The Trump administration is piloting a new Medicare plan that would require patients to receive approval before undergoing medical procedures, which critics say will worsen health outcomes.
Medicare is the government’s insurance program for seniors aged 65 and over and also covers younger people with disabilities.
Prior authorization is similar to how private insurers operate, often resulting in a delay or denial of treatments. However, traditional Medicare plans typically require far less prior approval for procedures than private insurance. That allows older Americans to get surgeries and other procedures without having to jump through red tape before undergoing treatment.
The Centers for Medicare & Medicaid Services said the pilot, which is set to begin in January across six states, would “crush fraud, waste, and abuse.”
Under the plans, the federal government would hire private companies to use artificial intelligence to evaluate whether patients would be covered for procedures such as skin and tissue substitutes, electrical nerve stimulator implants and knee arthroscopy for knee osteoarthritis.
The agency said that final decisions of the services that do not meet Medicare coverage “will be made by licensed clinicians, not machines.”
But Democratic lawmakers accused the agency’s administrator, Dr. Mehmet Oz, of adding new red tape to traditional Medicare that will “delay care and worsen health outcomes.”
House Democrats wrote to Oz on August 7 with their concerns, and highlighted that the Trump administration publicly recognized the harm of prior authorization earlier this year.
“On June 23, 2025, Trump Administration officials publicly touted a pledge by the health insurance industry to curtail prior authorization abuses,” the letter said. “And yet, not a week after these statements, CMS put forward a new proposal to increase the utilization of prior authorization in a type of health coverage that had seldom used the tactic before, replacing doctor’s medical knowledge with an algorithm designed to maximize care denial in order to increase profits.”
The pilot is due to be rolled out in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.
The latest pilot program is reminiscent of the uproar stirred up by former Alaska Gov. Sarah Palin in 2009, who likened similar healthcare proposals under former President Barack Obama to “death panels.”
Under the Medicare provision in the Affordable Care Act, widely referred to as Obamacare, the government would pay doctors to advise seniors about end-of-life care.
“The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care,” Palin said in a 2009 Facebook post that caused a media storm. “Such a system is downright evil.”
Palin’s false claim spread quickly as misinformation circulated.
Ultimately, the provision authorizing Medicare payment was not included in the final legislation.
