Speed, efficiency, and lower costs. Those are the traits artificial intelligence supporters celebrate. But the same qualities worry physicians who fear the technology could lead to insurance denials with humans left out of the loop.

With scant federal regulation, states are left to shape the rules on AI in health care. For residents in the Washington, D.C., metropolitan area, a divide is playing out on opposite sides of the Potomac River. Maryland and Virginia have taken very different approaches to regulating AI in health insurance.

Â鶹ŮÓÅ Health News correspondent Lauren Sausser joined WAMU’s Health Hub on April 15 to explain why where you live may determine how much of a role AI plays in your coverage.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Six months after a West Virginia man died following a protracted battle with his health insurer over doctor-recommended cancer care, the state’s Republican governor signed a bill intended to curb the harm of insurance denials.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.

“This legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill into law on March 31.

“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he said.

Delegate Laura Kimble, the Republican from Harrison County who introduced the legislation, told Â鶹ŮÓÅ Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

From Arizona to Rhode Island, at least half of all state legislatures have taken up bills this year related to prior authorization, a process that requires patients or their medical team to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country await relief from prior authorization hurdles, as promised by dozens of major health insurers in a pledge announced by the Trump administration last year.

The West Virginia law was inspired by Eric Tennant, a coal-mining safety instructor from Bridgeport who died on Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency of a $50,000 noninvasive cancer treatment, called histotripsy, that would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. His family didn’t expect the procedure to eradicate the cancer, but they hoped it would buy him more time and improve his quality of life. The insurer said the procedure wasn’t medically necessary and that it was considered “experimental and investigational.”

Becky Tennant, Eric’s widow, told members of a West Virginia House committee in late February that she submitted medical records, expert opinions, and data as part of several attempts to appeal the denial. She also reached out to “almost every one of our state representatives,” asking for help.

Nothing worked, she told lawmakers, until Â鶹ŮÓÅ Health News and NBC News got involved and posed questions to the Public Employees Insurance Agency about Eric’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

“But by then, the delay had already done its damage,” she said.

Within one week of the reversal in late May, Eric Tennant was hospitalized. His health continued to decline, and by midsummer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision did not simply delay care. It closed doors,” his wife said.

Had the new law been in effect, Kimble said, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill was passed unanimously by the state legislature in March.

U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, the health insurance industry trade group, says prior authorization acts as an important guardrail in preventing potential harm to patients and reducing unnecessary health care costs. But denials and delays tend to affect patients who need expensive, time-sensitive care, .

The practice has come under intense scrutiny in recent years, particularly after the in New York City in late 2024. Americans rank prior authorization as their biggest burden when it comes to getting health care, according to a by Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News.

Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law’s financial impact on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp said.

In a fiscal note attached to the bill, Jason Haught, the Public Employees Insurance Agency’s chief financial officer, said the law would cost the agency an estimated $13 million annually and “cause member disruption.”

West Virginia isn’t an outlier in targeting prior authorization. By late 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had some form of a prior authorization law — or laws — on the books, according to a by the National Association of Insurance Commissioners.

Many states have set up “gold carding” programs, which allow physicians with a track record of approvals to bypass prior authorization requirements. Some states establish a maximum number of days insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retrospective denials after a service has already been preauthorized. There are also a crop of new state laws seeking to regulate the use of artificial intelligence in prior authorization decision-making.

Meanwhile, prior authorization bills introduced this year across the country, including in Kentucky, Missouri, and New Jersey, have been supported by politicians from both parties.

“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. “They realize that they’re not really going to get much action at the federal level given the degree of gridlock we’ve already seen.”

Last summer, the Trump administration announced a pledge signed by dozens of health insurers vowing to reform prior authorization. The insurers promised to reduce the scope of claims that require preapproval, decrease wait times, and communicate with patients in clear language when denying a request.

Consumers, patient advocates, and medical providers that companies will follow through on their promises.

Becky Tennant is skeptical, too. That’s why she advocated for the West Virginia bill.

“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she told lawmakers. Tennant, who sees the bill’s passage as bittersweet, said she thought her husband would have been proud.

During Eric’s final hospital stay, Tennant recalled, right before he was discharged to home hospice care, she asked him whether he wanted her to keep fighting to change the state agency’s prior authorization process.

“‘Well, you need to at least try to change it,’” she recalled her husband saying. “‘Because it’s not fair.’”

“I told him I would keep trying,” she said, “at least for a while. And so I am keeping that promise to him.”

NBC News health and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report.

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Por eso, la joven de 31 años, de Henrico, Virginia, se quedó atónita cuando supo que Anthem finalmente tendría que pagar un tratamiento médico que le cambiaría la vida.

Durante dos años había luchado con la compañía para que cubriera infusiones de plasma sanguíneo llamadas inmunoglobulina intravenosa, o IVIG. En algunos casos, el tratamiento ha demostrado mejorar los síntomas asociados con la neuropatía de fibras pequeñas, una afección que hace que las extremidades de Ekirch se sientan como si estuvieran en llamas.

Pero Anthem había negado repetidamente la cobertura de IVIG, que cuesta alrededor de $10.000 por infusión. Luego, en febrero, una revisión externa de su caso realizada para la Oficina de Seguros de Virginia (Virginia Bureau of Insurance) revocó la negativa de Anthem.

Eso significaba que sus padres ya no tendrían que retirar dinero de los ahorros de jubilación de su padre para pagar el tratamiento de su propio bolsillo. Hasta entonces, ya habían gastado unos $90.000.

“Mi mamá estaba sollozando. Mi papá estaba de rodillas, llorando. No creo haberlo visto llorar así nunca”, dijo Ekirch al describir la reacción de sus padres ante la decisión.

“Creo que todavía estoy en shock por todo esto”, dijo.

En una declaración preparada, Stephanie DuBois, vocera de Anthem Blue Cross and Blue Shield, dijo que el tratamiento IVIG no “se ajustaba a nuestros estándares basados en evidencia”. Sin embargo, afirmó que la compañía respeta “la decisión del revisor externo” de revocar la negativa.

Mientras tanto, cada año millones de pacientes como Ekirch siguen enfrentando negativas a través del proceso de autorización previa, que exige que muchos pacientes o sus doctores obtengan aprobación anticipada de las aseguradoras antes de continuar con la atención médica.

Y a pesar de las promesas de reforma de las aseguradoras, las negativas siguen siendo una característica frustrante del sistema de salud.

En junio pasado, funcionarios de la administración Trump anunciaron en una conferencia de prensa que líderes de las aseguradoras de salud se habían comprometido a simplificar la autorización previa tomando medidas como que requieren aprobación anticipada. También prometieron tiempos de respuesta más rápidos y “explicaciones claras y fáciles de entender” sobre sus decisiones.

Sin embargo, en febrero, cuando Â鶹ŮÓÅ Health News contactó a más de una docena de grandes aseguradoras que firmaron el compromiso, la mitad de ellas no proporcionó detalles específicos sobre los servicios de salud para los cuales ya no exigen autorización previa.

Un indicó que la industria sigue comprometida con el esfuerzo. Pero doctores, consumidores y defensores de pacientes son pesimistas sobre la disposición de las aseguradoras a cumplir con estos cambios voluntarios.

“No tienen ningún deseo de hacer lo que es mejor para el paciente si eso va a afectar sus bolsillos”, dijo Matt Toresco, director ejecutivo de Archo Advocacy, una empresa de defensa y consultoría para pacientes.

“En el mundo de los seguros, la responsabilidad fiduciaria no es con el paciente”, dijo. “Es con Wall Street”.

¿Un cambio significativo?

El Departamento de Salud y Servicios Humanos de EE.UU. (HHS) no respondió a las preguntas para este artículo. Las pocas actualizaciones que el gobierno federal ha emitido desde junio sobre la reforma de la autorización previa incluyen un sobre garantizar que los médicos puedan enviar solicitudes de forma electrónica.

AHIP, el grupo comercial de aseguradoras de salud que publicó el comunicado de enero, no proporcionó información sobre tratamientos, códigos, medicamentos o procedimientos específicos que sus miembros hayan eliminado del requisito de autorización previa desde que firmaron el compromiso.

