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The Dictatorship

Dr. Oz’s plan to impose AI on Medicare patients is a recipe for disaster

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Dr. Oz’s plan to impose AI on Medicare patients is a recipe for disaster

When Daniel was consumed with severe and inexplicable pain for months, his physician prescribed an MRI. However, his health insurer required that it approve the test as well before he could undergo the procedure. When the insurer denied the prior authorization, that began his long journey to diagnose and treat his syringomyelia, or a cyst in his spinal column. For Daniel, it meant over a year of debilitating pain, weight loss, suicidal depression and dependence on opioids amid delayed diagnosis and treatment. And his repeated appeals of the denied authorization drained what little energy he had.

While writing my forthcoming book (on health insurance coverage delays and denials), I found that Daniel’s tragic experience is all too common. Of the 1,340 people I surveyed, 36% experienced at least one instance of coverage denial, often through prior authorization, that kept medical care out of reach. Prior authorization has been typically deployed by private health insurers, infuriating doctors and patients. Now, though, thanks to the Trump administration, Medicare beneficiaries will begin facing these obstacles to care as well.

Private insurers usually deploy prior authorization to limit low-value care and contain health care costs.

Starting next year, through its implementation of the Wasteful and Inappropriate Service Reduction (WISeR) Modelthe Centers for Medicare and Medicaid Services (CMS) will begin a pilot program that will import the prior authorization process to traditional Medicare plans in six states. The program will even employ artificial intelligence tools to decide whether those Medicare beneficiaries will receive the care physicians say they need.

Private insurers usually deploy prior authorization to limit low-value care and contain health care costs. Though the tactic was used sparingly in its early days, it is now applied to most higher-cost drugs and nearly all surgeries and procedures. While most prior authorizations are ultimately approved, they are a source of headaches and frustration among patients and physicians alike, sowing distrust in the health care system. Prior authorization creates delays and denials of health coverage — and the process of challenging denials is highly burdensome, especially for people who are already struggling with severe or even life-threatening health conditions.

Appealing a coverage denial demands a high degree of health insurance literacy and fortitude that most of us lack, especially in a health crisis. Coordinating between one’s physician and insurer, all while potentially going untreated, can lead patients such as Daniel to experience a sense of overwhelm and a loss of autonomy amid this navigation anxiety. It is little wonder why so few patients ultimately opt to appeal. In fact, among the 3.2 million denials of prior authorization rendered by Medicare Advantage plans in 2023, just 11.7% were appealed despite most appeals resulting in a reversal of the initial denial.

Thus, health care becomes rationed not through a final denial of coverage, but rather through accumulations of inconveniences as patients — especially those from marginalized backgrounds — struggle to navigate America’s labyrinthine health insurance bureaucracy. Perhaps not surprisingly, the use of prior authorization has effects that are not only pervasive, but also inequitable. My research has found that less affluent patients are less likely to appeal, and sicker patients and Black and Hispanic Medicaid patients are less likely to appeal successfully.

The roughly 33 million Americans in Medicare’s traditional fee-for-service plans have largely been able to evade these administrative burdens, as these plans use prior authorization very rarely, such as for durable medical equipment. On the other hand, 99% of Medicare Advantage beneficiaries have prior authorization requirements in their plans. But with the proposed changes under the Trump administration, the enrollees relying on traditional Medicare will get ensnared in red tape as well, likely leading to delayed or forgone care.

Health insurers’ reliance on AI to process claims has already faced legal challenges.

And remember, most of Medicare’s beneficiaries are 65 or older. Older adults tend to have lower health insurance literacyare more likely to have significant health challenges and more frequently suffer from cognitive decline, which makes navigating the complexities of these health insurance processes particularly onerous, if not infeasible.

CMS Director Dr. Mehmet Oz asserts that this pilot program is aimed at “crushing fraud, waste, and abuse.” But it will inevitably drive delays in care — and burdens of appealing — for seniors across the country. It will likewise exacerbate administrative burden for physicians, who must submit prior authorization documentation, conduct “peer to peer” reviews of denials, and craft appeal letters on behalf of their patients. In fact, quite apart from simply combating overprescribing, prior authorization-related burdens can actually lead to underprescribing to avoid subsequent delays or rejections of coverage.

