By: National Association of Insurance Commissioners and Wayne Turner
Executive Summary
A new report by the consumer representatives on the National Association of Insurance Commissioners examines the increasing use of AI by health insurers to make key payment decisions for care recommended by a patient’s medical team. The report highlights the lack of regulatory and legislative guardrails for such uses and outlines specific actions state regulators should take to protect patients from inappropriate or discriminatory denial of medically necessary care. It is particularly timely as President-elect Trump has pledged to roll back federal AI regulations, creating more urgency for state regulators to act swiftly to protect consumers.
While AI presents opportunities for plan efficiency, it also poses potential minefields for consumers. The speed of technological advances in AI is far outpacing the changes in state and federal health insurance regulation, and oversight is needed to protect consumers. Unregulated use of AI could also exacerbate existing bias and discrimination, particularly for disenfranchised communities who already experience disparate health care access challenges.
The report draws from a series of in-depth interviews with individuals representing the perspectives of health plans, state regulators, academia, consumer advocates, providers, and technical experts.