“Tendremos actualizaciones adicionales sobre el progreso más adelante esta primavera”, dijo Kelly Parsons, vocera de la Asociación Blue Cross Blue Shield, que representa a 33 compañías independientes de Blue Cross y Blue Shield. Tampoco ofreció detalles específicos.

Las compañías de Blue Cross y Blue Shield que cubren pacientes en Alabama, Arkansas, Iowa, Michigan, Pennsylvania, Carolina del Sur, Dakota del Sur y Tennessee no respondieron a las preguntas para este artículo o remitieron las consultas a la Asociación Blue Cross Blue Shield.

En contraste, otras aseguradoras sí citaron ejemplos específicos de cambios.

Aetna CVS Health comenzó a agrupar autorizaciones previas para procedimientos musculoesqueléticos, así como para pacientes con cáncer de pulmón, mama y próstata, dijo el vocero Phil Blando.

Esta práctica permite que los proveedores presenten una sola solicitud de autorización para el tratamiento de un paciente en lugar de varias.

Y Humana eliminó los requisitos de autorización previa para servicios de diagnóstico relacionados con colonoscopías, entre otros cambios, dijo el portavoz Mark Taylor.

UnitedHealthcare, que fue objeto de intenso escrutinio por su uso de la autorización previa tras de uno de sus ejecutivos a finales de 2024, eliminó el requisito de autorización previa el 1 de enero para ciertos estudios de imágenes nucleares, ultrasonidos obstétricos y procedimientos de ecocardiograma, entre otros cambios, dijo el vocero Matthew Rodriguez.

Aun así, algunos expertos del sistema de salud dudan que estos cambios tengan mucho impacto.

“Las aseguradoras han hecho promesas similares antes y no han cumplido con cambios significativos”, dijo Bobby Mukkamala, presidente de la Asociación Médica Estadounidense, que representa a doctores y estudiantes de medicina.

En 2018, , incluidos AHIP y la Asociación Blue Cross Blue Shield, anunciaron una alianza “para identificar oportunidades de mejorar el proceso de autorización previa”. Sin embargo, en respuesta al compromiso de junio que el proceso sigue siendo “costoso, ineficiente, poco transparente y, con demasiada frecuencia, peligroso para los pacientes”.

“La transparencia es esencial para que todos puedan ver si realmente se están produciendo reformas”, dijo a Â鶹ŮÓÅ Health News.

Entusiasmo moderado

La autorización previa puede estar recibiendo más atención política, pero los datos muestran que los pacientes —especialmente quienes tienen afecciones crónicas que requieren tratamiento continuo— siguen enfrentando obstáculos para recibir la atención recomendada por sus doctores.

Entre los pacientes de ese grupo, el 39 % dijo que la autorización previa es “la mayor carga” para recibir atención, según , una organización sin fines de lucro de información sobre salud que incluye a Â鶹ŮÓÅ Health News.

Eso es cierto para Payton Herres, 25 años, de Dayton, Ohio, quien en 2012 tuvo un trasplante de corazón, lo que requiere que tome un medicamento recetado contra el rechazo por el resto de su vida.

Pero el año pasado, dijo, Anthem negó la cobertura del costoso medicamento. Lo había estado tomando durante más de 10 años.

“He estado con Anthem toda mi vida y, de repente —no sé qué pasó— empezaron a negármelo una y otra vez”, dijo. “Casi me quedo sin medicamento”.

DuBois, la vocera de Anthem, confirmó que la compañía ha aprobado el medicamento. Cuando negó la cobertura, la empresa no había tomado en cuenta el historial de tratamiento de Herres, dijo DuBois.

Pero Herres dijo que la compañía le exigirá obtener una nueva autorización para el medicamento en septiembre.

“¿Van a negar otras cosas también?”, preguntó. “Espero no tener que seguir luchando así por el resto de mi vida”.

Anna Hocum, de 25 años, se prepara para una lucha similar. En 2024 y 2025, su aseguradora negó repetidamente la cobertura de un tratamiento costoso utilizado para ralentizar la progresión de una afección genética rara que destruye la función de sus pulmones.

“Simplemente pensé que iba a morir”, dijo Hocum, de Milwaukee. “Estaba luchando por sobrevivir y luego estaba luchando para convencer a alguien de que merecía sobrevivir”.

Al igual que con Ekirch, los padres de Hocum pagaron el tratamiento mientras esperaban que la compañía de seguros revocara las negativas iniciales. Amigos y familiares donaron más de $30.000 a través de una campaña en GoFundMe para ayudar a cubrir los costos.

Luego, la primavera pasada, Hocum dijo que su aseguradora revocó la negativa sin una explicación aparente. Pero la aprobación es válida solo por 12 meses, por lo que necesitará otra autorización previa este año.

“Da miedo”, dijo. “No está garantizado que lo acepten”.

Aunque ahora es “un enorme alivio” que Anthem esté obligada a cubrir el tratamiento de Ekirch, su madre no sabe si o cómo la familia recuperará el dinero que ya ha pagado.

En una carta a Ekirch confirmando la decisión del revisor externo, Anthem explicó que la autorización será válida por un año a partir del 25 de septiembre de 2025. “Nos complace poder ofrecer una respuesta favorable en este caso”, escribió un analista de quejas y apelaciones de Anthem.

Ekirch dijo que la carta resaltó la hipocresía de la compañía.

“Actúan como si fueran una organización benevolente que me está haciendo un favor”. En realidad, dijo, “pelearon conmigo con uñas y dientes en cada paso del camino, hasta el punto de que hicieron de mi vida un infierno”.

Ahora, el acceso de Ekirch a la IVIG podría volver a estar en peligro. Su cobertura COBRA a través de Anthem vence a finales de marzo. En abril tendrá que cambiar a un nuevo plan médico, y se está preparando para otra ronda de autorizaciones previas.

“Simplemente tengo mucho miedo de no tener la fuerza para pasar por todo lo que se necesita”, dijo Ekirch, “para luchar esta batalla otra vez”.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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That’s why Ekirch, 31, of Henrico, Virginia, was stunned when she learned Anthem would finally have to pay for life-changing medical treatment.

For two years, she had battled the company to cover blood plasma infusions called intravenous immunoglobulin, or IVIG. The treatment has been shown, in some cases, to improve symptoms associated with small-fiber neuropathy, a condition that makes Ekirch’s limbs feel like they’re on fire.

But Anthem had repeatedly denied coverage for IVIG, which costs about $10,000 per infusion. Then, in February, an external review of her case conducted for the Virginia Bureau of Insurance overturned Anthem’s denial. It meant her parents would no longer need to withdraw money from her father’s retirement savings to pay out-of-pocket. Already, they’d spent about $90,000.

“My mom was sobbing. My dad was on his knees, sobbing. I don’t think I’ve ever seen him cry like that,” said Ekirch, describing her parents’ reaction to the reversal.

“I think I’m in shock from it all,” she said.

In a prepared statement, Stephanie DuBois, a spokesperson for Anthem Blue Cross and Blue Shield, said IVIG did not “align with our evidence-based standards.” But she said the company respects “the external reviewer’s decision” to overturn the denial.

Meanwhile, each year millions of patients like Ekirch continue to face denials through the prior authorization process, which requires many patients or their doctors to seek preapproval from health insurers before proceeding with medical care. And despite promises of reform from insurance companies, denials remain a frustrating hallmark of the American health care system.

Last June, Trump administration officials announced in a press conference that health insurance leaders had pledged to simplify prior authorization by taking steps such as “” subject to preapproval. The insurers also promised faster turnaround times and “clear, easy-to-understand explanations” of their decisions.

Yet in February, when Â鶹ŮÓÅ Health News contacted more than a dozen major insurers that signed the pledge, half of them failed to provide specifics about health care services for which they no longer require prior authorization.

A said the industry remains committed to the effort. But physicians, consumers, and patient advocates are pessimistic about the insurers’ willingness to follow through with these voluntary changes.

