The Biden administration unveiled extensive healthcare proposals on Tuesday, including major reforms targeting discriminatory artificial intelligence practices in healthcare delivery. However, with the upcoming transition to a Trump administration, the future of these proposals remains uncertain.
The proposals aim to establish stronger oversight of AI systems used by Medicare Advantage insurers to prevent deepening bias and discrimination against vulnerable populations. This comes amid growing concerns about AI algorithms perpetuating existing healthcare inequities.
A key example highlighted by the administration involves AI systems predicting missed medical appointments. These systems have led to discriminatory practices where providers double-book appointment slots for low-income patients who may face genuine challenges with transportation, childcare, and work scheduling. This has resulted in longer wait times for these patients, creating a problematic cycle of missed appointments.
The proposals specifically address how AI trained on electronic health records can generate flawed recommendations. People of color and those from lower socioeconomic backgrounds often have incomplete or inaccurate health records, which can lead to biased AI outputs when these records are used for training.
Beyond AI regulations, the proposals include major changes to Medicare drug coverage, particularly for anti-obesity medications like Wegovy and Zepbound. The administration estimates approximately 15 million Medicare and Medicaid beneficiaries could gain access to these treatments.
The package also addresses prior authorization issues, proposing to prevent Medicare Advantage providers from denying previously approved inpatient hospital claims. Currently, while 80% of appealed claim denials are successful, only 4% of denials are actually appealed.
The comprehensive proposals, spanning over 700 pages, represent a substantial reform effort in healthcare delivery and equity. The estimated cost over a decade includes $25 billion for Medicare and $11 billion for Medicaid, with states contributing approximately $4 billion.
As the transition to a Trump administration approaches, healthcare advocates and industry stakeholders await clarity on whether these proposed reforms will be implemented or modified under new leadership.
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