What’s more, health insurers’ reliance on AI to process claims (including from Medicare Advantage beneficiaries) has already faced legal challenges. Lawsuits filed against UnitedHealthCignaand Humana challenge the deployment of AI programs to decide the amount of coverage that patients required, regardless of the recommendations of the treating physician. Despite the scrutiny in court, only a small minority of patients (usually more advantaged patients) appeal these prior authorization denials. In other words, the high rate at which these denials are reversed — as high as 90 percentaccording to the lawsuits — can be an acceptable cost to insurers if the process is so burdensome that few ever challenge the decisions in the first place.

Daniel ultimately received his spinal cord stimulator, but through his long-term suffering, he was left wondering what might have been absent his supportive family and team of physicians advocating for his access to care at each turn in the health insurance maze. Applying the tools of managed health care to seniors, who may face cognitive decline and worsened physical health, is a recipe for disaster in which, for far too many, health benefits will feel illusory. In a nation as wealthy as the United States, seniors’ epitaphs should not be at risk of reading, “Died of red tape.”

Miranda Yaver

Miranda Yaver is an assistant professor of health policy and management at the University of Pittsburgh and a health care fellow at the Roosevelt Institute.

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The Dictatorship

The latest generational test for Democrats: A House race in Mississippi

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The latest generational test for Democrats: A House race in Mississippi

The next test of whether a new generation of Democrats can unseat members of the old guard comes Tuesday, in a battle over who will represent much of western Mississippi in the U.S. House.

The race to represent the state’s 2nd Congressional District features 34-year-old Evan Turnage — a former lawyer in the offices of Senate Minority Leader Chuck Schumer, D-N.Y. and Sen. Elizabeth Warren, D-Mass. — mounting a longshot bid to replace 78-year-old incumbent Rep. Bennie Thompson. Whoever wins the Tuesday primary will almost certainly win the general election in the solidly Democratic district. (A third candidate, Petris Williams III, is also running in the Democratic primary.)

Turnage has branded himself as a fresh alternative to Thompson, alleging the incumbent hasn’t done enough to reduce poverty and other issues in the majority Black district — which has ranked among the poorest nationwide — during his 33 years in the seat.

“People in this district are ready for change,” Turnage told MS NOW in a phone interview on Monday. “This is the poorest district in the poorest state in the country, and it’s been like that for my entire life. People want better.”

Turnage is one of more than 80 Gen Z and millennial Democrats mounting primary contests this year against veteran House Democrats, according to data released last month by the Democratic political fundraising platform Oath. Others include Melat Kiros, a 28-year-old, Justice Democrats-backed lawyer and barista taking on 68-year-old Rep. Diana DeGette in Colorado in June; and Justin Pearson, a 31-year-old state legislator in Tennessee vying to replace Rep. Steve Cohen in August and backed by both Justice Democrats and Leaders We Deserve, the political action committee founded by 25-year-old Democratic activist David Hogg.

Progressive power broker Sen. Bernie Sanders, D-Vt., has also endorsed a small handful of the candidates taking on House Democrats, including Donavan McKinney, a Michigan state representative running in the state’s 13th district; and 32-year-old Nida Allam, a member of the Durham County Board of Commissioners who lost a tight race to oust Rep. Valerie Foushee in North Carolina last week. (Spokespeople for Sanders did not respond to requests for comment from MS NOW.)

Usamah Andrabi, communications director for Justice Democrats, told MS NOW the deep field of young primary challengers shows that “voters are overwhelmingly ready to usher in a new generation of leadership in this party.”

But he added that the group is not “simply looking to replace old incumbents with young incumbents,” and is instead focused on backing candidates who oppose “democratic corporatism and billionaire greed” and display “moral and political courage.”

“It does us no good to replace aging corporate shills with youthful corporate chills,” Andrabi said. “The problem is that the Democratic Party is overrun with corporate shills.”

“People in this district are ready for change,” Turnage told MS NOW in a phone interview on Monday. “This is the poorest district in the poorest state in the country, and it’s been like that for my entire life. People want better.”

In Mississippi, Thompson has leaned on his experience in Washington, which has included wielding significant power as the first Black Democrat to represent the state in Congress. He’s currently the ranking member on the House Homeland Security Committee, and formerly served as chair of the Select Committee on Jan. 6.

In an emailed statement to MS NOW, Thompson did not directly address the arguments Turnage has made about the need for generational change.

“Elections are about giving people a choice, and I respect that process. I have always run my campaigns by focusing on the needs of the people of Mississippi’s Second Congressional District and the work we’ve done together,” Thompson said. “There is always more to be done, and I remain committed to continuing that progress. Ultimately, I trust the voters of the district to look at the record and make the choice they believe is best for their communities.”