“They have no desire to do what’s in the best interest of the patient if it’s going to hurt their pockets,” said Matt Toresco, CEO of Archo Advocacy, a patient advocacy and consulting company.

“In the insurance world, the fiduciary responsibility is not to the patient,” he said. “It’s to the Street,” he said, referring to Wall Street.

Meaningful Change?

The Department of Health and Human Services did not respond to questions for this article. The few updates the federal government has issued since June on prior authorization reform include a about ensuring clinicians can submit requests electronically.

AHIP, the health insurer trade group that issued the January press release, did not provide information about specific treatments, codes, medications, or procedures that its members have released from prior authorization since signing the pledge.

“We will have additional progress updates coming out later this spring,” said Kelly Parsons, a spokesperson for the Blue Cross Blue Shield Association, which represents 33 independent Blue Cross and Blue Shield companies. She also offered no specifics.

Blue Cross and Blue Shield companies that cover patients in Alabama, Arkansas, Iowa, Michigan, Pennsylvania, South Carolina, South Dakota, and Tennessee either did not respond to questions for this article or deferred to the Blue Cross Blue Shield Association.

By contrast, other insurers cited specific examples of change.

Aetna CVS Health began “bundling” prior authorizations for musculoskeletal procedures, as well as for lung, breast, and prostate cancer patients, spokesperson Phil Blando said. This practice allows providers to file one authorization request for a patient’s treatment instead of several.

And Humana removed prior authorization requirements for “diagnostic services across colonoscopies,” among other changes, spokesperson Mark Taylor said.

UnitedHealthcare, which came under intense scrutiny for its use of prior authorization following the of one of its executives in late 2024, removed prior authorization requirements on Jan. 1 for “certain nuclear imaging, obstetrical ultrasound and echocardiogram procedures,” among other changes, spokesperson Matthew Rodriguez said.

Yet some health care insiders doubt these changes will amount to much.

“Insurers have made similar promises before and failed to deliver meaningful change,” said Bobby Mukkamala, president of the American Medical Association, which represents U.S. physicians and medical students.

In 2018, , including AHIP and the Blue Cross Blue Shield Association, announced a partnership “to identify opportunities to improve the prior authorization process.” Yet, in response to the June pledge, the process remains “costly, inefficient, opaque, and too often hazardous for patients.”

“Transparency is essential so everyone can see whether real reforms are happening,” he told Â鶹ŮÓÅ Health News.

Curbed Enthusiasm

Prior authorization may be getting more political attention, but data shows patients — particularly those with chronic conditions that require ongoing medical treatment — continue to face barriers to doctor-recommended care.

Among patients in that group, 39% said prior authorization is “the single biggest burden” in receiving care, according to a by Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News.

I was fighting to survive, and then I was fighting to convince someone that I deserved to survive.

Anna Hocum

That’s true for Payton Herres, 25, of Dayton, Ohio, who in 2012 received a heart transplant, which requires her to take an antirejection prescription medication for the rest of her life.

But last year, she said, Anthem denied coverage for the expensive drug. She’d been taking it for more than 10 years.

“I’ve been with Anthem my entire life, and then, all of a sudden — I don’t know what happened — they just started denying me over and over,” she said. “I almost ran out of medication.”

DuBois, the Anthem spokesperson, confirmed the company has approved the medication. It had not taken Herres’ treatment history into account when it denied coverage for the drug, DuBois said.

But Herres said the company will require her to obtain a new authorization for the medication in September.

“Are they going to deny other things, too?” she asked. “I hope I don’t have to keep fighting like this for the rest of my life.”

Anna Hocum, 25, is preparing for a similar fight. In 2024 and 2025, her insurer repeatedly denied coverage for expensive treatment used to slow the progression of a rare genetic condition that destroys her lung function.

“I just thought I was going to die,” said Hocum, of Milwaukee. “I was fighting to survive, and then I was fighting to convince someone that I deserved to survive.”

Like with Ekirch, Hocum’s parents paid while they waited for her insurance company to overturn the initial denials. Friends and family donated more than $30,000 through a GoFundMe campaign to help defray the costs.

Then last spring, Hocum said, her insurer reversed the denial without an apparent explanation. But the approval is valid for only 12 months, so she will need another prior authorization approval this year.

“It is scary,” she said. “It’s not guaranteed that it’ll be accepted.”

They fought me tooth and nail every step of the way, to the point that they made my life a living hell.

Sheldon Ekirch

Even though it’s a “huge relief” that Anthem is now obligated to cover Ekirch’s treatment, her mother doesn’t know if or how the family will recoup the money it has already paid.

In a letter to Ekirch confirming the external reviewer’s decision, Anthem explained that the authorization would be valid for a year beginning on Sept. 25, 2025. “We are pleased we can provide a favorable response in this case,” a grievance and appeals analyst for Anthem wrote.

Ekirch said the letter highlighted the company’s hypocrisy.

“They act as though they are a benevolent organization doing me a favor.” In reality, she said, “they fought me tooth and nail every step of the way, to the point that they made my life a living hell.”

Now, Ekirch’s access to IVIG may be in jeopardy again. Her COBRA coverage through Anthem expires in late March. In April, she will need to transition to a new insurance plan — and she’s bracing herself for another round of prior authorization.

“I just am so afraid that I don’t have the strength to go through and do what it takes,” Ekirch said, “to fight this battle again.”

Do you have an experience with prior authorization you’d like to share? to tell Â鶹ŮÓÅ Health News your story.

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La regulación de la inteligencia artificial, en especial su uso por parte de las aseguradoras de salud, se está convirtiendo en un tema que divide políticamente y altera las líneas partidarias tradicionales.

Quienes la impulsan, con Trump a la cabeza, no solo quieren insertar la IA de lleno en el gobierno, como en el experimento de Medicare que la utiliza en las autorizaciones previas (el proceso para autorizar ciertos tratamientos y medicamentos), sino que además buscan frenar a los estados que pretenden poner reglas y límites. Una firmada en diciembre busca invalidar la mayoría de los esfuerzos de los estados para regularla, al plantear que existe “una carrera con adversarios por la supremacía” en una nueva “revolución tecnológica”.

“Para ganar, las empresas estadounidenses de IA deben tener la libertad de innovar sin regulaciones engorrosas”, dice la orden de Trump. “Pero la regulación estatal excesiva frustra este imperativo”.

En todo el país, los estados se están rebelando. Al menos cuatro —Arizona, Maryland, Nebraska y Texas— aprobaron el año pasado leyes que limitan el uso de la IA en los seguros de salud. Otros dos, Illinois y California, habían aprobado leyes similares el año anterior.

Los legisladores de Rhode Island se proponen intentarlo de nuevo este año, después de que durante 2025 no lograran sancionar un proyecto que exigía a los organismos reguladores que recopilaran datos sobre el uso de las tecnologías. El año pasado, en Carolina del Norte, una iniciativa que exige que las aseguradoras no utilicen la IA como única base para decidir la cobertura generó interés entre legisladores republicanos.

DeSantis, ex candidato presidencial del Partido Republicano, ha presentado una “Carta de Derechos de la IA”, incluyen restricciones a su uso en la tramitación de reclamos de seguros y el requisito de que un organismo regulador estatal inspeccione los algoritmos.

“Tenemos la responsabilidad de garantizar que las nuevas tecnologías se desarrollen de forma moral y ética, de modo que refuercen nuestros valores estadounidenses, no que los erosionen”, dijo DeSantis durante su discurso anual sobre la situación de su estado en enero.

Lista para regular

Las encuestas muestran que los estadounidenses desconfían de la IA. En , un relevamiento  de Fox News encontró que el 63% de los votantes se describen como “muy” o “extremadamente” preocupados por la inteligencia artificial. La preocupación es mayoritaria en todo el espectro político. Casi dos tercios de los demócratas y poco más de 3 de cada 5 republicanos dijeron tener reparos sobre la IA.

Las tácticas de las aseguradoras de salud para reducir costos también preocupan a la población. Una de Â鶹ŮÓÅ mostró un descontento generalizado en temas como la autorización previa.

