hearing exposed the deepening fractures in Kennedy’s relationship with Congress, even among Republicans who initially supported his confirmation. What began as a routine budget hearing devolved into accusations of dishonesty, conflicts of interest and fundamental questions about whether Kennedy can be trusted to protect public health.

In one moment, representative Alexandria Ocasio-Cortez pressed Kennedy about his ignorance to the Trump administration’s reported investigation of UnitedHealthcare, the nation’s largest health insurer, for criminal fraud in Medicare Advantage plans.

“You are not aware that the Trump Department of Justice is investigating the largest insurance company in America?” Ocasio-Cortez asked again after suggesting he couldn’t confirm that it was happening.

When she said that for-profit insurers such as UnitedHealthcare defraud public programs of $80bn annually, Kennedy appeared confused about the scale: “Did you say 80 million or billion?”

“80 with a ‘B’,” Ocasio-Cortez said.