America's Doctor Vacancy: Why the Casey Means Surgeon General Nomination Is Stalling — And What's at Stake

The Vacancy Nobody Talks About

The United States has not had a Senate-confirmed surgeon general since January 20, 2025, when Dr. Vivek Murthy left office. For over fourteen months, the nation's top public health spokesperson position has been filled by acting officials or left functionally vacant — an unusual stretch even by Washington's standards.

The latest attempt to fill it, Dr. Casey Means, is stalled. Her confirmation hearing was held on February 25, 2026. More than a month later, her nomination has not advanced out of the Senate Health, Education, Labor and Pensions (HELP) Committee. As of March 29, 2026, the votes to move her forward are not there.

The stalling of a surgeon general nomination — by members of the president's own party — is the story behind why "Cassidy" is trending on X. Sen. Bill Cassidy (R-LA), the chair of the HELP Committee and a physician, has declined to comment on the delay. His silence, and the public opposition of several colleagues, is the key obstacle.

Who Is Casey Means?

Casey Means, 38, is a Stanford-educated physician who did not complete her surgical residency program. She holds a medical degree but does not hold an active medical license. She is best known as a wellness influencer, author, and co-founder of Levels — a company offering continuous glucose monitoring and testing to subscribers for a monthly fee. Health insurance does not cover Levels' services, and peer-reviewed evidence for the benefits of continuous glucose monitoring in non-diabetic people is limited.

Trump nominated Means, citing her "impeccable 'MAHA' credentials" — a reference to the Make America Healthy Again movement championed by Health and Human Services Secretary Robert F. Kennedy Jr. The president said she would "work closely" with Kennedy.

Means was not Trump's first surgeon general nominee. His original pick, Dr. Janette Nesheiwat, was withdrawn after she misrepresented where she obtained her medical degree. Means' confirmation hearing, originally scheduled for October 2025, was postponed after she went into labor.

What Happened at the Hearing

The February 25 hearing before the HELP Committee was combative. Senators from both parties pressed Means on several fronts:

Vaccines and autism: Multiple senators asked whether vaccines contribute to autism. Means deflected, saying there was "an autism crisis that's increasing" and calling for more research. She did not directly answer. Cassidy pressed her, noting that "there's been a lot of evidence" vaccines are "not implicated" in autism. According to FactCheck.org, large-scale scientific literature has found no connection between vaccines and autism.

Measles and flu vaccines: Cassidy asked directly whether Means would advise Americans to vaccinate against the flu and measles amid active outbreaks. She did not make that commitment. She emphasized "informed consent" and said "every individual needs to talk to their doctor before putting a medication in their body." Only after significant pressing did she say she was "supportive of the measles vaccine" and that "vaccines save lives."

Hepatitis B vaccine: Sens. Murkowski and Cassidy asked Means about her past doubts about the birth dose of the hepatitis B vaccine. She called it "important and lifesaving" but said parents should make decisions with their doctors. The CDC had stopped recommending that vaccine for all children late in 2025, a decision later temporarily blocked by a federal judge.

Psychedelic mushrooms: Sen. Susan Collins (R-ME) asked Means about past advocacy for therapeutic psychedelic mushroom use. Means said she would not recommend psychedelics for the American public.

Medical license: Democratic Sen. Andy Kim (NJ) challenged Means' inactive medical license as a disqualifier. A legal expert cited by FactCheck.org called this an "open question" legally, but confirmed it is a break from precedent. Every previous surgeon general who was a physician held an active license.

Financial disclosures: Democratic Sen. Chris Murphy (CT) alleged Means failed to disclose financial relationships with companies she promoted. Means denied this. An analysis by the nonprofit Public Citizen found "potential" violations of federal disclosure rules. Means stated she would divest her Levels stock and options if confirmed.