En los últimos años, y han destacado el uso de algoritmos para rechazar rápidamente reclamos de seguros o solicitudes de autorización previa, al parecer con muy poca revisión por parte de un profesional de salud.

En enero, el Comité de Medios y Arbitrios de la Cámara de Representantes convocó a ejecutivos de Cigna, UnitedHealth Group y otras grandes aseguradoras para discutir preocupaciones sobre los altos costos de la atención médica.

Cuando se les preguntó directamente, los ejecutivos negaron o evitaron referirse al uso de la tecnología más avanzada para rechazar solicitudes de autorización o descartar reclamos.

La IA “nunca se utiliza para una denegación”, aseguró a los legisladores David Cordani, director ejecutivo de Cigna. Al igual que otras empresas del sector de seguros de salud, la compañía enfrenta demandas por sus métodos para rechazar reclamos, como destacó ProPublica. Justine Sessions, vocera de Cigna, dijo que el proceso de rechazo de reclamos de la empresa “no está impulsado por la IA”.

De hecho, las compañías insisten en presentar la IA como una herramienta de apoyo que no decide sola. Optum, parte del gigante de la salud UnitedHealth Group, anunció el 4 de febrero que implementaría autorización previa impulsada por tecnología, destacando que permitirá aprobaciones más rápidas.

“Estamos transformando el proceso de autorización previa para abordar los puntos de conflicto que genera”, dijo John Kontor, vicepresidente sénior de Optum, en un .

Aun así, Alex Bores, científico informático y miembro de la Asamblea de Nueva York, una figura clave en el debate legislativo del estado sobre la IA—que terminó en una ley integral para regular esta tecnología—, aseguró que la IA es un campo que, naturalmente, requiere regulación.

“Muchas personas consideran que las respuestas que reciben de sus aseguradoras son difíciles de entender”, dijo Bores, demócrata que compite por un escaño en el Congreso. “Agregar una tecnología que no puede explicar sus propias decisiones no ayudará a hacer las cosas más claras”.

Al menos una parte del ámbito de la salud —por ejemplo, muchos médicos— respalda a los legisladores y a quienes defienden las regulaciones.

La Asociación Médica Americana (AMA, por sus siglas en inglés) “apoya las regulaciones estatales que buscan más responsabilidad y transparencia de las aseguradoras comerciales que usan herramientas de IA y aprendizaje automático para revisar solicitudes de autorización previa”, dijo John Whyte, su director ejecutivo.

Whyte señaló que las aseguradoras ya utilizan IA y que “los médicos siguen enfrentando retrasos en la atención de los pacientes, decisiones poco claras de las aseguradoras, reglas de autorización inconsistentes y una carga administrativa abrumadora”.

Las aseguradoras responden

Con legislación aprobada o pendiente de aprobación en por lo menos nueve estados, aún no está claro el impacto real que tendrán esas leyes estatales, dijo Daniel Schwarcz, profesor de Derecho en la Universidad de Minnesota. Los estados no pueden regular los planes “autoasegurados”, que utilizan muchos empleadores; solo el gobierno federal tiene esa facultad.

Pero hay problemas más profundos, dijo Schwarcz: la mayoría de las leyes estatales que ha visto exigirían que un ser humano apruebe cualquier decisión propuesta por la IA, pero no especifican qué significa eso en la práctica.

Las leyes no ofrecen un marco claro para entender cuánta revisión es suficiente y, con el tiempo, los humanos tienden a volverse un poco descuidados y simplemente dan el visto bueno a cualquier sugerencia de una computadora, dijo.

Aun así, las aseguradoras ven esta ola de proyectos de ley como un problema.

“En términos generales, la carga regulatoria es real”, dijo Dan Jones, vicepresidente sénior de asuntos federales de la Alliance of Community Health Plans, un grupo comercial que representa a algunas aseguradoras de salud sin fines de lucro. Si las aseguradoras pasan mucho tiempo lidiando con un mosaico de leyes estatales y federales, agregó, eso significa que se dispondrá de “menos tiempo y recursos para enfocarnos en lo que se supone que debemos hacer: asegurarnos de que los pacientes tengan el acceso adecuado a la atención médica”.

Linda Ujifusa, senadora estatal demócrata en Rhode Island, dijo que las aseguradoras se opusieron el año pasado a un proyecto que presentó para restringir el uso de la IA en las denegaciones de cobertura. Fue aprobado en una cámara, pero en la otra no avanzó.

“Hay una oposición enorme” a cualquier intento de regular prácticas como la autorización previa, dijo, y también “una oposición enorme” a señalar a intermediarios —como las aseguradoras privadas o los administradores de beneficios farmacéuticos— “como parte del problema”.

En , AHIP, el principal grupo que representa a las aseguradoras, pidió “políticas equilibradas que promuevan la innovación y, al mismo tiempo, protejan a los pacientes”.

“Los planes de salud reconocen que la IA tiene el potencial de impulsar mejores resultados en la atención médica mejorando la experiencia del paciente, cerrando brechas en la atención, acelerando la innovación y reduciendo la carga administrativa y los costos para mejorar el enfoque en la atención al paciente”, dijo Chris Bond, portavoz de AHIP, a Â鶹ŮÓÅ Health News.

Y agregó que el sector necesita “un enfoque nacional coherente basado en un marco federal integral de políticas de IA”.

En busca de equilibrio

En California, Newsom ha promulgado algunas leyes que regulan la IA, incluida una que exige que las aseguradoras de salud garanticen que sus algoritmos se apliquen de manera justa y equitativa. Pero el gobernador demócrata ha vetado otras iniciativas con un enfoque más amplio, como un proyecto que imponía más requisitos sobre cómo debe funcionar la tecnología y que exigía revelar su uso a reguladores, médicos y pacientes cuando lo pidieran.

Según Chris Micheli, lobista de Sacramento, es probable que el gobernador quiera asegurarse de que el presupuesto estatal —que se mantiene fuerte gracias a las grandes ganancias de la Bolsa, especialmente de las empresas tecnológicas— no se resienta. Y para eso, dijo, hace falta equilibrio.

Newsom está tratando de “garantizar que ese flujo de dinero continúe y, al mismo tiempo, que haya algunas protecciones para los consumidores de California”, afirmó. Añadió que las aseguradoras consideran que ya están sujetas a una gran cantidad de regulaciones.

La administración Trump parece estar de acuerdo. La reciente orden ejecutiva del presidente propone demandar ante la Justicia y restringir ciertos fondos federales a cualquier estado que apruebe lo que caracteriza como una regulación estatal “excesiva”, con algunas excepciones, como las políticas destinadas a proteger a los niños.

Esa orden posiblemente sea inconstitucional, dijo Carmel Shachar, experta en políticas de salud de la Facultad de Derecho de Harvard. La autoridad para invalidar leyes estatales generalmente recae en el Congreso, explicó, y los legisladores federales consideraron en dos ocasiones, pero finalmente rechazaron, una disposición que prohibía a los estados regular la IA.

“Según nuestro conocimiento previo del federalismo y del equilibrio de poderes entre el Congreso y el Poder Ejecutivo, es muy probable que una impugnación tenga éxito”, dijo Shachar.

Algunos legisladores ven la orden de Trump con mucho escepticismo, y señalan que la administración ha eliminado controles y ha impedido que otros los establezcan, en un grado extremo.

“En este momento, no se trata de decidir si la regulación debe ser federal o estatal”, dijo Alex Bores. “La pregunta es si va a haber regulación a nivel estatal o directamente no va a haber ninguna”.

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Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic, and it’s scrambling traditional partisan lines.

Boosters, led by Trump, are not only pushing its integration into government, as in Medicare’s experiment using AI in prior authorization, but also trying to stop others from building curbs and guardrails. A December seeks to preempt most state efforts to govern AI, describing “a race with adversaries for supremacy” in a new “technological revolution.”

“To win, United States AI companies must be free to innovate without cumbersome regulation,” Trump’s order said. “But excessive State regulation thwarts this imperative.”

Across the nation, states are in revolt. At least four — Arizona, Maryland, Nebraska, and Texas — enacted legislation last year reining in the use of AI in health insurance. Two others, Illinois and California, enacted bills the year before.

