Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Medicare Prior Authorization topic
No spam. Unsubscribe anytime.
Lawmaker says Trump administration broke promise by allowing AI-driven denials in Medicare
Summary
A lawmaker on the Senate floor accused the Trump administration of empowering private AI contractors to delay or deny care in traditional Medicare, cited denial and appeals statistics from Medicare Advantage plans, and urged colleagues to abandon the policy and vote against it.
A lawmaker on the Senate floor accused the Trump administration of empowering private AI contractors to delay and deny care under traditional Medicare and said President Trump’s promise not to 'touch Medicare' has been broken.
The lawmaker argued that seniors who paid into Medicare now face bureaucratic delays for procedures their doctors recommend and cited examples including knee arthroscopies, nerve stimulation, steroid injections and cervical fusion. "That Trump promise has been broken," the lawmaker said on the Senate floor.
The lawmaker pointed to federal and market data to support the critique. They said the Centers for Medicare and Medicaid Services had lowered payment rates for a procedure cited by the administration and argued those payment changes and the small share of so-called "skin substitute" procedures do not justify the broader prior-authorization model. The lawmaker said such substitutes account for "less than 1%" of services in Washington state.
On denials and appeals, the lawmaker said insurers selling Medicare Advantage plans denied more than 4,000,000 prior-authorization requests in 2024, that only about one in 10 denials were appealed, and that appeals were overturned eight times out of 10 when filed. The lawmaker presented those figures as evidence that prior authorization often operates as a deterrent to legitimate care rather than an appropriate clinical review.
The lawmaker warned the administration is attempting to import insurance-company prior-authorization tactics into traditional Medicare, saying that change would subject beneficiaries who choose traditional Medicare to the same hurdles they sought to avoid. "It's a mistake," the lawmaker said, urging colleagues to tell the administration to abandon the AI-driven prior-authorization experiment.
The lawmaker framed the concern as bipartisan, noting some Republican colleagues have also raised questions about prior authorization in Medicare Advantage, and called for collaborative work to strengthen both traditional Medicare and Medicare Advantage. The lawmaker concluded by urging a yes vote on a related measure and yielding the floor.
The debate centered on policy design and scope; the lawmaker's remarks do not record a formal change in law or a completed vote in the transcript excerpt.
