Vince Lahey of Carefree, Arizona, embraces chatbots. From Big Tech products to “shady” ones, they offer “someone that I could share more secrets with than my therapist.”

He especially likes the apps for feedback and support, even though sometimes they berate him or lead him to fight with his ex-wife. “I feel more inclined to share more,” Lahey said. “I don’t care about their perception of me.”

There are a lot of people like Lahey.

Demand for mental health care has grown. Self-reported poor mental health days rose by 25% since the 1990s, analyzing survey data. According to the Centers for Disease Control and Prevention, suicide rates in 2022 that hadn’t been seen in nearly 80 years.

There are many patients who find a nonhuman therapist, powered by artificial intelligence, highly appealing — more appealing than a human with a reclining couch and stern manner. with begging for a therapist who’s “not on the clock,” who’s less judgmental, or who’s just less expensive.

Most people who need care don’t get it, said Tom Insel, former head of the National Institute of Mental Health, citing his former agency’s research. Of those who do, 40% receive “minimally acceptable care.”

“There’s a massive need for high-quality therapy,” he said. “We’re in a world in which the status quo is really crappy, to use a scientific term.”

Insel said engineers from OpenAI told him last fall that about 5% to 10% of the company’s then-roughly 800 million-strong user base rely on ChatGPT for mental health support.

Polling suggests these AI chatbots may be even more popular among young adults. A KFF poll found about 3 in 10 respondents ages 18 to 29 for mental or emotional health advice in the past year. Uninsured adults were about twice as likely as insured adults to report using AI tools. And nearly 60% of adult respondents who used a chatbot for mental health didn’t follow up with a flesh-and-blood professional.

The App Will Put You on the Couch

A burgeoning industry of apps offers AI therapists with human-like, often unrealistically attractive avatars serving as a sounding board for those experiencing anxiety, depression, and other conditions.

Ñî¹óåú´«Ã½Ò•îl Health News identified some 45 AI therapy apps in Apple’s App Store in March. While many charge steep prices for their services — one listed an annual plan for $690 — they’re still generally cheaper than talk therapy, which can cost hundreds of dollars an hour without insurance coverage.

On the App Store, “therapy” is often used as a marketing term, with small print noting the apps cannot diagnose or treat disease. One app, branded as OhSofia! AI Therapy Chat, had downloads in the six figures, said OhSofia! founder Anton Ilin in December.

“People are looking for therapy,” Ilin said. On one hand, the product’s name ; on the other, it warns in that it “does not provide medical advice, diagnosis, treatment, or crisis intervention and is not a substitute for professional healthcare services.” Executives don’t think that’s confusing, since there are disclaimers in the app.

The apps promise big results without backup. its users “immediate help during panic attacks.” it was “proven effective by researchers” and that it offers 2.3 times faster relief for anxiety and stress. (It doesn’t say what it’s faster than.)

There are few legislative or regulatory guardrails around how developers refer to their products — or even whether the products are safe or effective, said Vaile Wright, senior director of the office of health care innovation at the American Psychological Association. Even federal patient privacy protections don’t apply, she said.

“Therapy is not a legally protected term,” Wright said. “So, basically, anybody can say that they give therapy.”

Many of the apps “overrepresent themselves,” said John Torous, a psychiatrist and clinical informaticist at Beth Israel Deaconess Medical Center. “Deceiving people that they have received treatment when they really have not has many negative consequences,” including delaying actual care, he said.

States such as Nevada, Illinois, and California are trying to sort out the regulatory disarray, enacting laws forbidding apps from describing their chatbots as AI therapists.

“It’s a profession. People go to school. They get licensed to do it,” said Jovan Jackson, a Nevada legislator, who co-authored an enacted bill banning apps from referring to themselves as mental health professionals.

Underlying the hype, outside researchers and company representatives themselves have told the FDA and Congress that there’s little evidence supporting the efficacy of these products. What studies there are — and some companion-focused chatbots are “consistently poor” at managing crises.

“When it comes to chatbots, we don’t have any good evidence it works,” said Charlotte Blease, a professor at Sweden’s Uppsala University who specializes in trial design for digital health products.

The lack of “good quality” clinical trials stems from the FDA’s failure to provide recommendations about how to test the products, she said. “FDA is offering no rigorous advice on what the standards should be.”

Department of Health and Human Services spokesperson Emily Hilliard said, in response, that “patient safety is the FDA’s highest priority” and that AI-based products are subject to agency regulations requiring the demonstration of “reasonable assurance of safety and effectiveness before they can be marketed in the U.S.”

The Silver-Tongued Apps

Preston Roche, a psychiatry resident who’s , gets lots of questions about whether AI is a good therapist. After trying ChatGPT himself, he said he was “impressed” initially that it was able to use techniques to help him put negative thoughts “on trial.”

But Roche said after seeing posts on social media discussing people developing psychosis or being encouraged to make harmful decisions, he became disillusioned. The bots, he concluded, are sycophantic.

“When I look globally at the responsibilities of a therapist, it just completely fell on its face,” he said.

This sycophancy — the tendency of apps based on large language models to empathize, flatter, or delude their human conversation partner — is inherent to the app design, experts in digital health say.

