Senator Bill Cassidy of Louisiana is attempting to reshape his political narrative as he eyes a 2026 reelection bid. However, he’s facing a significant challenge: Louisiana’s MAGA supporters vividly recall his vote to impeach former President Donald Trump in 2021 and his refusal to back Trump for the 2024 presidential race. Trump himself has not overlooked these actions, despite Cassidy’s efforts to mend fences, which have largely been unsuccessful.

During Cassidy’s 2020 campaign, he benefited from a fragmented opposition that included a lackluster Republican contender, numerous little-known Democrats, a few Independents, and a Libertarian, all diluting the opposing vote. The 2026 landscape is starkly different, with strong Republican contenders emerging. Given Louisiana’s deepening Republican lean since Democrat Mary Landrieu’s 2008 Senate victory, vote-splitting appears unlikely this time. Adding to the intrigue, one hopeful has already secured Trump’s endorsement, though she hasn’t officially announced her candidacy.

Among the notable Republicans already in the Senate race are State Treasurer and former Congressman John Fleming, State Senator Blake Miguez, LA Public Service Commission member Eric Skrmetta, State Representative Julie Emerson, and St. Tammany Parish Councilwoman Kathy Seiden. Yet, it is Representative Julia B. Letlow (LA-05) who has received Trump’s endorsement.

Whether Trump’s backing will significantly boost Letlow remains uncertain. Nonetheless, it’s evident that Trump has distanced himself from Cassidy. Reports indicate that Senate Majority Leader John Thune (R-SD) attempted to persuade Trump to support Cassidy during a recent phone call, but his efforts were in vain. Thune has actively campaigned for Cassidy in Louisiana, fulfilling his role as a supportive majority leader. Regardless of these maneuvers, Cassidy’s prospects appear bleak, and he may have only himself to blame.

Known for his political adaptability, similar to Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME), Senior Editor and Louisianan Joe Cunningham suggests that Cassidy grossly underestimated his constituents’ loyalty to Trump. During his 2020 reelection campaign, Cassidy presented himself as a staunch Trump supporter, only to reverse course post-victory. He cited the January 6 events as the reason for his impeachment vote against Trump.

This move proved to be a colossal misstep. Indeed, a substantial one.

I’m honored to have President Trump’s endorsement and trust. My mission is clear: to ensure the nation our children inherit is safer and stronger. ⁰
This United States Senate seat belongs to the people of Louisiana, because we deserve conservative leadership that will not waver. pic.twitter.com/851hQkXhIN

— Julia B Letlow, Ph.D. (@jbletlow) January 18, 2026

Whether Trump’s endorsement moves the needle for Letlow or not remains to be seen. What is clear is that Trump has washed his hands of Cassidy. According to other reporting, Senate Majority Leader John Thune (R-SD) attempted in a Friday phone call to convince Trump to endorse Cassidy, to no avail. Thune rallied this week for Cassidy in the Pelican State, being both a good majority leader and colleague. But no matter how the competition plays out, it’s pretty clear that Cassidy may be toast. If so, he has only himself to blame.

If Rep Julia Letlow does challenge Bill Cassidy, the latter will be in real trouble.

What Rs don’t have to worry about is a D posing a serious challenge. The last D to win a Senate election in LA? Mary Landrieu in the ‘08 wave. Her ‘14 reelection campaign didn’t go as well… pic.twitter.com/CDcpjHzwRR

— Nassau Centrist Mapper (@LIEngProf) January 18, 2026

Always a “flexible” senator, cut from the same cloth as Sen. Lisa Murkowski (R-AK) and Susan Collins (R-ME), our Senior Editor and Louisianan Joe Cunningham surmised that Cassidy badly miscalculated his constituents’ allegiance to the president. For his reelection run in 2020, Cassidy positioned himself as pro-MAGA and pro-Trump, then, after he won reelection, promptly flipped. According to him, it was the J6 kerfuffle that had him squawking InSURReXTiON! with the rest of the Democrat loons and choosing to vote to impeach Trump post-presidency.

Big mistake. YUGE.  

U.S. Senator Bill Cassidy last ran for re-election in 2020, down the ballot from then-President Donald Trump. He ran as a pro-Trump, MAGA-aligned candidate, drawing on Louisiana Republicans’ motivation to get Trump re-elected in order to stay in office. He won.

Then, January 6, 2021, happened, and Cassidy made a choice that continues to haunt him today: He voted to convict Trump in his post-term impeachment.

The reaction from Louisiana conservatives was swift. Statewide-syndicated radio host Moon Griffon declared that “Bill Cassidy just knifed us all in the back!”