Legislators in Rhode Island plan to try again this year after a bill requiring regulators to collect data on technology use failed to clear both chambers last year. A bill in North Carolina requiring insurers not to use AI as the sole basis of a coverage decision attracted significant interest from Republican legislators last year.

DeSantis, a former GOP presidential candidate, has rolled out an “AI Bill of Rights,” include restrictions on its use in processing insurance claims and a requirement allowing a state regulatory body to inspect algorithms.

“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,” DeSantis said during his State of the State address in January.

Ripe for Regulation

Polling shows Americans are skeptical of AI. A from Fox News found 63% of voters describe themselves as “very” or “extremely” concerned about artificial intelligence, including majorities across the political spectrum. Nearly two-thirds of Democrats and just over 3 in 5 Republicans said they had qualms about AI.

Health insurers’ tactics to hold down costs also trouble the public; from Â鶹ŮÓÅ found widespread discontent over issues like prior authorization. (Â鶹ŮÓÅ is a health information nonprofit that includes Â鶹ŮÓÅ Health News.) Reporting and in recent years has highlighted the use of algorithms to rapidly deny insurance claims or prior authorization requests, apparently with little review by a doctor.

Last month, the House Ways and Means Committee hauled in executives from Cigna, UnitedHealth Group, and other major health insurers to address concerns about affordability. When pressed, the executives either denied or avoided talking about using the most advanced technology to reject authorization requests or toss out claims.

AI is “never used for a denial,” Cigna CEO David Cordani told lawmakers. Like others in the health insurance industry, the company is being sued for its methods of denying claims, as spotlighted by ProPublica. Cigna spokesperson Justine Sessions said the company’s claims-denial process “is not powered by AI.”

Indeed, companies are at pains to frame AI as a loyal servant. Optum, part of health giant UnitedHealth Group, announced Feb. 4 that it was rolling out tech-powered prior authorization, with plenty of mentions of speedier approvals.

“We’re transforming the prior authorization process to address the friction it causes,” John Kontor, a senior vice president at Optum,

Still, Alex Bores, a computer scientist and New York Assembly member prominent in the state’s legislative debate over AI, which culminated in a comprehensive bill governing the technology, said AI is a natural field to regulate.

“So many people already find the answers that they’re getting from their insurance companies to be inscrutable,” said Bores, a Democrat who is running for Congress. “Adding in a layer that cannot by its nature explain itself doesn’t seem like it’ll be helpful there.”

At least some people in medicine — doctors, for example — are cheering legislators and regulators on. The American Medical Association “supports state regulations seeking greater accountability and transparency from commercial health insurers that use AI and machine learning tools to review prior authorization requests,” said John Whyte, the organization’s CEO.

Whyte said insurers already use AI and “doctors still face delayed patient care, opaque insurer decisions, inconsistent authorization rules, and crushing administrative work.”

Insurers Push Back

With legislation approved or pending in at least nine states, it’s unclear how much of an effect the state laws will have, said University of Minnesota law professor Daniel Schwarcz. States can’t regulate “self-insured” plans, which are used by many employers; only the federal government has that power.

But there are deeper issues, Schwarcz said: Most of the state legislation he’s seen would require a human to sign off on any decision proposed by AI but doesn’t specify what that means.

The laws don’t offer a clear framework for understanding how much review is enough, and over time humans tend to become a little lazy and simply sign off on any suggestions by a computer, he said.

Still, insurers view the spate of bills as a problem. “Broadly speaking, regulatory burden is real,” said Dan Jones, senior vice president for federal affairs at the Alliance of Community Health Plans, a trade group for some nonprofit health insurers. If insurers spend more time working through a patchwork of state and federal laws, he continued, that means “less time that can be spent and invested into what we’re intended to be doing, which is focusing on making sure that patients are getting the right access to care.”

Linda Ujifusa, a Democratic state senator in Rhode Island, said insurers came out last year against the bill she sponsored to restrict AI use in coverage denials. It passed in one chamber, though not the other.

“There’s tremendous opposition” to anything that regulates tactics such as prior authorization, she said, and “tremendous opposition” to identifying intermediaries such as private insurers or pharmacy benefit managers “as a problem.”

In a , AHIP, an insurer trade group, advocated for “balanced policies that promote innovation while protecting patients.”

“Health plans recognize that AI has the potential to drive better health care outcomes — enhancing patient experience, closing gaps in care, accelerating innovation, and reducing administrative burden and costs to improve the focus on patient care,” Chris Bond, an AHIP spokesperson, told Â鶹ŮÓÅ Health News. And, he continued, they need a “consistent, national approach anchored in a comprehensive federal AI policy framework.”

Seeking Balance

In California, Newsom has signed some laws regulating AI, including one requiring health insurers to ensure their algorithms are fairly and equitably applied. But the Democratic governor has vetoed others with a broader approach, such as a bill including more mandates about how the technology must work and requirements to disclose its use to regulators, clinicians, and patients upon request.

Chris Micheli, a Sacramento-based lobbyist, said the governor likely wants to ensure the state budget — consistently powered by outsize stock market gains, especially from tech companies — stays flush. That necessitates balance.

Newsom is trying to “ensure that financial spigot continues, and at the same time ensure that there are some protections for California consumers,” he said. He added insurers believe they’re subject to a welter of regulations already.

The Trump administration seems persuaded. The president’s recent executive order proposed to sue and restrict certain federal funding for any state that enacts what it characterized as “excessive” state regulation — with some exceptions, including for policies that protect children.

That order is possibly unconstitutional, said Carmel Shachar, a health policy scholar at Harvard Law School. The source of preemption authority is generally Congress, she said, and federal lawmakers twice took up, but ultimately declined to pass, a provision barring states from regulating AI.

“Based on our previous understanding of federalism and the balance of powers between Congress and the executive, a challenge here would be very likely to succeed,” Shachar said.

Some lawmakers view Trump’s order skeptically at best, noting the administration has been removing guardrails, and preventing others from erecting them, to an extreme degree.

“There isn’t really a question of, should it be federal or should it be state right now?” Bores said. “The question is, should it be state or not at all?”

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Now, though, it seems unlikely to become state law. In November, a vote to advance beyond a legislative subcommittee failed. Four out of six Republicans on the Senate Medical Affairs Committee subpanel refused to vote on the measure.

Republican state Sen. Jeff Zell said during a November subcommittee hearing that he wanted to help “move this pro-life football down the field and to save as many babies as we can.” Still, he could not support the bill as written.

“What I am interested in is speaking on behalf of the South Carolinian,” he said, “and they’re not interested in this bill right now or this issue right now.”

While that bill stalled, it signals that abortion will continue to loom large during 2026 legislative sessions. More than three years after the Supreme Court overturned Roe v. Wade, measures related to abortion have already been prefiled in several states, including Alabama, Arizona, Florida, Missouri, and Virginia.

Meanwhile, the South Carolina bill also exposed a rift among Republicans. Some GOP lawmakers are eager to appeal to their most conservative supporters by pursuing more restrictive abortion laws, despite the lack of support for such measures among most voters.

Until recently, the idea of charging women who obtain abortions with a crime was considered “politically toxic,” said Steven Greene, a political science professor at North Carolina State University.

Yet introduced “abortion as homicide” bills during 2024-2025 legislative sessions, many of which included the death penalty as a potential sentence, according to Dana Sussman, senior vice president of Pregnancy Justice, an organization that tracks the criminalization of pregnancy outcomes.

Even though none of those bills was signed into law, Sussman called this “a hugely alarming trend.”

“My fear is that one of these will end up passing,” she said.

Less than a month after the bill stalled in South Carolina, — which would create criminal penalties for “coercion to obtain an abortion” — was prefiled ahead of the Jan. 13 start of the state’s legislative session.

“The issue is not going away. It’s a moral issue,” said state Sen. Richard Cash, who introduced the abortion bill that stalled in the subcommittee. “How far we can go, and what successes we can have, remain to be seen.”