“The models were developed to answer a question or prompt that you ask and to give you what you’re looking for,” said Insel, the former NIMH director, “and they’re really good at basically affirming what you feel and providing psychological support, like a good friend.”

That’s not what a good therapist does, though. “The point of psychotherapy is mostly to make you address the things that you have been avoiding,” he said.

While polling suggests many users are satisfied with what they’re getting out of ChatGPT and other apps, there have been about the service or encouragement to self-harm.

And or have been filed against OpenAI after ChatGPT users died by suicide or became hospitalized. In most of those cases, the plaintiffs allege they began using the apps for one purpose — like schoolwork — before confiding in them. These cases are being .

Google and the startup Character.ai — which has been funded by Google and has created “avatars” that adopt specific personas, like athletes, celebrities, study buddies, or therapists — are settling other wrongful-death lawsuits, .

OpenAI’s CEO, Sam Altman, has said up to may talk about suicide on ChatGPT.

“We have seen a problem where people that are in fragile psychiatric situations using a model like 4o can get into a worse one,” Altman said in a public question-and-answer session reported by , referring to a particular model of ChatGPT introduced in 2024. “I don’t think this is the last time we’ll face challenges like this with a model.”

An OpenAI spokesperson did not respond to requests for comment.

The company has said it on safeguards, such as referring users to 988, the national suicide hotline. However, the lawsuits against OpenAI argue existing safeguards aren’t good enough, and some research shows the problems are . OpenAI its own data suggesting the opposite.

OpenAI is , offering, early in one case, a variety of defenses ranging from denying that its product caused self-harm to alleging that the defendant misused the product by inducing it to discuss suicide. It has also said it’s working to .

Smaller apps also rely on OpenAI or other AI models to power their products, executives told Ñî¹óåú´«Ã½Ò•îl Health News. In interviews, startup founders and other experts said they worry that if a company simply imports those models into its own service, it might duplicate whatever safety flaws exist in the original product.

Data Risks

Ñî¹óåú´«Ã½Ò•îl Health News’ review of the App Store found listed age protections are minimal: Fifteen of the nearly four dozen apps say they could be downloaded by 4-year-old users; an additional 11 say they could be downloaded by those 12 and up.

Privacy standards are opaque. On the App Store, several apps are described as neither tracking personally identifiable data nor sharing it with advertisers — but on their company websites, privacy policies contained contrary descriptions, discussing the use of such data and their disclosure of information to advertisers, like AdMob.

In response to a request for comment, Apple spokesperson Adam Dema to the company’s App Store policies, which bar apps from using health data for advertising and require them to display information about how they use data in general. Dema did not respond to a request for further comment about how Apple enforces these policies.

Researchers and policy advocates said that sharing psychiatric data with social media firms means patients could be profiled. They could be targeted by dodgy treatment firms or charged different prices for goods based on their health.

Ñî¹óåú´«Ã½Ò•îl Health News contacted several app makers about these discrepancies; two that responded said their privacy policies had been put together in error and pledged to change them to reflect their stances against advertising. (A third, the team at OhSofia!, said simply that they don’t do advertising, though their app’s notes users “may opt out of marketing communications.”)

One executive told Ñî¹óåú´«Ã½Ò•îl Health News there’s business pressure to maintain access to the data.

“My general feeling is a subscription model is much, much better than any sort of advertising,” said Tim Rubin, the founder of Wellness AI, adding that he’d change the description in his app’s privacy policy.

One investor advised him not to swear off advertising, he said. “They’re like, essentially, that’s the most valuable thing about having an app like this, that data.”

“I think we’re still at the beginning of what’s going to be a revolution in how people seek psychological support and, even in some cases, therapy,” Insel said. “And my concern is that there’s just no framework for any of this.”

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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.

Ñî¹óåú´«Ã½Ò•îl 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.

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Even the Trump administration is testing AI’s usefulness in managing the prior authorization process for the Medicare program, as well as seeking to override AI regulation by states.

But class action lawsuits have accused insurers of using AI to wrongfully withhold treatment. And outlines the risks of training AI on a current system rife with wrongful denials.

“There is a world in which using AI could make that worse, or at least replicate a bad human system, because the data that it would be training on is from that bad human system,” said Michelle Mello, a co-author of the study.

Although, Mello said, the research team found “real positives alongside the risks.”

In this video produced by Ñî¹óåú´«Ã½Ò•îl Health News’ Hannah Norman, Darius Tahir, a correspondent covering health technology, explains.

You can read Tahir’s recent coverage of AI’s use by health insurers below:

• “Red and Blue States Alike Want To Limit AI in Insurance. Trump Wants To Limit the States,” by Darius Tahir and Lauren Sausser.
• “AI Will Soon Have a Say in Approving or Denying Medicare Treatments,” by Lauren Sausser and Darius Tahir.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—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).

“Realmente puedo sentarme, interactuar, concentrarme en ellos y escuchar”, dijo Boose, quien .

Hace aproximadamente dos años, comenzó a usar una aplicación de IA para tomar notas durante las consultas. La herramienta escucha mientras Boose habla con sus pacientes y luego genera automáticamente un resumen de la visita basado en la conversación.

Este resumen suele estar listo en cuestión de segundos después de que termina la cita.

