by More than a dozen House Democrats are pushing back against a Centers for Medicare & Medicaid Services (CMS) plan to expand prior authorization requirements to traditional Medicare through a new pilot program set to launch in six states in January.
The pilot, announced by CMS Administrator Mehmet Oz, will incorporate artificial intelligence to help determine approvals for certain medical services — a move the agency says is aimed at reducing waste and improving efficiency.
Growing Political Divide
The proposal has sparked heated debate on Capitol Hill over how to control Medicare spending without restricting patient access. Critics argue the changes will slow care delivery, add red tape, and undermine the program’s patient-centered focus.
“Let’s call it what it is: profit-driven healthcare,” a financial expert told Newsweek. “Profit motive and patient care mix about as well as oil and water. Lawmakers are sounding the alarm, because this directly affects many of their constituents.”
House Democrats say traditional Medicare has rarely required prior authorization, and that adding it could limit access to life-saving treatments, create delays, and impose significant burdens on both providers and patients.
What To Know
- The pilot will launch in six states in January.
- Led by Reps. Suzan DelBene (D-WA) and Ami Bera (D-CA), more than a dozen Democrats sent a letter to CMS urging the cancellation of the program.
- Lawmakers cite previous voluntary pledges from major insurers to simplify prior authorization in Medicare Advantage, arguing those commitments recognized the harm such policies can cause.
- Senate Republicans, meanwhile, see the pilot as part of a broader effort to fight fraud, reduce overpayments, and modernize CMS operations.
The letter to CMS called prior authorization “a cost-containment strategy” that in practice “increases provider burden, takes time away from patients, limits patients’ access to life-saving care, and creates unnecessary administrative burden.”
Next Steps
House Democrats have formally requested CMS provide documentation on the decision-making process and cancel the planned pilot.
In the Senate, broader discussions on Medicare reform are ongoing, with committee deliberations likely to decide whether changes to Medicare Advantage payments or CMS operations make it into larger legislative packages later this year.