‘Wrongful Death’

Florida law already bans abortion after six weeks of pregnancy. But a Republican lawmaker introduced for the “wrongful death” of a fetus. If enacted, the measure will allow parents to sue for the death of an unborn child, making them eligible for compensation, including damages for mental pain and suffering.

The bill says neither the mother nor a medical provider giving “lawful” care could be sued. But anyone else deemed to have acted with “negligence,” including someone who helps procure abortion-inducing pills or a doctor who performs an abortion after six weeks, could be sued by one of the parents.

In Missouri, a constitutional amendment to legalize abortion passed in 2024 with 51.6% of the vote. In 2026, state lawmakers are asking voters to repeal the amendment they just passed. A new proposed amendment would effectively reinstate the state’s ban on most abortions, with new exceptions for cases of rape, incest, and medical emergencies.

“I think that’s a middle-of-the-road, common sense proposal that most Missourians will agree with,” said , a Republican state representative who to put the measure on the ballot.

Lewis said the 2024 amendment went too far in allowing a legal basis to challenge all of Missouri’s abortion restrictions, sometimes called “targeted regulation of abortion providers,” or TRAP, laws. Even before Missouri’s outright ban, the number of abortions recorded in the state had dropped from to .

Meanwhile, Lewis backed another proposed constitutional amendment that will appear on the 2026 ballot. That measure would make it harder for Missourians to amend the state constitution, by requiring any amendment to receive a majority of votes in each congressional district.

One analysis suggested as few as any ballot measure under the proposal. Lewis dismissed the analysis as a “Democratic talking point.”

‘Gerrymandered’ Districts

Republican lawmakers aren’t necessarily aiming to pass abortion laws that appeal to the broadest swath of voters in their states.

Polling conducted ahead of Missouri’s vote in 2024 showed 52% of the state’s likely voters supported the constitutional amendment to protect access to abortion, a narrow majority that was consistent with the final vote.

In Texas, state law offers no exceptions for abortion in cases of rape or incest, even though a 2025 survey found 83% of Texans believe the procedure should be legal under those conditions.

In South Carolina, a 2024 poll found only 31% of respondents supported the state’s existing six-week abortion ban, which prohibits the procedure in most cases after fetal cardiac activity can be detected.

But Republicans hold supermajorities in the South Carolina General Assembly, and some continue to push for a near-total abortion ban even though such a law would probably be broadly unpopular. That’s because district lines have been drawn in such a way that politicians are more likely to be ousted by a more conservative member of their own party in a primary than defeated by a Democrat in a general election, said Scott Huffmon, director of the Center for Public Opinion & Policy Research at Winthrop University.

The South Carolina legislature is “so gerrymandered that more than half of the seats in both chambers were uncontested in the last general election. Whoever wins the primary wins the seat,” Huffmon said. “The best way to win the primary — or, better yet, prevent a primary challenge at all — is to run to the far right and embrace the policies of the most conservative people in the district.”

That’s what some proposals, including the “abortion as homicide” bills, reflect, said Greene, the North Carolina State professor. Lawmakers could vote for such a measure and suffer “very minimal, if any,” political backlash, he said.

“Most of the politicians passing these laws are more concerned with making the base happy than with actually dramatically reducing the number of abortions that take place within their jurisdiction,” Greene said.

Yet the number of abortions performed in South Carolina has dropped dramatically — by 63% from 2023 to 2024, when the state enacted the existing ban, according to data published by the state’s Department of Public Health.

Kimya Forouzan, a policy adviser with the Guttmacher Institute, which tracks abortion legislation throughout the country and advocates for reproductive rights, said South Carolina’s attempt to pass “the most extreme bill that we have seen” is “part of a pattern.”

“I think the push for anti-abortion legislation exists throughout the country,” she said. “There are a lot of battles that are brewing.”

Â鶹ŮÓÅ Health News correspondent Daniel Chang and Southern bureau chief Sabriya Rice contributed to this report.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Spartanburg County, in South Carolina’s Upstate region, has been fighting a measles outbreak since early October, with more than 50 cases identified. Health officials have encouraged people who are unvaccinated to get a shot by visiting its mobile vaccine clinic at any of its several stops throughout the county.

But on a Monday afternoon in Boiling Springs, only one person showed up.

“It’s progress. That progress is slow,” Linda Bell, the state epidemiologist with the Department of Public Health, said during a recent press briefing. “We had hoped to see a more robust uptake than that in our mobile health units.”

As South Carolina tries to contain its measles outbreak, public health officials across the nation are concerned that the highly contagious virus is making a major comeback. The Centers for Disease Control and Prevention has tallied and 45 outbreaks in 2025. The largest started in Texas, where hundreds of people were infected and two children died.

For the first time in more than two decades, the United States is poised to lose its measles , a designation indicating that outbreaks are rare and rapidly contained.

South Carolina’s measles outbreak isn’t yet as large as those in other states, such as ,Ìý, and . But it shows how a confluence of larger national trends — including historically low vaccination rates, skepticism fueled by the pandemic, misinformation, and “health freedom” ideologies proliferated by conservative politicians — have put some communities at risk for the reemergence of a preventable, potentially deadly virus.

“Everyone talks about it being the canary in the coal mine because it’s the most contagious infectious disease out there,” said Josh Michaud, associate director for global and public health policy at Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News. “The logic is indisputable that we’re likely to see more outbreaks.”

Schools and ‘Small Brush Fires’

Spartanburg’s vaccination rate is among the lowest of South Carolina’s 46 counties. And that was true “even before covid,” said Chris Lombardozzi, a senior vice president with the Spartanburg Regional Healthcare System.

Nearly 6,000 children in Spartanburg County schools last year — 10% of the total enrollment — either received an exemption allowing them to forgo required vaccinations or did not meet vaccine requirements, according to data published by the state.

Lombardozzi said the county’s low vaccination rate is tied to misinformation not only published on social media but also spread by “a variety of nonmedical leaders over the years.”

The pandemic made things worse. Michaud said that fear and misinformation surrounding covid vaccines “threw gasoline on the fire of people’s vaccine skepticism.” In some cases, that skepticism transferred to childhood vaccines, which historically have been less controversial, he said.

This made communities like Spartanburg County with low vaccination rates more vulnerable. “Which is why we’re seeing constant, small brush fires of measles outbreaks,” Michaud said.

In Spartanburg, the overall percentage of students with required immunizations fell from 95.1% to 90% between the 2020-21 and 2024-25 academic years. Public health officials say a minimum of 95% is required to prevent significant spread of measles.

Children who attend public and private schools in South Carolina are required to show that they’ve received some vaccinations, including the measles, mumps, and rubella vaccine, but religious exemptions are relatively easy to obtain. The exemption form must be notarized, but it does not require a doctor’s note or any disclosure about the family’s religious beliefs.

The number of students in South Carolina who have been granted religious exemptions has increased dramatically over the past decade. That’s particularly true in the Upstate region, where religious exemptions have increased sixfold from a decade ago. During the 2013-14 school year, 2,044 students in the Upstate were granted a religious exemption to the vaccine requirements, according to . By fall 2024, that number had jumped to more than 13,000.

Some schools are more exposed than others. The beginning of the South Carolina outbreak was largely linked to one public charter school, Global Academy of South Carolina, where only 17% of the 605 students enrolled during the 2024-25 school year provided documentation showing they had received their required vaccinations, according to data published by the Department of Public Health.

No one from Global Academy responded to interview requests.

‘Health Freedom’

In April, after visiting a Texas family whose daughter had died from measles, Health and Human Services Secretary Robert F. Kennedy Jr. wrote on social media that the “most effective way to prevent the spread of measles is the MMR vaccine.” He made a similar statement during an interview on “Dr. Phil” later that month.

But these endorsements stand at odds with other statements Kennedy has made that cast doubt on vaccine safety and have falsely linked vaccines with autism. The CDC, under his authority, now claims such links “have been ignored by health authorities.”

“What would I do if I could go back in time and I could avoid giving my children the vaccines that I gave them?” he said on a podcast in 2020. “I would do anything for that. I would pay anything to be able to do that.”

Throughout 2025, he has made other . During a congressional hearing in September, Kennedy defended his past claims that he was not anti-vaccine but affirmed his stated position that no vaccines are safe or effective.