“Se encarga de todo ese trabajo tedioso de registrar información y tomar notas durante la visita”, dijo. “Me libera mucho tiempo completando eso, y hasta puedo llegar a casa con mi familia más temprano”.

Casi un tercio de las prácticas médicas están utilizando asistentes de IA para tomar notas, y otras están trabajando para incorporar esta herramienta, con el objetivo de reducir el trabajo administrativo.

Si tu doctor sugiere usar un asistente de inteligencia artificial en tu próxima cita, hay tres cosas que debes tener en cuenta:

1. Los profesionales de salud deben pedirte permiso.

Al comienzo de una cita, tu doctor podría preguntarte algo como: “¿Está bien si uso un asistente de inteligencia artificial para ayudarme a tomar notas durante esta consulta?”. Una práctica común es aceptar el consentimiento verbal, no por escrito, antes de activar la herramienta. Sin embargo, los requisitos legales para obtener permiso para grabar una conversación con un paciente varían según el estado.

Boose dijo que el paciente puede pedir que se detenga al asistente de IA en cualquier momento, especialmente para hablar de algo sensible. Y si decides no usarlo, tu doctor probablemente volverá a tomar notas manualmente en una computadora.

1. Los asistentes de IA también cometen errores, así que revisa tu información.

Como otras herramientas de inteligencia artificial, estos asistentes pueden “alucinar”, es decir, agregar errores de forma espontánea en un registro. También pueden omitir información importante o perder el contexto dentro de una conversación.

Se supone que los profesionales de salud deben revisar y editar los resúmenes generados por IA antes de agregarlos al historial del paciente. Como paciente, es buena práctica revisar cuidadosamente el resumen de tu visita y comunicarte con tu proveedor de salud si notas errores.

1. Sí, la empresa de IA podría usar tus datos, pero con limitaciones.

Las empresas y sistemas de salud que ofrecen estas herramientas tienen acceso a datos médicos y están sujetos a normas federales sobre cómo usan y almacenan la información del paciente, bajo la Ley de Portabilidad y Responsabilidad del Seguro de Salud (HIPAA, por sus siglas en inglés).

Pueden usar los datos de tu consulta para mejorar su software sin informarte, dijo Darius Tahir, quien cubre tecnología de salud para Ñî¹óåú´«Ã½Ò•îl Health News. “Si la información está ‘no identificada’, lo que puede significar eliminar identificadores y asegurarse de que no se pueda rastrear a una persona, entonces hay más libertad para usarla de otras maneras”, explicó. “Hay muchos menos requisitos regulatorios”.

Si quieres saber cómo se están usando tus datos, puedes preguntarle a tu doctor o al sistema de salud. Pero es posible que no recibas una respuesta clara, dijo Tahir.

Personas y políticas

Es probable que el sistema de salud en Estados Unidos continúe integrando tecnología de IA en la atención al paciente.

La administración Trump apoya firmemente su desarrollo y uso, especialmente en el sector salud. A comienzos de 2025, el presidente Donald Trump emitió una orden ejecutiva que reduce regulaciones existentes sobre inteligencia artificial para ayudar al país a “mantener el liderazgo global en inteligencia artificial”.

En diciembre, el Departamento de Salud y Servicios Humanos (HHS) publicó una estrategia sobre IA en la que afirma que apoya “la integración de la inteligencia artificial para modernizar la atención y la infraestructura de salud pública y mejorar la salud a nivel individual y poblacional”.

Emily Siner, de Nashville Public Radio, contribuyó con este artículo.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Family physician Eric Boose has been using an artificial intelligence tool to get back to what he calls “old-fashioned medicine” — talking with patients face-to-face, without having to type into a computer at the same time.Ìý

“I can really just sit there and engage and just focus on them and listen,” saidÌýBoose, who .Ìý

Roughly twoÌýyears ago, he started using an AI notetaker app during patient visits. The tool listens while he talks with patients and then automatically generates a visit summary based on the conversation. The summary is usually ready within seconds after the appointment ends.Ìý

“It’s taking care of all that tedious work of charting and taking notes during the visit,” he said. “It’s just freeing up a lot more time to get that done, and I can get home to my family earlier.”Ìý

Nearly a third of physician practices are using AIÌýscribesÌýand others are working to add the tool, in an effort to cut down on administrative work.Ìý

If your practitioner suggests using an AI scribe at your next appointment,Ìýhere are three things to keep in mind:

1.ÌýClinicians should ask for your permission.Ìý

At the start of an appointment, your doctor might ask something like, “Are you OK if I use an AI scribe to help me take notes during this appointment?”ÌýA common practiceÌýis to accept verbal, not written, consent from patients before turning the tool on. However, the legal requirements for getting permission to record aÌýpatientÌýconversation vary by state.Ìý

Boose said you can ask to pause the AI scribe at any point, especially to discuss something sensitive. And if you decline altogether, your practitioner willÌýlikely returnÌýto taking manual notes on a computer.Ìý

2.ÌýAI scribes make mistakes too, so check their work.Ìý

Like other AI tools, medical scribes can “hallucinate,” or spontaneously add errors into a record. AI scribes can also omitÌýimportant informationÌýor miss context clues within a conversation.Ìý