Where the Votes Are

To advance to a full Senate vote, Means needs every Republican on the 23-member HELP Committee — which includes 12 Republicans and 11 Democrats — to support her. Following the hearing, two Republicans publicly signaled uncertainty:

Sen. Lisa Murkowski (R-AK) told reporters she was "just in the same spot" regarding her hesitations as of March 24. Sen. Susan Collins (R-ME) did not respond to multiple inquiries about the delay. Chairman Cassidy also did not respond.

The White House said it has been having "productive conversations with the Senate" and praised Means' "elite academic credentials." Kennedy spokesman Andrew Nixon backed the nomination, praising Means' focus on lifestyle changes over "sick care."

MAHA Action, the Kennedy-aligned advocacy group led by Tony Lyons, organized a phone campaign urging supporters to "call them time after time" — targeting Murkowski and Collins specifically.

Trump's First Surgeon General Is Now Opposing His Second

On March 29, 2026, Trump's first surgeon general, Dr. Jerome Adams — who served through the Trump administration's first term, including through COVID-19 — went on CBS's "Face the Nation" to oppose Means' confirmation.

Adams stated that Means is unqualified, pointing specifically to her lack of an active medical license. He also argued the nomination is damaging public health at a critical moment. "America's most pressing health threat today isn't opioids or obesity, it's mistrust," Adams told CBS. He cited polling showing that 70% of Americans support childhood vaccines and school mandates, but that a similar majority says it does not trust health information from RFK Jr. or Means. He said Republican pollster Fabrizio Ward had warned the party that vaccine skepticism "is going to hurt Republicans in November elections."

Adams also linked the nomination standoff to the ongoing measles outbreak. The U.S. had approximately 250 measles cases in 2024. That rose to roughly 2,000 in 2025. As of March 29, 2026, the CDC count stood at more than 1,500 confirmed cases for the current year. Adams cited states including Utah, Colorado, Florida, Georgia, and Kentucky as having fallen below the 95% vaccination threshold required for herd immunity — a level at which outbreaks can spread exponentially.

Adams attributed the accelerating outbreak in part to CDC staffing cuts: nearly 20,000 HHS employees have been cut, reducing the field capacity to contain individual cases before they spread.

What the Surgeon General Actually Does

According to the HHS website, the surgeon general is the "nation's doctor" — responsible for communicating "the best available scientific information" to the public on health matters. The role includes leading the Commissioned Corps of the U.S. Public Health Service, a uniformed service dedicated to public health response.

During a measles outbreak, an active surgeon general would typically lead public communications, coordinate with state health departments, and issue formal public health advisories. The position has been in acting or functional limbo since January 2025.

Historically, the surgeon general has been most visible during public health crises — from the original Surgeon General's Report on Smoking in 1964 to AIDS communications in the 1980s to COVID-19 guidance in 2020-2021.

The Broader MAHA Context

Means' nomination is the latest friction point between RFK Jr.'s MAHA health agenda and traditional Republican physicians in Congress. The same week her nomination stalled, Kennedy's broader agenda had already suffered two legal setbacks: a federal judge on March 16 had nullified Kennedy's restructuring of the Advisory Committee on Immunization Practices (ACIP), invalidating 13 hand-picked committee appointments and reversing a one-third reduction to the childhood vaccine schedule.

Cassidy, a gastroenterologist, has been among the most persistent Republican voices challenging vaccine skepticism within the party. He voted to convict Trump in his second impeachment trial — a rare break — and has consistently defended vaccination science in committee hearings. His silence on the Means nomination has been widely interpreted as continued skepticism rather than passive support.

What Happens Next

As of March 29, 2026, there is no confirmed vote scheduled for Means' nomination in the HELP Committee. The White House says discussions are ongoing. The nomination has not been formally withdrawn.

If Murkowski, Collins, or Cassidy vote against Means in committee, her nomination effectively dies unless the White House withdraws and resubmits a different candidate. If the committee advances her on a party-line vote, she would still face a full Senate confirmation vote where several moderate Republicans could become deciding factors.

The U.S. has not had a confirmed surgeon general for over 14 months. The measles case count is above 1,500 for 2026 with no public end in sight.