Automation and the Fight for Care

The Trump administration recently announced plans to use AI to decide whether Medicare enrollees in some states can receive medical care through a process called prior authorization. Private insurers have been using automated prior authorizations to deny care for years, including for Medicare Advantage plans. But the move is deeply unpopular. With opposition from doctors, patients, lawmakers, and the general public to the rollout of privatized automated prior authorization denials in Medicare, there is a chance to push back against this expansion of automation.

Policy responses to new uses of automation often focus on addressing the immediate impacts to individuals, whether it’s to fight denial of services, privacy violations, or lack of transparency. But this focus, while important, ignores significant collective harms. The introduction of automation into public healthcare also circumscribes people’s power to fight for their right to care.

The use of automation widens the gap between people’s access to care and the political question of their right to care. People’s efforts to access the care they need become focused on technocratic questions about eligibility and the technology that determines it, rather than on the political choices that reduced a right to care to a question of who deserves it. In other words, automation has a depoliticizing effect that makes it harder to build collective power for access to healthcare.