Emily Hilliard, a spokesperson for the Department of Health and Human Services, told Â鶹ŮÓÅ Health News that Kennedy is “pro-safety, pro-transparency, and pro-accountability.” Hilliard said HHS is working with “state and local partners in South Carolina” and in other states to provide support during the measles outbreaks.

Meanwhile, Kennedy has frequently championed the idea of health freedom, or freedom of choice, regarding vaccines, a talking point that has taken root among Republicans.

That has had a “chilling effect all the way down through state and local lawmakers,” Michaud said, making some leaders hesitant to talk about the threat that the ongoing measles outbreaks poses or the effectiveness and safety of the MMR vaccine.

Brandon Charochak, a spokesperson for South Carolina Gov. Henry McMaster, said the governor was not available to be interviewed for this article but referenced McMaster’s comment from October that measles “is a dangerous disease, but in terms of diseases, it’s not one that we should panic about.”

On a separate occasion that month, the Republican governor said he does not support vaccine mandates. “We’re not going to have mandates,” he said, “and I think we are responding properly.”

Even though the South Carolina Department of Public Health has repeatedly encouraged measles vaccines, the push has been notably quieter than the agency’s covid vaccine outreach efforts.

In 2021, for example, the agency partnered with breweries throughout the state for a campaign called “Shot and a Chaser,” which rewarded people who got a covid vaccine with a free beer or soda. By contrast, the pop-up measles vaccine clinic at the Boiling Springs Library featured no flashy signage, no freebies, and wasn’t visible from the library’s main entrance.

Edward Simmer, interim director of the Department of Public Health, would not speak to Â鶹ŮÓÅ Health News about the measles outbreak. During a legislative hearing in April, Republican state lawmakers voted against his permanent confirmation because of his past support for covid vaccines and masking. One lawmaker specifically criticized the agency during that hearing for the Shot and a Chaser campaign.

Public health officials in other states also have been blocked from new roles because of their covid response. In Missouri, where among kindergartners since 2020 and measles cases have been reported this year, Republican lawmakers in 2022 after vaccine opponents protested his appointment.

In South Carolina, Simmer, lacking lawmakers’ confirmation, leads the public health agency in an interim capacity.

South Carolina Sen. Tom Davis of Beaufort was the only Republican on the Senate Medical Affairs Committee who voted to confirm Simmer in April. He told Â鶹ŮÓÅ Health News that his Republican colleagues raised valid questions about Simmer’s past support for covid vaccines.

But, Davis said, it would be “tremendously unfortunate and not beneficial from a public health perspective” if the Republican Party just took a stance against vaccines “as a matter of policy.”

The Department of Public Health had administered 44 doses of the MMR vaccine through its mobile health unit from October to mid-November. The last mobile vaccine clinic was scheduled for Nov. 24. But health officials are encouraged that patients are seeking vaccines elsewhere. The agency’s tracking system shows that providers across Spartanburg County administered more than twice as many measles vaccines in October as they did a year ago.

As of mid-November, more than 130 people remained in quarantine, most of them students at local elementary and middle schools. Cases have also been linked to a church and Greenville-Spartanburg International Airport.

“We’re reminding people that travel for the upcoming holidays increases the risk of exposures greatly,” said Bell, the state epidemiologist. “Due to that risk, we’re encouraging people to consider getting vaccinated now.”

Â鶹ŮÓÅ Health News correspondent Amy Maxmen contributed to this report.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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“It’s good to be home,” he said after one hospital stay in early June, “yet I’m tired and ready to get on with things.”

In 2023, Tennant, of Bridgeport, West Virginia, was diagnosed with cholangiocarcinoma, a rare cancer of the bile ducts that had spread throughout his body.

None of the initial treatments prescribed by his doctors had eradicated the cancer. But a glimmer of hope came in early 2025, when Tennant was recommended for histotripsy, a relatively new procedure that would use ultrasound waves to target, and potentially destroy, the largest tumor in his body — in his liver.

“My dad was a little nervous because it was something new, but it definitely gave us some hope that he would be around a little bit longer,” said Tennant’s daughter, Amiya.

There was just one hitch: His insurer wouldn’t pay for it.

Tennant, 58, died of cancer on Sept. 17. His story illustrates how a bureaucratic process called prior authorization can devastate patients and their families.

It’s infeasible to count the people harmed by this , which, by delaying or denying care, helps drive health insurers’ profits. No government agency or private group tracks such data.

That said, Â鶹ŮÓÅ Health News has heard from hundreds of patients in recent years who claim that they or someone in their family has been harmed by prior authorization. More than 1 in 4 physicians in December said that prior authorization had led to a serious adverse event for a patient in their care. And 8% responded that prior authorization led to a disability, birth defect, or death.

In June, the Trump administration announced a pledge, signed by dozens of private insurers, to streamline prior authorization, which often requires patients or their medical teams to ask insurers for permission before proceeding with many types of care. It remains unclear when patients can expect to see improvement.

The commitments “depend on the full cooperation of the private insurance sector” and will “take time to achieve their full effect,” said Andrew Nixon, a spokesperson for the Department of Health and Human Services. But the pledge exists, he said, “to prevent tragic deaths like Eric’s from occurring at the hands of an inefficient system.”

Chris Bond, a spokesperson for AHIP, a health insurance industry trade group, said he could not speak to any specific insurer’s prior authorization policies. Broadly, though, he said prior authorization “acts as a guardrail” to make sure medicines and treatments are not used inappropriately.

At the same time, he said, insurers recognize that patients can be frustrated when their doctor-recommended care is denied. That’s why “there is a dedicated effort across the industry to make the process more straightforward, faster, and simpler for patients and providers,” Bond said.

In the meantime, the process continues to take its toll on people like Eric Tennant, whose grave diagnoses often require expensive health care services.

“Eric is gone,” his widow, Becky, said. “He’s not coming back.”

Tennant was a safety instructor for the West Virginia Office of Miners’ Health Safety and Training and insured by the state’s Public Employees Insurance Agency, which contracts with UnitedHealthcare to administer benefits for state employees, their spouses, and dependents.

In February and March, UnitedHealthcare, the Public Employees Insurance Agency, and an outside reviewer issued a series of denials that concluded Eric’s benefits would not cover histotripsy, claiming the treatment was not medically necessary. Becky Tennant estimated the procedure would cost the family about $50,000 out-of-pocket.

Although the treatment wasn’t guaranteed to work, it was worth a shot, the Tennants thought, so they considered withdrawing money from their retirement savings. But then, in May, after Â鶹ŮÓÅ Health News and NBC News posed a series of questions to UnitedHealthcare and the Public Employees Insurance Agency about Eric’s case, the agency reversed course. PEIA decided to cover his treatment.

Notably, the agency contacted Â鶹ŮÓÅ Health News about the approval hours before it notified the Tennant family of the decision.

But the approval came too late. Eric was hospitalized in late May and prescribed medication that prevented him from undergoing histotripsy at that time. His family held out hope that his health would improve and he would qualify for the procedure that summer.

In July, they took a family vacation to Marco Island, Florida. It would be their last. Two days after they returned home, a scan revealed Eric’s cancer had continued to spread. Histotripsy was out of the question.

“I’m sad for what we will miss out on,” Becky said. “I’m sad at the unfairness of it.”

She said if Eric had been able to undergo histotripsy in February, as originally recommended by his doctor, it might have destroyed the tumor in his liver that ultimately killed him.

“We’ll never know. That’s the thing. Any lawyer for the insurance will say, ‘Well, you don’t know it would have helped.’ No. You took that chance away from us,” she said.

In October, Samantha Knapp, a spokesperson for the West Virginia Department of Administration, told Â鶹ŮÓÅ Health News that the Public Employees Insurance Agency has not changed its policies related to prior authorization for histotripsy and continues to follow UnitedHealthcare’s guidelines.

UnitedHealthcare declined to answer questions for this article.

On Sept. 17, in a hospice bed set up in their dining room, Eric was surrounded by his family and their dogs as he died. Becky held his hand as his heart rate began to drop.

