{
"type": "rich",
"version": "1.0",
"provider_name": "Action Network",
"provider_url": "https://actionnetwork.org",
"html": "",
"author_name": "Inequality Media Civic Action",
"author_url": "https://actionnetwork.org/groups/inequality-media-civic-action",
"title": "Tell Congress: Stop Medicare from using AI to deny care.",
"thumbnail_url": "https://actionnetwork.org//images/generic_facebook.jpg",
"description": "Picture a death panel run by robots. Machines spitting out authorization denials by the batch, with little or no human review, prioritizing cost cutting over patient care. Imagine these machines making decisions based on algorithms written by data scientists, rather than on the hands-on expertise and ethics-based care of your primary care doctor and specialists. This is not just some dystopian future. This is here, now — and it’s about to get worse. Several major Medicare Advantage providers — UnitedHealthcare, Humana, and CVS — have already started using AI in their prior authorization processes. Insurance companies second-guessing licensed physicians to determine which patients will be allowed to receive which prescribed medications and procedures is nothing new. But when Medicare Advantage, and now traditional Medicare as well, starts farming out prior authorizations to Artificial Intelligence (AI) — this is not going to end well. Starting in January 2026, Congress has given traditional Medicare the go-ahead to implement its own AI pilot program, to run for 6 years in 6 states. This new, experimental AI program, being developed by the Centers for Medicare & Medicaid Services (CMS), is called the “Wasteful and Inappropriate Service Reduction (WISeR) Model.” But take a look — “Reduction” of “Service” is right there in the name! It’s clear what the system’s priorities are going to be. Think of it as taking a power chainsaw to the nation’s premier healthcare service system — the one Trump promised he would never touch. What could possibly go wrong? A recent Senate subcommittee report on the use of AI to review prior authorizations points to serious concerns. During the period that UnitedHealthcare, Humana, and CVS adopted AI tools, denials of authorization increased by 54% to 108%, depending on the insurer. For instance, when UnitedHealthCare first implemented AI for authorization decisions, it more than doubled its denials of post-acute care such as rehab facilities and nursing homes. Denials of certain services increased 16-fold. Physicians, too, are speaking up about AI. A recent American Medical Association survey of 1,000 physicians (including 400 Primary Care Physicians and 600 specialists) found these concerns: 61% reported insurers’ using AI increases denials and harm to patients 94% said delays and denials negatively affect patients’ outcomes 82% have seen patients abandon treatment due to authorization problems Despite insurers’ claims about the bottom line benefits of AI review, the Senate study also found that patients with insurers utilizing AI will see their premiums rise $21.50/month from 2025 to 2026. Using AI caused sharp increases in delays, denials, and lawsuits for Medicare Advantage patients, and the upcoming pilot program for traditional Medicare puts even more patients at risk. Don’t leave life and death decisions to inhuman machines! Tell Congress to prohibit Medicare Advantage and traditional Medicare from using AI to review procedures prescribed by human doctors!",
"url": "https://actionnetwork.org/letters/stop-medicare-from-using-ai-to-deny-healthcare"
}