Clinicians are supposed to review and edit the AI-generated visit summaries before adding them to aÌýpatient’sÌýrecord. As a patient,Ìýit’sÌýa good practice to carefully review your visit summary and contact your health provider if you notice errors.Ìý

3.ÌýYes, the AI company could use your data, with limitations.Ìý

Companies and health systems that offer AI scribe tools have access to medical data and are subject to federal standards about how they use and store patient data, under theÌýHealth Insurance Portability and Accountability Act, more commonly known asÌýHIPAA.Ìý

They may use data from your appointment to help improve their software without informing you, said Darius Tahir, who reports on health technology for Ñî¹óåú´«Ã½Ò•îl Health News.Ìý“ IfÌýinformation is ‘de-identified,’Ìýwhich can mean stripping it of identifiers [and] making sureÌýit’sÌýnot personally traceable back to people, then it isÌýmore freeÌýto be used in more ways,” he said. “There are way fewer regulatory requirements.”Ìý

If you want to know how your data is being used, ask either your practitioner or medical system for more information. But you might not get a clear answer,ÌýTahirÌýsaid.Ìý

People and PolicyÌý

The U.S. health care system willÌýlikely continueÌýto integrate AI technology into patient care. The Trump administration strongly supports the development and use of AI, especially in health care. In early 2025, President Donald Trump issuedÌýÌýreducing existing regulations on AI to help the U.S. “retain global leadership of artificial intelligence.” In December, the U.S. Department of Health and Human Services releasedÌýanÌýÌýstating that the department supports “integrating AI to modernize care and public health infrastructure to improve health at the individual and population levels.”Ìý

Emily Siner at Nashville Public Radio contributed to this report.Ìý

HealthQÌýis a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system.ÌýIt’sÌýa collaboration between Nashville Public Radio and Ñî¹óåú´«Ã½Ò•îl Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Científicos familiarizados con el proceso esperan que los CDC publiquen muchos más datos en las próximas semanas, lo que permitirá ver si Estados Unidos ha perdido su estatus de país libre de sarampión, logrado con tanto esfuerzo.

Los CDC retuvieron los datos durante meses mientras un equipo golpeado por despidos masivos y renuncias organizaba la información.

Pero ahora que los científicos de la agencia publicaron su primer lote de genomas completos del sarampión —el “mapa genético” de los virus—, el resto “debería empezar a fluir más fácilmente y a un ritmo más rápido”, dijo Kristian Andersen, virólogo evolutivo del Scripps Research Institute, que no participa en el trabajo de los CDC, pero lo sigue de cerca.

Los CDC no respondieron a las consultas de Ñî¹óåú´«Ã½Ò•îl Health News sobre cuándo planean publicar los datos o análisis de la investigación. Sin embargo, una vez que toda la información sea pública, los científicos podrán hacer rápidamente que indiquen si los brotes registrados a lo largo del país el año pasado se debieron a la propagación continua entre estados o a casos aislados importados del extranjero.

Si se verifica que hubo transmisión continua durante un año, eso significa que Estados Unidos perdió su estatus de país libre de sarampión. Ese estatus, que mantiene desde el año 2000, es reflejo de las tasas de vacunación: dos dosis de la vacuna triple viral (sarampión, paperas y rubéola) previenen la mayoría de las infecciones y frenan la propagación de los brotes.

Los análisis más detallados toman semanas.

“En abril ya deberíamos tener un informe”, sostuvo Andersen, “en el caso de que no haya interferencias políticas”.

Esta es la primera vez que Estados Unidos aplica técnicas genómicas sofisticadas al sarampión, una enfermedad que prácticamente había desaparecido del país desde hacía unos 25 años gracias a la alta cobertura de vacunación.

La desinformación, la , y también los recortes presupuestarios y la respuesta tardía a los brotes durante la administración Trump han impulsado el resurgimiento de la enfermedad. Con al menos 2.285 casos en 44 estados, 2025 fue el peor año para el sarampión en más de tres décadas. Y este año va camino a superarlo, con 1.575 casos hacia fines de marzo.

Aunque valoran los datos científicos, los investigadores coinciden en que la prioridad del gobierno debería ser frenar la propagación del virus.

“Creo que es sumamente importante realizar la secuenciación del genoma completo cuando se presentanÌý brotes. Pero, en realidad, no deberíamos tener que hacerlo en el caso del sarampión, ya que contamos con una vacuna extremadamente eficaz y segura”, señaló Andersen.

“El solo hecho de que estemos hablando de esto es una locura”, agregó.

Robert F. Kennedy Jr., secretario de Salud y Servicios Humanos (HHS), y otros funcionarios del gobierno “deberían dar la alarma por el regreso del sarampión y lanzar campañas de vacunación a nivel nacional”, explicó Rekha Lakshmanan, directora ejecutiva de , una organización sin fines de lucro de Houston que promueve el acceso a las vacunas.

“Aplaudo los avances científicos, pero lo más urgente es controlar el sarampión lo antes posible”, insistió.

En cambio, altos funcionarios han minimizado la gravedad de la enfermedad, y en los CDC de Kennedy se ha dado un nuevo impulso a ideas falsas sobre las vacunas. Esto incluye modificaciones repentinas en la información que brindan los sitios web de los CDC.

Según las asociaciones médicas, estas creencias no se basan en evidencia científica y ponen vidas en riesgo.