“Bill Cassidy is one of the most arrogant rear ends that I have ever seen in my life,” he added during his monologue on February 10, 2021.

Scott McKay, who publishes The Hayride, a Louisiana-based political commentary site, was similarly harsh.

“[T]his is a career-ending mistake on his part and there is zero point in Bill Cassidy running for re-election,” McKay wrote. “In fact, he would do well to resign his seat as soon as there is a Republican governor in Louisiana available to replace him.”

The Louisiana GOP voted to censure Cassidy. Republicans across the state condemned him. Fast forward five years, and the Louisiana doctor-turned-politician is facing a myriad of challengers for his seat—almost all of them Republicans.

It’s not just MAGA Republicans, but MAHA ones. The revolution has grown even more in prominence and popularity since Robert F. Kennedy Jr. was confirmed as Health and Human Services Secretary. A Trump nomination that Cassidy opposed and resisted until the very end. OG (Old Gangsta) MAHA has never forgotten nor will they forget that, as Chairman of the Senate Health, Labor, and Pensions (HELP) committee, it was Cassidy who championed and pushed through the nomination of former CDC Director Susan Monarez. After Monarez was confirmed, she decided her job was to derail the MAHA agenda, and Kennedy rightly fired her after only 29 days on the job. Monarez ran straight to Cassidy, who, along with ranking member Sen. Bernie Sanders (I-VT), demanded HHS Secretary Kennedy sit before the HELP committee to be excoriated for doing his job.

Dive Deeper: The Senate Is Out for Robert Kennedy Over Monarez Firing, CDC Resignations

The Monarez Senate Testimony and the Ploy to Derail Changes to the Childhood Vaccine Schedule

This went nowhere, as the hearing exposed Monarez as the duplicitous shill that she is. In that, Monarez and Cassidy make great bedfellows. 

Cassidy still does all he can to undermine Secretary Kennedy and to co-opt the MAHA agenda toward his own ends. He too often drapes himself in his white doctor’s coat to tout his superior knowledge and experience, taking not-so-subtle potshots at Secretary Kennedy and his MAHA loyalists, like consultant Calley Means.

As a doctor who treated patients for decades, my top priority is protecting children and families. Multiple children have died or were hospitalized from measles, and South Carolina continues to face a growing outbreak. Two children have died in my state from whooping cough. All…

— U.S. Senator Bill Cassidy, M.D. (@SenBillCassidy) January 5, 2026

As a doctor who treated patients for decades, my top priority is protecting children and families. Multiple children have died or were hospitalized from measles, and South Carolina continues to face a growing outbreak. Two children have died in my state from whooping cough. All of this was preventable with safe and effective vaccines. 

The vaccine schedule IS NOT A MANDATE. It’s a recommendation giving parents the power. Changing the pediatric vaccine schedule based on no scientific input on safety risks and little transparency will cause unnecessary fear for patients and doctors, and will make America sicker.

It is well known that Big Pharma funds Cassidy’s campaign and therefore controls his votes. Cunningham wrote last year about his work to undercut 340B programs that helped to keep drug costs under control for rural Louisianians.

It’s no coincidence that as Cassidy moves to undercut 340B, Big Pharma is lining his campaign coffers. Just last quarter, he pocketed $16,500 from employees at PhRMA, Eli Lilly, Sanofi, and Bristol Myers-Squibb — the same four drugmakers leading the charge against 340B. For a man who claims to represent Louisiana, only about a third of his donations last quarter actually came from Louisiana voters. The rest? Out-of-state interests, including Big Pharma.

This isn’t the first time Cassidy has cozied up to the pharmaceutical giants. During the 2024 election cycle, Big Pharma ranked as his fourth-largest source of campaign donations. In 2022, they were fifth. The money keeps flowing, and Cassidy keeps pushing policies that benefit drug companies at the expense of his constituents.

The Battle Lines Form As RFK Jr. Prepares to Take on Big Pharma Over Childhood Vaccines

But no matter, Cassidy will still name-check Donald Trump and declare his allegiance to the president’s agenda, while touting his pro-life bona fides and endorsements, co-opting MAHA health plan tenets, and collecting Big Pharma money as he desperately tries to outrun his inconsistent and disingenuous record.

My record speaks for itself. No one in this race comes close. I’ve delivered real results for Louisiana working with @realDonaldTrump, and my fight for our country and our state isn’t over. pic.twitter.com/6tFFI8SWCo

— Bill Cassidy, M.D. (@BillCassidy) January 9, 2026

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