Trump’s New Plan for Medicare: Let AI Decide Whether You Should Be Covered or Not

By Lucas Ropek

Donald Trump says he is Making America Great Again, which seems like it might be code for: making everything shittier, less affordable, and less efficient. Certainly, when it comes to the realm of public services, the White House seems to be doing everything in its power to make the century-old social welfare programs—like Social Security and Medicare—significantly less helpful.

The latest unfortunate example of this unfurled itself this week with the announcement of a new pilot program being trialed by the Centers for Medicare and Medicaid Services. The pilot, which the New York Times reports is scheduled to begin next year in six different states, will use artificial intelligence software to determine whether certain kinds of coverage are “appropriate” or not. In a press release on the agency’s website that feels very DOGE-like, the CMS notes that its new program will “Target Wasteful, Inappropriate Services in Original Medicare.” It reads: 

The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care.

Yes, you wouldn’t want to have unnecessary care, would you? That would be terrible. The press release continues:

Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars.

Prior authorization is the process whereby medical providers are required to check with insurance companies before providing certain types of care. Traditionally, folks enjoying public benefits with Original Medicare do not need to worry about this sort of thing, but for those using the more “modernized” program, Medicare Advantage, they seem to be getting hit with it all the time. In this case, recipients who are receiving Original Medicare will still be subjected to prior authorization through the pilot program. The AI algorithms will be used to determine whether the care recipients are getting represents an “appropriate” expenditure of “federal taxpayer dollars.” This is all packaged by the government as if it’s doing you some sort of favor. The press release states:

The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use.

The New York Times notes that algorithms of this sort have been subjected to litigation, while also noting that the AI companies involved “would have a strong financial incentive to deny claims,” and the new pilot has already been referred to as an “AI death panels” program. Gizmodo reached out to the government for information.