Bill Cassidy is playing a gambit.
The Republican doctor from Louisiana appears ready to fight for his Senate seat next year, a race complicated by his checkered history with President Donald Trump and a new primary system that could make reelection more difficult.
His main hurdle? Convincing his Louisiana base that he’s gotten behind Trump’s agenda, despite his vote to convict Trump in his 2021 impeachment trial. His GOP challengers have already seized on that vote, pitching themselves as better Trump loyalists.
The gambit is that voters will be swayed by Cassidy’s late turn toward Trump, including support this year for the president’s controversial pick for Health and Human Services secretary, Robert F. Kennedy Jr.
Going against the grain of the party ramps up the political risk, noted Chris Cooper, a professor of political science at Western Carolina University.
“That’s always been true for senators or any politicians, but that’s particularly true in the age of Donald Trump,” he said in an interview. “Where, if you are Republican and you cross Trump, you’re running the risk of him putting you on full alert on Truth Social, and sending a message that will be received by Republican voters.”
Further complicating his fate is Louisiana’s new closed primary system, which applies to his seat and means that he will be competing in a smaller and more conservative pool of voters.
John Couvillon, a Louisiana pollster who founded JMC Analytics & Polling, said the state’s previous primary system — in which all candidates ran in the same race and the top two finishers advanced to the general election — forced Republican candidates to consider moderate voters in the primary. The new system means a distinct shift to the right.
“When you’re taking registered Democrats out of the equation, you’re talking about a much more conservative primary electorate, and so those two things are the challenge that Sen. Cassidy faces next spring,” he said.
That fact appears to be top of mind for Cassidy, based on his voter record during the first months of the second Trump administration.
So far in 2025, Cassidy is 100 percent aligned with Trump’s legislative agenda according to CQ Vote Watch. That wasn’t always the case, as in the tail end of Trump’s first term in 2020 when Cassidy’s presidential support score was at 95 percent .
‘Because he is guilty’
Cassidy was among seven Republicans in the Senate to vote to convict Trump in his impeachment trial in 2021, explaining his decision in a blunt video following the vote. Just two other GOP senators who voted to convict — Lisa Murkowski of Alaska and Susan Collins of Maine — remain in their seats.
“Our Constitution and our country is more important than any one person,” Cassidy said after the vote. “I voted to convict President Trump because he is guilty.”
Speaking on ABC News after his vote, Cassidy said that it was clear to him that Trump incited the attack on the Capitol on Jan. 6, 2021, defining insurrection as the attempt to prevent the peaceful transition of power. He said that the president needed to be held accountable for his role in that.
At that point, Cassidy wouldn’t have anticipated a Trump comeback, said Robert Mann, a retired communications professor at Louisiana State University who spent a career in communications for Democratic Louisiana officials.
“I think Cassidy did it because he thought Trump was finished, and he thought it was a safe vote, that it wouldn’t really matter in a few years,” Mann said. “And I think he miscalculated.”
Cassidy in 2023 said Trump shouldn’t run for another term in 2024, and didn’t endorse him when it was clear that he was a serious presidential nominee.
It’s not yet clear whether Trump will weigh in on the Louisiana race. Trump endorsed three Republican candidates elsewhere last week –– Michael Whatley in North Carolina, Mike Rounds of South Dakota, and Ashley Moody of Florida. But he hasn’t weighed in on Sen. John Cornyn of Texas, who faces a serious primary threat from Texas Attorney General Ken Paxton.
Cassidy’s campaign did not return a request for comment on whether the senator has sought the president’s endorsement.
According to the 2024 vote results, the state that has tipped even more to the right since he was last elected in 2020.
Despite those challenges, he appears well-positioned leading up to next spring’s primary. His campaign added more than $2 million this year, bringing his total war chest to about $9 million.
His main opponent in the primary is Louisiana state treasurer John Fleming, who had a total of $2.1 million as of earlier this month, though most of that came from himself.
Also in the mix are state senator Blake Miguez and Louisiana Public Service Commissioner Eric Skrmetta.
Couvillon, who has conducted polling for Fleming, said that Cassidy’s and Fleming’s fundraising numbers at this point in the race could deter other candidates.
“For all practical purposes, you really need to be jumping into that race now if you want to be able to post respectable fundraising totals,” he said.
Kennedy vote
Cassidy, chair of the Senate Health, Education, Labor and Pensions Committee, publicly struggled with his decision on whether to advance Robert F. Kennedy Jr.’s nomination as Health and Human Services secretary, voicing concerns that Kennedy had emboldened a sector of the country to reject settled science around vaccines.
“Convince me that you will become the public health advocate, but not just churn old information so that there’s never a conclusion,” Cassidy told Kennedy at his hearing before the HELP committee.
Cassidy came to public service from a career in medicine. A gastroenterologist by training, he previously worked at a clinic for uninsured patients and ran a program providing free Hepatitis B vaccines to the greater Baton Rouge area. Following Hurricane Katrina, Cassidy set up an emergency health center in a K-Mart to provide emergency care to hurricane victims.
Cassidy ultimately voted to advance Kennedy’s nomination and voted for him on the Senate floor, after he said Kennedy made a series of concessions and agreed to a close relationship.
Cassidy’s vote for Kennedy was an effort to show he is willing to back Trump’s agenda, Couvillon said.
“A pro-impeachment-slash-conviction vote is basically strike one, strike two and strike two and a half,” Couvillon said. “So you don’t really have room for error, so to speak, with regards to casting additional votes that are against what the president wants.”
Mann said that prior to the RFK Jr. vote, he had heard murmurings of an effort among Louisiana independents and even some Democrats to back Cassidy in the primary, in an effort to keep the even further right Republican candidates from winning the nomination.
Mann said that in Cassidy’s quest to win over conservative MAGA supporters in his state, he’s lost the support of moderates.
“Any chance that that had of getting off the ground was just kneecapped when Cassidy voted for RFK,” Mann said.
Since then, Kennedy has made several unprecedented decisions around vaccines at HHS.
He fired all 17 members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which makes vaccination recommendations for the public. He replaced them with eight members, many of whom don’t have a background in immunology or have a history of expressing doubt in vaccines.
Cassidy called on Kennedy to postpone the panel’s most recent meeting, citing concerns that any recommendations the panel makes will be seen as skewed. But Kennedy forged ahead.
Cassidy has shown no deviation from the president’s agenda during the second Trump term. He voted for the president’s reconciliation law, which included deep cuts to Medicaid, and cited Trump’s preference for the version with fewer cuts.
Cooper, the poli-sci professor, noted the similarities to the vote by Sen. Thom Tillis, R-N.C., in favor of Defense Secretary Pete Hegseth. He said that behind the scenes, Tillis had reservations about Hegseth but ultimately voted to advance his nomination. But unlike Cassidy, Tillis is choosing to retire.
Cooper said that it’s logical that politicians will make concessions to keep their seats, often making the judgment that they will be more effective at making change if they hold on to their political power.
“It’s not necessarily selfishness,” Cooper said. “It’s just they believe they’re the ones who can do it the best, and they can make the most positive change if they’re in office.”
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