Kennedy sigue promoviendo medicamentos no probados que pueden hacer que los padres piensen que pueden dejar de vacunar a sus hijos sin consecuencias.

En el podcast , a fines de febrero, Kennedy habló largo rato sobre medidas para mejorar la salud en Estados Unidos, pero no mencionó las vacunas. Dijo que las medidas preventivas podrían incluir “la medicina holística, tomar vitaminas o tomar vitamina D, que, como se sabe, es casi milagrosa”.

“El riesgo de sarampión sigue siendo bajo para la mayor parte de Estados Unidos”, escribió Emily Hilliard, vocera del HHS. “Los CDC han puesto a disposición $8,5 millones para apoyar la respuesta a los brotes de sarampión en siete jurisdicciones”, expresó. “Los CDC, los principales funcionarios del HHS y el secretario han sido claros en que la vacuna triple viral (MMR) es la mejor forma de protegerse contra el sarampión”.

1.000 genomas

En diciembre, los CDC recurrieron a uno de los principales centros de secuenciación de virus del país, el Broad Institute, en Cambridge, Massachusetts. Importantes brotes de sarampión en Texas, Utah y South Carolina fueron causados por el mismo tipo de virus, identificado como D8-9171. Pero dado que este mismo tipo también circula en Canadá y México, los investigadores necesitan más datos para determinar si la propagación se produjo entre estados o si el virus ingresó a Estados Unidos desde el exterior en diferentes oportunidades.

La secuenciación del genoma completo aporta esa información porque los virus van cambiando con el tiempo. El virus del sarampión sufre una mutación cada dos a cuatro transmisiones entre personas, explicó Bronwyn MacInnis, directora de vigilancia de patógenos en el Broad Institute.

“Hay suficientes indicios en estos datos para desentrañar las cuestiones que nos ocupan”, dijo MacInnis. “La principal es si hay transmisión sostenida dentro del país”.

El equipo de MacInnis trabajó horas extra para secuenciar los genomas completos de virus del sarampión inactivados que se habían recogido en distintos estados en 2025 y 2026.

“Hemos analizado alrededor de unas 1.000 muestras y entregado los datos genómicos a los CDC, enviándolos de forma continua desde diciembre”, contó Bronwyn MacInnis. “Les corresponde a los CDC publicar esos datos”, explicó.

Los CDC no publicaron ni uno solo de esos genomas hasta fines de marzo, cuando aparecieron ocho en una base de datos pública del Centro Nacional de Información Biotecnológica (NCBI, por sus siglas en inglés). Para el 1 de abril, se habían subido otros 154.

“Los datos deberían estar publicados en el NCBI dentro de las dos semanas desde que se obtienen, y cuando hay un brote activo, desde luego, no deberían tardar más de un mes”, opinó Kristian Andersen.

Los datos genómicos contienen pistas sobre cómo comienzan y se propagan los brotes. Esta información permite que los investigadores desarrollen pruebas, tratamientos y vacunas, y también ayuda a detectar variantes que podrían evadirlos.

Ese tipo de datos fueron claves durante la pandemia de covid. Científicos de China y Australia el 10 de enero de 2020, apenas de haberlo secuenciado.

“Definitivamente la publicación de los datos genéticos del sarampión no debería llevarle meses a los CDC”, señaló Eddie Holmes, el virólogo australiano que colaboró en la publicación de la primera secuencia del coronavirus.

Una de las razones de la demora es que el laboratorio de sarampión de los CDC quedó con muy poco personal por los despidos masivos y otras turbulencias que sufrió la agencia durante el último año, dijo a Ñî¹óåú´«Ã½Ò•îl Health News un científico de los CDC (Ñî¹óåú´«Ã½Ò•îl Health News aceptó no identificarlo por temor a represalias).

Otra razón, agregó el investigador, es la curva de aprendizaje: hasta ahora, los CDC y los departamentos de salud no habían tenido que secuenciar cientos de genomas completos de sarampión.

A diferencia de los CDC, el Laboratorio de Salud Pública de Utah ha compartido rápidamente los genomas del sarampión. La mayoría de los aproximadamente 970 genomas publicados en línea desde el 1 de enero de 2025 fueron secuenciados por ese estado. Las muestras provenían de Utah, Arizona, Carolina del Sur y otros estados dispuestos a compartirlas.

“Solo tenemos unas pocas muestras de Texas, recogidas más o menos en mitad del brote”, informó Kelly Oakeson, investigadora en genómica del Departamento de Salud y Servicios Humanos de Utah. Aunque son similares, los genomas de los virus del sarampión detectados en Texas y Utah presentan algunas diferencias. “Esto indica que faltan variantes intermedias del virus”, explicó Oakeson.

Si el código genético de los virus recogidos hacia el final del brote en Texas se parece más al de los de Utah, eso indicaría que la transmisión fue continua y que Estados Unidos podría haber perdido su estatus de país libre de sarampión. Los centenares de secuencias genómicas que aún se encuentran en los CDC probablemente contengan la respuesta.

Esperando a los CDC

Los CDC tenían previsto terminar su investigación antes de abril, según dijo Daniel Salas, director ejecutivo del programa de inmunización de la Organización Panamericana de la Salud (OPS), que trabaja con la Organización Mundial de la Salud (OMS). La OPS tenía previsto evaluar en ese momento la situación del sarampión en Estados Unidos.

