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TRUMP’S SNEAK ATTACK ON MEDICARE  
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Robert Kuttner
July 2, 2025
The American Prospect
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_ For the first time, required pre-authorizations are coming to
traditional Medicare. The Trump administration proposes to extend
pre-authorizations to traditional Medicare, just like Medicare
Advantage. This maneuver has gotten little attention. _

Jon Elswick/AP Photo // The American Prospect,

 

Traditional Medicare has been an oasis of freedom for clinicians and
patients alike from the plague of “pre-authorizations” required by
private insurance plans and especially by so-called Medicare Advantage
plans. Pre-authorization requires advance approval for medical
procedures, except in emergencies. Insurers even sometimes challenge
after the fact whether an event was a true emergency and withhold
payments or bill subscribers.

Medicare Advantage, first authorized in 1997, is not really Medicare
at all. It is private insurance using Medicare branding and Medicare
financing, and the program is a classic bait-and-switch.

Subscribers to Medicare Advantage, now more than half of all seniors,
are led to believe that they are getting a more comprehensive package
of covered benefits than under traditional public Medicare. But in
practice, Medicare Advantage policies make their money by denying a
great deal of care as supposedly medically unnecessary—and the rules
make it very difficult for frustrated consumers to switch back to
traditional public Medicare.

Now the Trump administration proposes to extend pre-authorizations to
traditional Medicare as well. With all the other assaults on health
care in the budget bill, this maneuver has gotten little attention.

On June 27, the Department of Health and Human Services’s Centers
for Medicare and Medicaid Services (CMS) announced a pilot project in
six states [[link removed]],
which will require pre-authorization for 17 kinds of services that HHS
says are sometimes overused and subject to abuse. The six states are
New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington, and the
pilot program will run for six years. The services include “skin
substitutes,” deep brain stimulation for Parkinson’s disease, some
treatments for sexual impotence, and arthroscopy for knee
osteoarthritis.

The idea of cracking down on abuses is not crazy. Under the Biden
administration, on January 1 Medicare began requiring
pre-authorization for several unproven treatments for spinal
conditions that are often overused. Medicare payments for “skin
substitutes,” which are really fancy bandages made of dried
placenta, doubled in one year
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more than $10 billion in 2024, with some doctors getting kickbacks for
prescribing them. 

What’s perverse is the way Medicare is going about limiting abuses.
It has long been well-documented that some doctors, especially in
states such as Florida, run Medicare mills and profit
from unnecessary treatments and costly surgeries
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By requiring pre-approvals for procedures rather than cracking down on
unethical doctors, Medicare creates bureaucratic hassles for patients
and ethical doctors alike. One of the truly insidious aspects of the
pilot program is that it encourages the use of AI and machine learning
in pre-authorization decisions, which further removes medical
decisions from doctors and is a gift to the AI industry.

The only good news here, sort of, is that the idea of expanding
required Medicare pre-approvals is not a scheme by MAGA. It originated
with the CMS career staff as a way of restraining costs. But the
private insurance industry, long an inside player at CMS, has been a
cheerleader for these policies. And as Trump’s policies target
Medicaid, NIH, CDC, and the Civil Service, and HHS Secretary Robert F.
Kennedy Jr. and CMS Administrator Mehmet Oz increasingly have their
way with these agencies, competent career professionals will keep
exiting.

Meanwhile, CMS has simultaneously announced a voluntary program with
major insurers
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sponsor Medicare Advantage to reduce excessive rejections of
pre-approvals. Participating insurers include Aetna, AHIP, Blue Cross
Blue Shield, Cigna, Humana, Kaiser Permanente, and UnitedHealthcare,
which pledged to work with HHS to streamline pre-approvals and
“reduce the volume of medical services subject to prior
authorization.”

This timing is no coincidence. As the difference between traditional
Medicare and privatized Medicare Advantage narrows, the insurance
industry will gain one more marketing pitch.

Unlike in the case of Medicaid, a means-tested program for the poor,
Trump lacks the nerve to assault the universal Medicare program
directly. So HHS and the insurance industry are trying to weaken it by
stealth.

_[ROBERT KUTTNER is co-founder and co-editor of The American Prospect
[[link removed]], and professor at Brandeis University’s
Heller School.]_

_Read the original article at Prospect.org
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_

_Used with the permission. © The American Prospect
[[link removed]], Prospect.org, 2025 [[link removed]].
All rights reserved.  _

_Support the American Prospect [[link removed]]._

_Click here [[link removed]] to support the Prospect's
brand of independent impact journalism._

* Medicare
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* Healthcare
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* health insurance
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* privatization
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* Medicare Advantage
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* Medicare Advantage Plans
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* Donald Trump
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* Trump 2.0
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* MAGA
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* CMS
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* federal government
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* Pre-authorizations
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* Trump Budget
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* GOP Budget
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* House Budget
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* Senate Budget Bill
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* Budget Reconciliation
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* House GOP
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* (20441)
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