Protecting Patients from Automated Denials Act

The proposed legislation amends the Social Security Act to regulate the use of artificial intelligence in prior authorization denials by Medicare Advantage organizations. As a condition of participation in a federal spending program, Congress possesses undoubted authority under the General Welfare Clause to prescribe the manner in which federal funds are disbursed and administered. The bill is a proper exercise of the spending power, as it ensures that the administration of Medicare—a program established for the general welfare—is conducted with due regard for accuracy and fairness. Moreover, …

The Constitution grants Congress only enumerated powers, and the regulation of artificial intelligence in prior authorization decisions for Medicare Advantage organizations is not among them. The proposed bill exceeds the limited scope of federal authority by intruding into a domain properly reserved to the states under the Tenth Amendment. Moreover, the Ninth Amendment reminds us that the people retain rights not explicitly listed, including the liberty to manage healthcare decisions without undue federal interference. Congress cannot derive such a power from the Spending Clause, as that woul…

The proposed bill seeks to regulate the use of artificial intelligence in Medicare Advantage prior authorization denials. Under the Constitution, Congress possesses the power to regulate commerce among the several states and to provide for the general welfare, which includes the authority to set conditions on federal spending programs such as Medicare. However, the Tenth Amendment reserves to the states or to the people all powers not delegated to the United States. If the bill imposes mandates that exceed the necessary and proper execution of the spending power, or if it intrudes upon areas t…

This bill falls within the constitutional authority of Congress under the Spending Clause and the Necessary and Proper Clause. Congress may condition the receipt of federal funds on compliance with reasonable regulations, and the regulation of artificial intelligence in prior authorization denials is a legitimate means to ensure the efficient and lawful administration of the Medicare Advantage program. The power to establish a program includes the power to set rules for its operation, as affirmed in McCulloch v. Maryland.