Salas explicó que la entidad postergó la evaluación hasta la reunión anual de la organización, que será en noviembre, en parte porque los CDC necesitaban más tiempo para realizar el análisis genómico y porque también se está revisando la situación del sarampión en México, Bolivia y otros países. Celebrar reuniones escalonadas para cada país resulta poco práctico, agregó.

Estados Unidos es el único país que utiliza la secuenciación del genoma completo para responder si mantuvo la eliminación del sarampión, señaló Salas. Por lo general, los países clasifican los virus del sarampión según un pequeño fragmento de sus genes y luego asumen que los grandes brotes causados por el mismo tipo están relacionados.

Los genomas completos ofrecen una visión más precisa.

“Si Estados Unidos puede llenar los vacíos con datos genómicos, supone una suerte de avance”, dijo Salas. “Eso no significa que otros países vayan a ser capaces de implementar este tipo de análisis”, añadió. “Se necesitan muchos conocimientos especializados y recursos”.

El equipo para secuenciar y analizar genomas cuesta más de $100.000, y el costo de procesar cada muestra, incluyendo el pago a los investigadores, suele oscilar entre $100 y $500 por secuencia.

“Estoy a favor de la ciencia, pero no deberíamos tener que hacer esto”, dijo Theresa McCarthy Flynn, presidenta de la Sociedad de Pediatría de Carolina del Norte. “No tenemos por qué sufrir una epidemia de sarampión”.

Flynn contó que muy seguido recibe preguntas de padres preocupados por la desinformación difundida por Kennedy y los grupos antivacunas, incluido el que fundó el mismo secretario antes de incorporarse al gobierno de Trump. Los padres también han señalado cambios en las recomendaciones de los CDC y en el sitio web que contradicen el consenso científico.

Antes de que Kennedy asumiera, afirmaba en letras grandes que “las vacunas no causan autismo” y enumeraba que refutaban la existencia de una relación entre las vacunas y los trastornos del desarrollo.

El año pasado, el pasó a afirmar que “LasÌý autoridades sanitarias han ignorado los estudios que respaldan la relación entre las vacunas y los trastornos de desarrollo”.

Las publicaciones científicas rigurosas fueron sustituidas por el informe de un único investigador vinculado a grupos antivacunas.

En un correo electrónico enviado a Ñî¹óåú´«Ã½Ò•îl Health News, la vocera del HHS, Hilliard, repitió las erróneas afirmaciones sobre las vacunas publicadas en el sitio web, ignorando la amplia evidencia científica sobre el tema.

Flynn de la asociación pediátrica aseguró: “No puedo exagerar la gravedad de que los propios CDC estén difundiendo información errónea sobre las vacunas”.

Aunque el director en funciones de los CDC, Jay Bhattacharya, afirma que las vacunas son la mejor forma de prevenir el sarampión, él también ha socavado la política de vacunación. Por ejemplo, dijo que la polémica de reducir el número de vacunas recomendadas a los niños se basaba en “ciencia de referencia”. De hecho, el nuevo calendario convierte a Estados Unidos en entre naciones pares.

Hilliard escribió que el calendario actualizado estaba “alineando las directrices de Estados Unidos con las normas internacionales”.

El mes pasado, en respuesta a una demanda presentada por la Academia Americana de Pediatría y otros grupos, un tribunal federal dejó sin efecto temporalmente el nuevo calendario.

Bhattacharya no ha realizado conferencias ni con la prensa ni públicas sobre el repunte del sarampión este año ni tampoco activó los recursos de emergencia de los CDC.

“Normalmente, haríamos una gran campaña para aumentar las tasas de vacunación en las zonas donde son bajas. También haríamos una gran campaña en las redes sociales, publicaríamos anuncios sobre vacunación”, aseguró otro científico de los CDC con quien Ñî¹óåú´«Ã½Ò•îl Health News también acordó no revelar su identidad.

“El personal de los CDC quiere hacer campañas, pero los funcionarios políticos de la agencia no lo permiten”, dijo.

Además, los recortes y retrasos de los fondos de salud pública aplicados por el gobierno de Trump han dificultado que las autoridades locales protejan a sus comunidades.

Philip Huang, director de Salud y Servicios Humanos del condado de Dallas, en Texas, dijo que el departamento perdió más de $4 millones cuando el gobierno federal retiró unos $11.000 millones de los departamentos de salud a principios del año pasado, justo cuando se producía un brote de sarampión en el estado.

“Perdimos a 27 empleados y tuvimos que cancelar más de 20 de nuestras campañas de vacunación comunitaria, incluidas las dirigidas a escuelas que ya tenían bajas tasas de vacunación. Se están produciendo ataques simultáneos contra las vacunas que dificultan nuestro trabajo”, afirmó.

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The CDC withheld the data for months as a team hit hard by mass layoffs and resignations sorted through the information. But now that scientists at the agency have posted their first batch of whole measles genomes — the genetic blueprint of the viruses — the rest should “start flowing more smoothly at a more rapid cadence,” said Kristian Andersen, an evolutionary virologist at the Scripps Research Institute who isn’t involved with the CDC’s effort but is following it.