Tough Democratic primaries for some veterans is a hallmark of the 2026 midterm election cycle.

But the recent outcomes of some of these early races underscore the uphill battles younger candidates like Turnage face — and emphasize that they do not all share the same strategies for unseating older incumbents.

In North Carolina, Allam’s race against Foushee was widely seen as a bellwether for how far a left-wing challenger could go in a bid to oust an establishment Democrat in a deep blue district.

And in Texas, Rep. Christian Menefee, the 37-year-old elected to the House in a special election earlier this year, and Rep. Al Green, who has served in Congress for more than two decades, will head to a May runoff election to represent a newly-redrawn district after neither cleared earned 50% of votes in their race last week. (Menefee came out on top, earning about 46% of votes to Green’s 44%, according to the Associated Press.)

Similarly to Allam, Turnage has taken direct aim at his opponent in emphasizing the benefit of electing a millennial to Congress.

“People in my age group are the first age group in generations in America who are expected to have less wealth than their parents, expected to have lower life expectancy than their parents, and that is because of failed leadership from the current generation,” Turnage said.

Both he and Allam also criticized their opponents’ reliance on big-money donors.

Turnage noted that Thompson’s top donor is a group associated with Aflac, the insurance company, and that he has taken thousands from corporate political action committees. (Campaign filings show that, as of last month, Turnage had about $40,000 cash on hand and $85,000 in debts, compared to Thompson’s $1.5 million on hand.)

Allam — who did not respond to repeated inquiries from MS NOW — criticized Foushee for receiving support from outside groups aligned with AIPAC, the pro-Israel lobby. (Allam had close to $229,000 on hand last month and $86,000 in debts, compared to Foushee’s approximately $184,000 on hand.)

Menefee, on the other hand, swatted away questions about his candidacy representing a generational shift, telling MS NOW in an interview last week that he sees his challengers as President Donald Trump and the Republicans who supported gerrymandering the district in which he’s running rather than Green.

“Our support in this race has been intergenerational,” Menefee said.

“We’ve focused very heavily on making sure that folks know that I’m looking to bring new strategies to standing up to the Trump administration,” he added.

Green, on the other hand, has criticized Menefee for missing several votes during his first couple months in Congress, and has said he is proud of his own voting record; he has also claimed, “I am the generational change.”

When it comes to critiques of big-money donors in the Texas race, it is Menefee who has fielded criticism for earning the support of the cryptocurrency lobby — though he has said he was “not at all cognizant” of the financial power they wield.

For the Justice Democrats and the candidates they back, big-money is an ever-present obstacle. Still, Andrabi said, we “want to win every campaign we run.”

But the group also sees Allam’s loss to Foushee — by a single percentage point, compared to a 9-point difference in 2022 — as a win. They also take credit for pushing Foushee to denounce U.S. funding of the Israeli military and regulate artificial intelligence, two issues she said are among her priorities in her statement celebrating her victory.

“If nothing else,” Andrabi said, “we are showing Democratic incumbents that what they are doing is wholly insufficient for their own voters.”

In Mississippi, Turnage has been trying to send the same message to Thompson. But he said he did not seek out the support of groups like Justice Democrats because he did not want “to nationalize this race.”

“We are focused on the issues in Mississippi,” he said.

Still, Turnage said he finds hope in both Allam’s close race and the fact that Menefee — who Turnage said is a friend — will proceed to the runoff.

“I think it’s just another sign that, especially here in the South, people are ready for a new generation of leadership,” Turnage said.

Julianne McShane is a breaking news reporter for MS NOW who also covers the politics of abortion and reproductive rights. You can send her tips from a non-work device on Signal at jmcshane.19 or follow her on X or Bluesky.

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The Dictatorship

Georgia’s special election shows a better way to vote, but not everyone gets to use it

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The race to replace former Rep. Marjorie Taylor Greene is a doozy.

After the firebrand Georgia Republican resigned in January, nearly two dozen Republicans and Democrats filed to run for her seat, ranging from the usual local elected officials and business leaders to a farmer, a horse trainer and a travel consultant.

With no candidate likely to win an outright majority on Tuesday, the top two will face off in a runoff on April 7.

Every year, about a dozen special elections like this are held to fill House seats left vacant because a lawmaker accepted another government appointment, died or resigned, as Greene did in January.

