On August 11, 2025, Washington found itself at the intersection of two high-stakes debates, both swirling around the future of Medicare and the country’s broader economic health. House Democrats, led by Representatives Suzan DelBene of Washington and Ami Bera of California, raised the alarm about a new Department of Health and Human Services (HHS) pilot program that, they argue, could make it harder for seniors to access care. Meanwhile, the Trump administration, embroiled in a fierce legal battle over its tariff policies, warned that striking down the president’s tariffs could trigger a 1929-style depression and jeopardize the very existence of federal benefits like Social Security and Medicare.
At first glance, these stories might seem only loosely connected—one about health policy, the other about international trade. But at their core, both are about the same thing: how government decisions, whether in the name of cost control or economic protectionism, ripple through the systems that millions of Americans rely on. And in both cases, the stakes are nothing short of existential for the country’s most vulnerable citizens.
Let’s start with the controversy over Medicare. According to The Hill, House Democrats sent a pointed letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, questioning a new HHS demonstration project that would add prior authorization requirements for certain outpatient procedures in traditional Medicare. For decades, traditional Medicare has rarely required such prior authorizations, a practice more commonly associated with private Medicare Advantage (MA) plans. Those MA plans have drawn criticism for using prior authorization—a process that requires doctors to get approval from insurers before providing certain treatments—as a cost-saving measure that can sometimes delay or deny care.
"The Trump Administration publicly recognized the harm of prior authorization…And yet, not a week after these statements, CMS put forward a new proposal to increase the utilization of prior authorization in a type of health coverage that had seldom used the tactic before, replacing doctor’s medical knowledge with an algorithm designed to maximize care denial in order to increase profits," the lawmakers wrote in their letter, as reported by The Hill.
The new CMS pilot program, according to the lawmakers, targets outpatient procedures flagged as vulnerable to fraud, waste, abuse, or inappropriate use. Under the model, CMS will partner with private companies—including some of the very Medicare Advantage plans criticized for their use of prior authorization. These companies will be rewarded based on how effectively their technology solutions reduce spending on medically unnecessary or non-covered services.
But the lawmakers are worried that this approach could create what they call "perverse incentives"—essentially rewarding companies that deny the most care. Their concerns are not unfounded: an analysis of 2023 HHS data by KFF found that about 81 percent of prior authorization denials were at least partially overturned after beneficiaries appealed. That statistic, cited in the lawmakers’ letter, suggests that the system sometimes gets it wrong, and that patients can face real barriers to getting the care they need.
"Prior authorization has long been abused, and it is bad for patients and providers," the letter states. The lawmakers warn that the demonstration will likely limit beneficiaries’ access to care, increase the burden on an already overworked health care workforce, and put profit over patients. They’re demanding detailed information on the pilot’s scope, implementation plan, and—perhaps most importantly—what safeguards will be in place to protect beneficiaries.
All this comes as the Trump administration touts voluntary pledges from insurance companies to streamline and reform the prior authorization process in Medicare Advantage plans. "There’s violence in the streets over these issues," Mehmet Oz remarked during an event announcing the industry pledges, according to The Hill. The administration’s efforts, at least on the surface, seem to acknowledge the harms of excessive prior authorization, even as the new pilot program appears to move in the opposite direction for traditional Medicare.
But that’s only half the story. On the very same day, the Trump administration took its case to a federal appellate court, warning that overturning the president’s tariffs could have catastrophic consequences for the U.S. economy—and for federal benefits like Social Security and Medicare. In a letter filed with the U.S. Court of Appeals for the Federal Circuit, Solicitor General D. John Sauer and Assistant Attorney General Brett Shumate argued that if the court struck down Trump’s tariffs, the United States might be forced to pay back trillions of dollars from deals that haven’t even been fully signed yet.
"If the United States were forced to pay back the trillions of dollars committed to us, America could go from strength to failure the moment such an incorrect decision took effect," they wrote in their letter, as reported by Axios. They warned that the forced dissolution of these agreements could "lead to a 1929-style result," with people losing their homes, millions of jobs disappearing, Americans losing their savings, and even Social Security and Medicare coming under threat.
What’s behind these dire predictions? The administration’s tariff agreements with countries like Japan, South Korea, and the European Union include pledges to establish investment funds totaling over $1 trillion for U.S. projects. But, as Axios points out, these are financing commitments for future projects—not direct payments to the U.S. Treasury. There are already disputes about how much actual money foreign governments will put up, and the administration’s own officials admit that any replacement tariff programs would be less effective and shorter-term.
"Other tariff authorities that the President could potentially use are short-term, not nearly as powerful, and would render America captive to the abuses that it has endured from far more aggressive countries," Sauer and Shumate wrote. With a ruling from the appellate court expected soon, and a likely trip to the Supreme Court looming, the outcome could reshape the economic landscape—and, if the administration’s warnings are to be believed, the safety net that millions of Americans depend on.
Beneath the legal and policy wrangling, the real question is about trust: Can Americans trust that the systems designed to protect them—whether Medicare, Social Security, or the broader economy—will actually deliver when it matters most? As lawmakers and administration officials spar over the details, the stakes for ordinary people couldn’t be higher. With both the health care and economic fronts in flux, the coming months promise to be anything but dull for those watching the future of America’s safety net.