The CDC did not answer queries from Ñî¹óåú´«Ã½Ò•îl Health News on its timeline for publishing measles data or analyses. However, once all the data is public, researchers can run that will signal whether outbreaks across the U.S. last year resulted from the continuous spread of the disease between states, rather than separate introductions from abroad. If there was continuous transmission for a year, that means the U.S. has lost its status as a country that has eliminated measles. That status, which the U.S. has held since 2000, reflects a country’s vaccination rates: Two doses of the measles-mumps-rubella vaccine prevent most infections and so stop outbreaks from growing.

More careful analyses take weeks.

“We should see a report in April,” Andersen said, “assuming no political interference.”

This is the first time that the U.S. has applied sophisticated genomic techniques to measles, which largely disappeared from the country a quarter-century ago because of broad vaccine uptake.

Declining , misinformation, and the Trump administration’s lagging response to outbreaks have fueled a resurgence of the disease. With at least 2,285 cases in 44 states, 2025 was the worst year for measles in more than three decades. This year is on track to surpass that, with 1,575 cases as of late March.

While welcoming the science, researchers say the government’s top priority should be to stop the virus from spreading.

“I think it’s incredibly important to do whole genome sequencing for outbreaks,” Andersen said, “but we shouldn’t need to do this for measles in the first place, because we have an extremely effective and safe vaccine.”

“That we’re even talking about this is nuts,” he added.

Health and Human Services Secretary Robert F. Kennedy Jr. and other government officials should sound an alarm about measles’ comeback and launch nationwide vaccine campaigns, said Rekha Lakshmanan, executive director of , a nonprofit in Houston that advocates for vaccine access.

“I applaud the science,” she said, “but the more urgent need is to get measles under control as quickly as possible.”

Top officials have instead downplayed the seriousness of the disease, and false notions about vaccines have been granted new life in Kennedy’s CDC. This includes abrupt changes to vaccine information on CDC websites that medical say aren’t based on evidence and endanger lives.Ìý

Kennedy continues to promote unproven remedies that could mislead parents into believing that they can avoid vaccines without consequence. On the podcast in late February, Kennedy spoke at length about measures to improve America’s health but didn’t mention vaccines. He said preventive measures could entail “holistic medicine, or take vitamins, or take vitamin D, which is, as you know, it’s kind of miraculous.”

“The risk of measles remains low for most of the United States,” HHS spokesperson Emily Hilliard wrote. “CDC has made $8.5 million available to address measles response activities in 7 jurisdictions experiencing outbreaks,” she wrote. “The CDC, HHS principles, and the Secretary have been vocal that the MMR vaccine is the best way to protect yourself against measles.”

1,000 Genomes

In December, the CDC enlisted the help of one of the country’s leading centers for virus sequencing, the Broad Institute in Cambridge, Massachusetts. Major outbreaks in Texas, Utah, and South Carolina had been fueled by the same type of measles virus, labeled D8-9171. But since that type also circulates in Canada and Mexico, researchers need more data to discern whether it spread among states or entered the U.S. multiple times.

Whole genome sequencing provides that information because viruses evolve over time. The measles virus acquires a mutation every two to four transmissions between people, said Bronwyn MacInnis, director of pathogen surveillance at the Broad.

“There is enough signal in this data to tease apart questions at hand,” MacInnis said, “the main one being sustained transmission within this country.”

MacInnis’ team worked overtime to sequence the entire genomes of inactivated measles viruses that had been collected from states in 2025 and 2026.

“We’ve done about 1,000 samples and delivered the genome data back to the CDC,” sending it on a rolling basis since December, MacInnis said. “This is the CDC’s data to publish.”

The CDC didn’t post a single one of those genomes until late March, when eight appeared on a public database hosted by the National Center for Biotechnology Information. By April 1, an additional 154 had gone online.

“It should be on NCBI within a couple of weeks of being produced,” Andersen said, “and certainly not take longer than a month when you have an active outbreak.”

Genomic data holds clues about how outbreaks start and spread. It allows researchers to develop tests, treatments, and vaccines — and detect variants that might evade them.

Such data was critical in the covid pandemic. Chinese and Australian scientists online on Jan. 10, 2020, of sequencing it. “It definitely shouldn’t take the CDC months,” said Eddie Holmes, the Australian virologist who helped publish the first coronavirus sequence.

One reason for the delay is that the CDC’s measles lab has been sorely understaffed amid mass layoffs and other turmoil at the agency over the past year, a CDC scientist told Ñî¹óåú´«Ã½Ò•îl Health News. Another reason, the researcher added, is a learning curve: The CDC and health departments haven’t needed to sequence hundreds of whole measles genomes before now. (Ñî¹óåú´«Ã½Ò•îl Health News agreed not to identify the scientist, who feared retaliation.)

In contrast with the CDC, the Utah Public Health Lab has shared measles genomes rapidly. Most of some 970 measles genomes posted online since Jan. 1, 2025, were sequenced by the state, hailing from Utah, Arizona, South Carolina, and other states willing to share them.

“We’ve only got a handful of samples from Texas that were collected kind of in the middle of their outbreak,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services. The genomes of the Texas and Utah measles viruses are similar but distinct, Oakeson said, meaning that intermediate versions of the virus are missing.

