The Algorithmic Assault on Healthcare: When AI Decides Who Gets Treatment

The Emerging Battle Over AI in Health Insurance

The use of artificial intelligence in health insurance has become the latest frontier in America’s ongoing healthcare debate, creating unlikely political alliances and revealing deep concerns about how technology intersects with human welfare. According to recent reporting, Republican Governor Ron DeSantis of Florida and the Democratic-led Maryland government find themselves aligned against President Donald Trump and California Governor Gavin Newsom on the critical question of how health insurers should utilize AI technology.

This political realignment reflects the complex nature of regulating emerging technologies that directly impact human lives. The Trump administration, through a December executive order, has positioned itself against what it characterizes as “excessive State regulation,” arguing that United States AI companies “must be free to innovate without cumbersome regulation.” This approach frames AI development as a national security imperative in a “race with adversaries for supremacy” in technological advancement.

State-Level Resistance and Legislative Action

Despite federal resistance, states across the nation are mounting what can only be described as a rebellion against unregulated AI in healthcare. At least four states—Arizona, Maryland, Nebraska, and Texas—enacted legislation last year specifically reining in the use of AI in health insurance. Two additional states, Illinois and California, passed similar bills the previous year. The movement continues to gain momentum, with legislators in Rhode Island planning to reintroduce legislation after previous efforts stalled.

Governor DeSantis has notably rolled out an “AI Bill of Rights” that includes restrictions on AI use in processing insurance claims and requires state regulatory bodies to inspect algorithms. During his January State of the State address, DeSantis emphasized that “We have a responsibility to ensure that new technologies develop in ways that are moral and ethical, in ways that reinforce our American values, not in ways that erode them.”

Public Concern and Industry Practices

The push for regulation aligns with significant public skepticism about AI. A December Fox News poll found that 63% of voters describe themselves as “very” or “extremely” concerned about artificial intelligence, with majorities across the political spectrum expressing qualms. This concern is compounded by existing public dissatisfaction with health insurers’ cost-control tactics, particularly around prior authorization processes.

Investigative reporting from ProPublica and other outlets has highlighted how algorithms are being used to rapidly deny insurance claims or prior authorization requests, often with minimal human review. When executives from major health insurers like Cigna and UnitedHealth Group were pressed by the House Ways and Means Committee about using advanced technology to reject authorization requests, they either denied or avoided discussing the practice.

Cigna CEO David Cordani explicitly told lawmakers that AI is “never used for a denial,” despite the company facing lawsuits over its claims-denial methods. This contradiction between public statements and legal realities underscores the urgent need for transparency and accountability.

The Ethical Imperative for Regulation

Protecting Human Dignity in Healthcare Decisions

The fundamental question at stake transcends political affiliation or technological advancement: should algorithms have unchecked power over life-and-health decisions? As a society committed to human dignity and the right to quality healthcare, we must answer with a resounding no. The use of AI in health insurance represents not just a technological shift but a moral crisis that threatens to erode the physician-patient relationship and replace medical judgment with profit-driven algorithms.

Alex Bores, a computer scientist and New York Assembly member, perfectly captured the danger when he noted that “So many people already find the answers that they’re getting from their insurance companies to be inscrutable. Adding in a layer that cannot by its nature explain itself doesn’t seem like it’ll be helpful there.” This gets to the heart of the problem—the inherent opacity of AI systems that makes accountability impossible.

The False Choice Between Innovation and Protection

The insurance industry’s argument that regulation stifles innovation represents a false dichotomy that prioritizes corporate interests over human welfare. We can both embrace technological advancement and establish robust safeguards. The American Medical Association’s support for state regulations seeking “greater accountability and transparency” demonstrates that medical professionals understand this balance better than insurers apparently do.

John Whyte, the AMA’s CEO, highlighted the current reality: insurers already use AI while “doctors still face delayed patient care, opaque insurer decisions, inconsistent authorization rules, and crushing administrative work.” This suggests that the promised benefits of AI—efficiency, consistency, and reduced administrative burden—have not materialized for healthcare providers or patients.

The Constitutional and Federalism Questions

The Trump administration’s attempt to preempt state regulation through executive order raises serious constitutional concerns. As Harvard Law School’s Carmel Shachar noted, the source of preemption authority is generally Congress, not the executive branch. This overreach represents a dangerous expansion of presidential power that undermines our system of federalism and states’ traditional role in regulating insurance.

The administration’s threat to restrict federal funding for states enacting “excessive” regulation—with vague exceptions for policies protecting children—creates a chilling effect that could prevent necessary consumer protections. This approach prioritizes corporate freedom over state sovereignty and individual rights.

The Path Forward: Principles for Ethical AI in Healthcare

Transparency as a Non-Negotiable Requirement

Any use of AI in healthcare decisions must be subject to complete transparency. Patients and providers have the right to know when algorithms are being used, how they work, and what data informs their decisions. The current practice of insurers using black-box systems to make coverage determinations violates basic principles of fairness and accountability.

Human Oversight as a Fundamental Safeguard

While state legislation often requires human sign-off on AI decisions, as University of Minnesota law professor Daniel Schwarcz notes, most laws don’t specify what meaningful human review entails. We need clear standards that ensure humans aren’t merely rubber-stamping algorithmic decisions but are actively exercising independent judgment.

Federal-States Partnership, Not Preemption

Rather than attempting to stifle state innovation through preemption, the federal government should establish minimum standards while allowing states to enact stronger protections. This approach respects our constitutional framework while ensuring that all Americans benefit from basic safeguards against algorithmic abuse.

Patient-Centered Design

AI systems should be designed to serve patients, not insurance company profits. This means prioritizing patient outcomes over administrative convenience and ensuring that algorithms don’t systematically disadvantage vulnerable populations.

Conclusion: Reclaiming Healthcare for Humanity

The battle over AI in health insurance is about more than technology regulation—it’s about whether we will allow corporate interests to automate humanity out of healthcare decisions. The unusual political alliances forming around this issue demonstrate that protecting patients transcends partisan politics.

We stand at a crossroads where we must choose between a future where algorithms deny care based on opaque calculations and one where technology serves human needs under transparent, ethical guidelines. The states leading this regulatory effort deserve praise for recognizing that innovation without accountability isn’t progress—it’s predation.

As citizens committed to democracy, freedom, and human dignity, we must demand that our healthcare system prioritizes people over profits, transparency over obscurity, and human judgment over algorithmic efficiency. The right to quality healthcare is fundamental to life, liberty, and the pursuit of happiness—values worth protecting from unaccountable automation.