House Dems flip over Medicare pilot program

House Democrats are opposing the Centers for Medicare & Medicaid Services’ plan to introduce a new pilot program that would impose prior authorization requirements on traditional Medicare. The move has sparked concern among lawmakers who fear it could create barriers for patients and add burdens to healthcare providers.

Pushback from lawmakers

A group of more than a dozen House Democrats, led by Representatives Suzan DelBene and Ami Bera, sent a letter to CMS Administrator Mehmet Oz asking for detailed information about the pilot program and urging CMS to cancel it. The lawmakers pointed out that traditional Medicare rarely requires prior authorization and warned that this change could lead to limited access to critical care.

Concerns over patient care

The letter stressed that prior authorization is often seen as a way to control costs, but in reality, it increases paperwork and can delay treatments. Kevin Thompson, CEO of 9i Capital Group, echoed these concerns, calling prior authorization a “profit-driven” process that can clash with quality patient care. “Let’s call it what it is: profit-driven healthcare. And 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,” he explained to Newsweek.

CMS plans limited

CMS intends to start the prior authorization pilot in six states beginning in January. Past administrations got insurers to simplify prior authorization for Medicare Advantage. However, lawmakers say applying these rules to traditional Medicare overlooks the problems doctors have already seen.

Lawmaker’s response

“Prior authorization has long been abused, and it is bad for patients and providers. The American Medical Association notes, ‘Among America’s physicians, more than nine in 10 surveyed say that prior authorization has a negative impact on patient clinical outcomes.’” They urged Administrator Oz to cancel the pilot program, known as the WISeR model, and look for alternative ways to reduce fraud and waste in Medicare.

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