These elections can cost hundreds of thousands of dollars to run. Turnout is typically low — about half that of the previous regular election — and even lower when there is a runoff. In states without runoffs, the winner of a multicandidate race may not even win a majority of the votes cast, meaning they were chosen by a fraction of a fraction of the district’s voters.

The state’s Republicans aren’t keen on talking about it, because it refutes a major GOP talking point on election reform.

Georgia has found a solution to almost all of these problems. But there’s a catch: Only members of the military and voters who live overseas can use it. And Republicans in the state are pushing to ban it for everyone else.

The solution is called ranked-choice voting, and it works pretty similar to the runoff Georgia’s regular voters will likely face in a month for Greene’s seat.

Instead of casting a second ballot, military and overseas voters simply rank the field of candidates in order of their preference. (For example: 1) the farmer, 2) the horse trainer, 3) the travel consultant.) If no candidate gets 50%, the lowest-ranked candidate is removed, and the second choices of their voters are reassigned. (So if the farmer came in last, your vote now goes to the horse trainer.) Some advocates refer to this as an “instant runoff,” since it works the same way as a runoff.

This works well for military voters, who must receive a ballot at least 45 days before a federal election under federal law so that they have enough time to receive it, fill it out and return it. In Texas, which doesn’t have a ranked-choice ballot for military voters, the alternative is to hold the runoff much later. This is why Sen. John Cornyn, R-Texas, and Texas Attorney General Ken Paxton won’t face off for the Republican Senate nomination until late May, which can create problems for the eventual nominee.

Ranked-choice voting isn’t just convenient for military voters, though. Research has also shown that it can boost turnoutreduce negative campaigningincrease the number of women and minority candidates, eliminate the “spoiler effect” of third-party candidateselect more moderates and make governing more bipartisan. That’s why it’s used in elections from the New York City Democratic mayoral primary won by Zohran Mamdani to statewide races in Maine and Alaska to Australian national elections. It’s even used to determine the Academy Award for Best Picture and the Heisman Trophy.

To be fair, there are some drawbacks. It’s a little more expensive, takes longer to count and can be more work for voters — although polls show that most people who’ve used it found it “easy.” and want to keep it.

For many Republican lawmakers, though, ranked-choice voting is a nefarious plot. Sen. Tom Cotton, R-Ark., has called it a “naked power grab” by liberals “hoping to split the conservative vote” and elect Democrats. Gov. Kay Ivey, R-Ala., called it “complicated and confusing” and argued it “makes winners out of losers.” The Republican National Committee adopted a resolution that said it amounted to “voter suppression” and put elections in the hands of “confusing technology” and “unelected bureaucrats.”

Opposition to ranked-choice voting has quickly become an article of faith in the GOP. Earlier this month, Indiana became the 19th state to ban the use of ranked-choice voting, even at the local level.

In quieter moments away from the spotlight, some Republicans seem to understand its benefits. During the pandemic, the Indiana Republican Party used ranked-choice voting to streamline its virtual state convention in 2020. The Virginia GOP had no problem with it the following year when it chose Glenn Youngkin as its nominee for governor after five rounds of ballot counting. And Utah has long used it at state conventions.

But the biggest tell is its use for military and overseas voters in six statesincluding Georgia as well as Alabama, Arkansas, Louisiana, Mississippi and South Carolina. Of those states, only Georgia and South Carolina haven’t banned the use of rank-choice voting in all other situations, and Republican lawmakers in both states are currently considering bans.

There’s really no argument being made against ranked-choice voting that holds for members of the military but not for the public at large. Either it’s a partisan scheme to elect Democrats that is too confusing, suppresses voters and empowers nefarious bureaucrats — or it’s not. The only argument would be that it’s much more convenient for voters deployed to another country but not worth the hassle for voters back home, but that’s not what Republicans have argued.

The biggest fear among Republicans seems to be that ranked-choice voting will help elect Democrats, but a recent survey of research by the Institute of Government and Public Affairs at the University of Illinois-Chicago found there’s no evidence that it helps or hurts either party.

In fact, the only candidates that it seems to hurt are ideological extremists who disdain bipartisanship and struggle to reach out to their rival’s supporters. Lawmakers who continue to oppose it may be telling on themselves more than they realize.

This is a preview of MS NOW’s Project 47 Newsletter. As President Trump continues implementing his ambitious agenda, get expert analysis on the administration’s latest actions and how others are pushing back sent straight to your inbox every Tuesday. Sign up now.