If the genetic code of viruses collected late in the Texas outbreak are a closer match to those from Utah’s, that will suggest that spread was continuous and the country has lost its measles-free status. The hundreds of genome sequences still sitting at the CDC probably hold the answer.

Waiting on the CDC

The CDC expected to finish its analysis before April, said Daniel Salas, executive manager of the immunization program at the Pan American Health Organization, which works with the World Health Organization. That’s when PAHO was slated to evaluate the United States’ measles status.

He said PAHO delayed its evaluation until the organization’s annual meeting in November, partly because the CDC needed more time to do the genomic analysis and partly because the measles status of Mexico, Bolivia, and other countries is also under review, and holding staggered meetings for each country is inefficient.

The U.S. is the only country using whole genome sequencing to answer the elimination question, Salas said. Typically, countries classify measles viruses according to a tiny snippet of genes, then assume that large outbreaks caused by the same type are linked. Whole genomes provide a more accurate view.

“If the U.S. can fill in the blanks with genomic data, that’s a sort of breakthrough,” Salas said. “That doesn’t mean other countries are going to be able to pull off this kind of analysis,” he added. “It takes a lot of specialized knowledge and resources.”

Equipment to sequence and analyze genomes costs upward of $100,000, and the cost to process each sample, including paying the researchers involved, typically ranges from $100 to $500 per sequence.

“I’m pro-science, but we shouldn’t have to do this,” said Theresa McCarthy Flynn, president of the North Carolina Pediatrics Society. “We don’t have to have a measles epidemic.”

Flynn said she regularly fields questions from parents concerned by misinformation spread by Kennedy and anti-vaccine groups, including the one he founded before joining the Trump administration. Parents have also pointed to changes in the CDC’s recommendations and to its websites that are at odds with the scientific consensus.

Before Kennedy took the helm, a said “Vaccines do not cause autism” in prominent type, and listed in premier scientific journals that refuted a link between vaccines and developmental disorders.

Last year, shifted to saying, “Studies supporting a link have been ignored by health authorities.” The high-quality studies were replaced with a report from a single investigator who has ties to anti-vaccine groups. In an email to Ñî¹óåú´«Ã½Ò•îl Health News, HHS spokesperson Hilliard echoed the altered website’s claims about vaccines, disregarding extensive studies on the topic.

Flynn, of the pediatrics association, said, “The CDC itself is spreading misinformation about vaccines. I cannot overstate the seriousness of this.”

Although the acting director of the CDC, Jay Bhattacharya, says vaccines are the best way to prevent measles, he too has undermined vaccine policy. He said the controversial to reduce the number of vaccines recommended to children was based on “gold standard science.” In fact, the new schedule makes the among peer nations. Hilliard wrote that the updated schedule was “aligning U.S. guidance with international norms.”

A federal court temporarily invalidated the change last month in a lawsuit brought by the American Academy of Pediatrics and other groups.

Bhattacharya hasn’t held briefings with the public or the press on the surge of measles this year or activated the CDC’s emergency capabilities.

“Normally, we’d have a big push to get vaccination rates up in areas where it’s low. We’d do a big social media push, put out ads on getting vaccinated,” said another CDC scientist whom Ñî¹óåú´«Ã½Ò•îl Health News agreed not to identify, because of fears of retaliation. “People at the CDC want to do this, but political leadership at the agency has not allowed the CDC to do it.”

Further, the Trump administration’s cuts and delays to public health funds have made it hard for local health officials to protect communities. Philip Huang, director at Dallas County Health and Human Services in Texas, said the department lost over $4 million when the administration clawed back about $11 billion from health departments early last year as a measles outbreak surged in the state.

“We lost 27 staff and had to cancel over 20 of our community vaccination efforts, including to schools identified as having low vaccination rates,” he said. “There are simultaneous attacks on immunizations that are making our jobs harder.”

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• (starts at 21:03).
• Read Rayasam’s “When Health Insurance Costs More Than the Mortgage.”

Ñî¹óåú´«Ã½Ò•îl Health News rural health reporter Andrew Jones discussed the spread of measles across the Carolinas on WUNC’s Due South on March 17.

• Read Jones’ “Hospitals Fighting Measles Confront a Challenge: Few Doctors Have Seen It Before.”

Céline Gounder, Ñî¹óåú´«Ã½Ò•îl Health News’ editor-at-large for public health, discussed on CBS News 24/7’s The Daily Report on March 16 how U.S. hospitals and insurers are turning to AI to settle disputes over medical claims and payments. On March 17, she outlined the court ruling blocking the Trump administration’s vaccine policy changes for children on CBS News’ CBS Mornings. Gounder also discussed Susie Wiles’ decision to stay on as White House chief of staff amid breast cancer treatment on CBS News 24/7’s The Takeout on March 16.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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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 Ìýde 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 KFF 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 Ñî¹óåú´«Ã½Ò•îl 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 KFF found widespread discontent over issues like prior authorization. (KFF is a health information nonprofit that includes Ñî¹óåú´«Ã½Ò•îl 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 Ñî¹óåú´«Ã½Ò•îl 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?”

Do you have an experience navigating prior authorization to get medical treatment that you’d like to share with us for our reporting? Share it with us here.

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