AI for All. Who Needs Doctors or Insurance?

Four months into Donald Trump’s presidency, his and Robert F. Kennedy Jr.’s plan to “Make America Healthy Again” appears to be taking shape: It consists of throwing millions of Americans off their health insurance plans, making Americans pay more for health care in various ways, and slashing health spending and research — all to help fund a tax bill that will yet again disproportionately benefit the rich. 

Don’t worry, though: Dr. AI will see you now. He’s ready to stand in for experienced and licensed doctors, nurses, emergency room workers, and the world’s best scientists — and to fill the void that may be left by your previous insurance plan.

“The AI revolution has arrived,” Kennedy, who’s leading Trump’s Department of Health and Human Services (HHS), proclaimed on Wednesday in congressional budget hearings.

Artificial intelligence is all the rage in the second-term edition of Trump’s America. Powerful companies have invested a lot of money in it, hoping to achieve technological breakthroughs, cut costs, or maybe just pay fewer workers. Republicans want to protect AI from state and local regulation. Perhaps you, yourself, have started using AI to write your emails or essays. Maybe you’ve encountered AI when using Google — the place where you used to search for relevant information, and now you get weird approximations of an answer. Is your AI obsession ruining your life? 

Or perhaps you’ve read about AI in the health care context, where the insurer UnitedHealth Group is accused of using an algorithm with a “90-percent error rate” to systematically deny claims for very ill patients in order to move them out of nursing homes early.  

Speaking to House lawmakers on Wednesday, Kennedy touted the Food and Drug Administration’s plan to use AI for Phase 3 drug testing — designed to demonstrate whether products benefit specific populations — to limit expenses and avoid testing on animals, in order to get biotechnology products to market faster.  

When a Republican congresswoman from Louisiana asked Kennedy about his plan to improve rural health access in her district, one with many “medical deserts” and residents in poor health, he pledged to “dramatically revolutionize the availability of telehealth and AI so that people can avoid emergency rooms by getting treated at home.”

“I looked at a technology yesterday that can accurately diagnose strep throat by telephone, using your telephone camera, [by] taking one picture of the inside of your throat, and the accuracy of that test is greater than a strep swab,” said Kennedy, a vaccine skeptic who separately admitted Wednesday, “I don’t think people should be taking medical advice from me.”

Republicans on the House Ways and Means Committee have proposed a measure in their reconciliation legislation — Trump’s “one, big, beautiful bill” to reauthorize his 2017 tax cuts for the rich — that would direct HHS to use AI tools to reduce and recover improper payments made to health care providers under the traditional Medicare program. 

“This provision provides $25 million for the Secretary of Health and Human Services to contract with artificial intelligence contractors and data scientists to examine Medicare improper payments and recoup overpayments,” says Republicans’ bill summary. “Additionally, the Secretary is required to report to Congress on progress on decreasing the number of Medicare improper payments.”

Health care experts are skeptical.

“The track record of using AI or algorithms in Medicare Advantage prior authorization and coverage decisions does not inspire confidence that such technology is ready to apply to assessing the propriety of payments in other parts of Medicare,” says David Lipschutz, a co-director at the Center for Medicare Advocacy. 

“A good deal of improper payment in Medicare is due to incomplete paperwork,” he says, referencing a KFF report that notes the most common reason for improper payments is insufficient or lack of documentation from providers. “What would be the opportunities or mechanisms to correct erroneous decisions from AI? Would beneficiaries be held harmless if an AI tool determines that services they already received were improper? Oftentimes, whether a given item or service is proper or medically necessary is a nuanced analysis that can include clinical judgment and application of complex coverage criteria, and should be an individualized assessment for a specific individual. It would be dangerous to leave this important analysis to an algorithm.”

Alex Lawson, executive director at Social Security Works, says of the proposal: “Like many things AI, this is obviously a get-rich-quick gimmick for some tech bro bandit with access to Republican politicians.” He adds that “this is all part of a bill that rips health care away from 14 million people to give trillions in tax handouts to billionaires,” pointing to an analysis by the nonpartisan Congressional Budget Office.

The efforts to expand the use of AI in health care comes as Trump, Kennedy, and Republicans push to slash spending on Medicaid, the government health insurance program for low-income Americans and the disabled. 

Republicans have rallied behind the idea of imposing work requirements on all able-bodied adults under the age of 65, demanding they work at least 80 hours a week. That’s in order to qualify for a program that strictly limits how much income people can make, and effectively demands they be poor. (Medicaid recipients will also be expected to share more costs.)

Under the terms of Republicans’ reconciliation package, more than 10 million Americans are expected to lose their Medicaid or Children’s Health Insurance Program coverage — losses that will help fund tax cuts for the rich. 

Kennedy endorsed the proposed Medicaid work requirements in a New York Times op-ed on Wednesday. 

Slashing Medicaid enrollment will likely cause hospitals to eat the expenses associated with caring for sicker, uninsured patients. The reconciliation bill would also limit the use of so-called provider taxes, which states use to give supplemental payments to hospitals, doctors, and other health care providers to help cover their Medicaid patients — a change that providers warn could force many rural hospitals to close. 

Republicans’ legislation would separately allow for the expiration of expanded premium subsidies helping millions of Americans pay for individual health insurance plans purchased on state Affordable Care Act marketplaces. The bill would also impose steep penalties on low-income people who purchase their insurance using advance premium tax credits if they end up earning more money than they initially estimate to the IRS. 

Taken together, the Medicaid and Affordable Care Act marketplace changes in Republicans’ reconciliation bill are expected to cost nearly 14 million Americans their health insurance coverage. Slashing Medicaid funding and using AI to review and recoup Medicare payments could put significant strain on doctors and hospitals.

Dr. AI may not be the doctor you need — but he could be all you’ve got.