Ryan Teague Beckwith is a newsletter editor for MS NOW. He has previously worked for such outlets as Time magazine and Bloomberg News. He teaches journalism at Georgetown University’s School of Continuing Studies and is the creator of Your First Byline.

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The Dictatorship

Stephen Miller is down but not out

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The mass deportation sweeps integral to meeting Stephen Miller’s goals have slowed substantially after last month’s federal retreat from Minnesota. It’s the biggest setback the White House deputy chief of staff has faced in his bid to purge the country of millions of immigrants. But as the highly visible raids featuring Immigration and Customs Enforcement and Border Patrol have receded, it would be unwise to mistake a change in tactics with a change in Miller’s overall strategy and goals.

If there were one word to describe the Trump administration’s deportation campaign months before its surge into Minnesota, it would be “unsubtle.” The quota of arrests Miller had set — 3,000 per day by June, double his demand for 1,500 daily in January — required ICE to ditch its longstanding methods. Rather than targeting specific individuals, it adopted mass roundups of immigrants as its standard operating procedure.

If there were one word to describe the Trump administration’s deportation campaign months before its surge into Minnesota, it would be “unsubtle.”

The sight of these indiscriminate, and yet highly discriminatory, arrests helped tank President Donald Trump’s approval ratingespecially toward his immigration policies. Border Patrol chief Greg Bovino’s self-important, heavy-handed antics helped add fuel to the growing embers of public discontent toward the federal interventions. That discontent swelled into outrage when federal immigration agents killed two Minneapolis residents within the span of two weeks. Reportedly it was Miller behind the initial claim that one of those victims, Alex Pretti, was a “domestic terrorist,” a false charge that helped galvanize the opposition to ICE’s tactics.

Withdrawing from Minnesota last month was the first of several major setbacks for Miller’s policies. The Department of Homeland Security is still partially shutdown as Senate Democrats hold up funding in hopes of instituting new reforms on ICE and Border Patrol. Meanwhile, the department itself is soon to be without a leader after Kristi Noem’s firing last week, with no hearing scheduled to get her replacement confirmed.

According to The New York TimesICE pulling back on massive city-wide operations and returning to more targeted arrests has had an impact Miller must hate:

In February, Immigration and Customs Enforcement officers arrested roughly 11 percent fewer people per day than they had the previous month, according to internal government figures reviewed by The New York Times. The drop was driven in part by ICE arresting fewer immigrants without criminal records, the data show. Overall, arrests have fallen to their lowest levels since September.

While any drop off is encouraging, the danger in this moment is that the “softer touch” Trump said his administration needed will be mistaken as a reversion to the norm. According to the Times’ review of ICE data, in February, agents were still detaining about 1,115 people daily, which remains “about four times as high as they were during the last year of the Biden administration.” And 40% of the people ICE arrested in February had no criminal recordonce again exposing the lie in Trump’s claims that only the “worst of the worst” were being targeted.

The public’s opinion soured toward the brutish show of force Miller’s demands required, but there’s no guarantee that the public will maintain that disapproval as the memory of heavily armed agents patrolling city streets fades. And while Sen. Thom Tillis, R-N.C., suggested Sunday that Miller needs to be firedhe made clear he  has issue with the administration’s methods, not its goal.

“We’ve lost the debate over immigration and deportations,” Tillis told CNN. “I believe that we should deport everyone that we can find that came across the borders during the Biden administration. But we’ve got to be smart, use our limited resources, go after the most dangerous first.”

The upside for Miller is that while he may have lost several recent battles, the war is still ongoing.

That’s almost exactly how Trump sold Americans on his mass deportation scheme, only for Miller to carry out the real agenda of hitting a million deportations a year, no matter who got caught up in the dragnet.

The upside for Miller is that while he may have lost several recent battles, the war is still ongoing. After all, he still has three more years and billions of dollars already appropriated to ICE and DHS more broadly to help bring to life his vision of an America purged of its immigrants. Even though ICE and Border Patrol are at least temporarily restrained, DHS is still procuring warehouses and factories to convert into the detention facilities that Miller seeks to fill.

Meanwhile, hundreds of immigrants are still being rounded up daily despite committing no crime. The comparative quiet on city streets isn’t being matched in the cries of anguish of families who know a loved one won’t be coming home. Even if the deportation figures aren’t rising as fast as Miller would like, the sum of lives forever changed by his cruelty won’t be receding anytime soon.

Hayes Brown is a writer and editor for MS NOW. He focuses on politics and policymaking at the federal level, including Congress and the White House.

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