“He wasn’t afraid to die, but he didn’t want to die,” she said. “And you could tell the last day that he was fighting it big time.”

At the very end, she whispered in his ear: “You know I love you. You have been the best husband and the best dad, and you’ve always taken such good care of us,” Becky recalled.

And then, she said, he gasped. His eyebrows seemed to shoot up in wonder. During his last moment alive, she said, he smiled.

“The look on his face was pure, total amazement,” she said. “I still can’t believe he’s not here.”

Do you have an experience with prior authorization you’d like to share? to tell Â鶹ŮÓÅ Health News your story.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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No notó al diminuto insecto hasta el lunes, cuando empezó a sentir dolor en el músculo de la pantorrilla. Esa misma mañana, hizo una cita virtual con una doctora —recomendada por su plan de salud—, quien le recetó un tratamiento de 10 días con doxiciclina para prevenir la enfermedad de Lyme, y le insistió en que también fuera a una consulta en persona. Así que, más tarde ese mismo día, fue, sin cita previa, a una clínica cerca de su casa en Brunswick, Maine, donde la evaluaron y le recetaron una dosis más alta, única, del mismo medicamento.

Fue una buena decisión porque el personal de la clínica encontró otra garrapata en el cuerpo de Leah durante esa visita. Además, después de enviar uno de los insectos a un laboratorio para su análisis, el resultado de la prueba fue positivo para Lyme.

“Pude haberme enfermado seriamente”, dijo Kovitch.

Pero la aseguradora de Kovitch rechazó cubrir la visita a la clínica. ¿La razón? No había obtenido una derivación de su médico para ver un especialista ni autorización previa. “Su plan no cubre este tipo de atención, por lo tanto, rechazamos este cargo”, explicaba un documento.

Las aseguradoras de salud han argumentado durante años que la autorización previa ayuda a reducir el fraude, los gastos innecesarios y a proteger a los pacientes. Y si bien estos rechazos suelen asociarse con tratamientos costosos, como los del cáncer, la diminuta picadura de una garrapata que sufrió Kovitch muestra cómo las compañías también utilizan esta política para evitar pagar por servicios de todo tipo, incluso cuando son considerados económicos y médicamente necesarios.

Promesas de cambio

El gobierno del presidente Donald Trump anunció este verano que docenas de aseguradoras privadas de salud aceptaron realizar cambios significativos en el proceso de autorización previa.

La promesa incluye eliminar por completo el requisito de autorización para ciertos servicios médicos. También se acordó otorgar un período de gracia a pacientes que cambian de plan médico, para que no enfrenten nuevas reglas que interrumpan sus tratamientos en curso.

Mehmet Oz, administrador de los Centros de Servicios de Medicare y Medicaid (CMS), anunció en una conferencia de prensa en junio que algunos de los cambios entrarían en vigencia en enero.

Pero, hasta ahora, el gobierno federal ha ofrecido pocos detalles sobre cuáles de los códigos de diagnóstico —utilizados para fines de facturación médica— quedarán exentos de autorización previa, o cómo hará que las aseguradoras privadas cumplan las nuevas reglas. No está claro si casos como el de Kovitch, relacionados con la enfermedad de Lyme, estarían exentos.

Chris Bond, vocero de AHIP, el principal grupo comercial de la industria de seguros médicos, confirmó que las aseguradoras se comprometieron a implementar algunos de los cambios para el 1 de enero. tomarán más tiempo. Por ejemplo, las compañías acordaron responder al 80% de las solicitudes de autorización en “tiempo real”, pero eso no ocurrirá sino hasta 2027.

Andrew Nixon, vocero del Departamento de Salud y Servicios Humanos de Estados Unidos (HHS), explicó a Â鶹ŮÓÅ Health News que los cambios prometidos por las aseguradoras buscan “reducir la burocracia, acelerar las decisiones de atención médica y fomentar la transparencia”, aunque advirtió que requerirán tiempo para lograr un impacto completo.

Mientras tanto, algunos expertos en políticas de salud se muestran escépticos sobre si las compañías realmente cumplirán con lo prometido. No es la primera vez que las grandes aseguradoras anuncian una reforma del proceso de autorización previa.

, presidente de la American Medical Association (AMA), escribió que las promesas hechas por las aseguradoras en junio son “casi idénticas” a las que la industria del seguro hizo .

“Creo que esto es una estafa”, opinó Neal Shah, autor del libro (“Asegurados hasta la muerte: cómo el seguro de salud perjudica a los estadounidenses y cómo podemos recuperarlo”).

Según Shah, las aseguradoras firmaron el acuerdo impulsadas por la presión pública. La indignación colectiva contra las compañías aseguradoras aumentó tras la muerte del director ejecutivo de United Healthcare, Brian Thompson, en diciembre. Oz indicó que el compromiso de las aseguradoras fue una respuesta a la “violencia en las calles”.

“Cada vez rechazan más reclamos”, dijo Shah, que es uno de los fundadores de , una compañía que usa inteligencia artificial para ayudar a los pacientes a apelar las negativas del seguro. “Nadie se hace responsable.”

Resolver el caso

La factura que Kovitch recibió por su cita en la clínica fue de $238 y tuvo que pagarla de su bolsillo luego de enterarse de que su aseguradora, Anthem, no cubriría ni un centavo. Primero intentó apelar la decisión. Incluso consiguió una remisión retroactiva de su doctora de atención primaria, que respaldaba la necesidad de la visita.

No funcionó. Anthem volvió a negar la cobertura. Kovitch dijo que cuando llamó para averiguar la razón, la representante con la que habló no supo explicarle.

“Era como si no lo entendieran”, explicó Kovitch. “Todo lo que repetían, una y otra vez, era que no tenía autorización previa”.

Después, Jim Turner, vocero de Anthem, atribuyó el rechazo de la aseguradora a un “error de facturación” cometido por Maine Health, el sistema de salud que opera la clínica donde Kovitch fue atendida. Según Turner, el error provocó que el reclamo se procesara como si fuera una visita a un especialista, en lugar de una visita de atención sin cita previa o de urgencia.

Turner no proporcionó documentación que mostrara cómo ocurrió el error. Los registros médicos que Kovitch entregó muestran que Maine Health codificó su visita como “mordida de garrapata en la parte inferior izquierda de la pierna, primer encuentro”, y no queda claro por qué Anthem la interpretó como una visita a un especialista.

Después de que Â鶹ŮÓÅ Health News contactara a Anthem para preguntar sobre la factura de Kovitch, Turner dijo que la compañía “debió haber identificado el error de facturación antes, en el proceso, y pedimos disculpas por los inconvenientes que esto le causó a la señora Kovitch”.

Caroline Cornish, vocera de Maine Health, dijo que no es la primera vez que Anthem niega cobertura a pacientes que llegan sin cita previa. Señaló que las reglas de procesamiento de Anthem a veces se aplican de forma incorrecta a este tipo de visitas, lo que lleva a “rechazos inapropiados”.

Afirmó que estas visitas no deberían requerir autorización previa y que el caso de Kovitch ilustra cómo las aseguradoras suelen utilizar los rechazos administrativos como respuesta inicial.

“Maine Health considera que las aseguradoras deberían enfocarse en pagar la atención que sus afiliados necesitan, en lugar de crear obstáculos que retrasan la cobertura y pueden desalentar a los pacientes a buscar atención”, dijo. “El sistema, con demasiada frecuencia, está en contra de las personas a las que se supone que debe servir”, agregó.

Finalmente, en octubre, Anthem le envió a Kovitch una actualización de su resumen de beneficios, en la que se indicaba que una combinación de pagos de la aseguradora y descuentos cubriría el costo total de la consulta. Kovitch contó que una representante de la empresa la llamó para disculparse. A principios de noviembre, recibió el reembolso de los $238.

Pero hace poco se enteró de que, según nuevas reglas establecidas por Anthem, su cita anual con el oftalmólogo ahora requiere una derivación de su doctora de atención primaria.

“Esto sigue igual”, dijo. “Pero ahora conozco mejor cómo actúan”.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).