Every fall, tens of millions of Americans open a website, read four columns of unfamiliar words, and pick one. Bronze, silver, gold, platinum. Deductible, coinsurance, out-of-pocket maximum, in-network, prior authorization. Most finish it confused and afraid — afraid of the car crash, the tumor, the appendix at 2 a.m. — but they sign anyway.

The fear is reasonable. The product is not.

Run the Numbers Before You Sign

The benchmark silver plan on the Affordable Care Act (ACA) marketplace costs a 40-year-old an average of $625 a month in 2026, according to KFF, the nonpartisan health policy research organization formerly known as the Kaiser Family Foundation. Premiums range from $401 a month in New Hampshire to $1,299 in Vermont.

Compare that monthly bill to what the same care costs when a patient pays cash.

CCHF staff have priced this ourselves. One CCHF employee needed a follow-up CT scan in Arizona. She had paid more than $400 out of pocket for the first scan while covered by a platinum health plan. She returned to the same imaging center the following year without coverage and paid the cash price: $205. A second CCHF employee needed an X-ray in Minnesota. His health plan quoted $500 to $600. The cash price was $200.

Direct Primary Care (DPC) clinics — practices that charge a flat monthly membership fee and accept no health plan or government payment — commonly charge $50 to $150 a month for unlimited primary care. Published cash prices at independent imaging centers commonly run $200 to $500 for a CT scan and $300 to $725 for an MRI — a fraction of what the same scan is billed at through insurance. CCHF maintains a directory of these practices at JoinTheWedge.com.

You can do the math. A person paying the average 2026 benchmark premium would need a DPC membership, a CT scan, and an MRI every single month to spend as much on care as they spend on their monthly plan premium.

That care is not what the ACA plan buys. It buys a network, a deductible, and a permission process. The federal cap on out-of-pocket costs for 2026 is $10,600 for an individual, and it applies no matter which tier you buy — paid on top of the premium. That means a 40-year-old paying the benchmark premium hands over $7,500 a year for the privilege of paying two to three times the cash price for the same scan, and for the privilege of asking a company’s permission before the doctor is authorized to order it. Americans are being fleeced.

This is the deal. Americans instinctively know it is a bad one. Very few know why it exists.

Congress Did Not Nationalize Medicine. Congress Franchised It.

Americans argue about socialized medicine as though it were a foreign threat waiting at the border not understanding that a version of it arrived in 2010 wearing a corporate health plan logo.

The ACA did not put the federal government in the exam room, directly. Congress instead forced Americans to buy coverage from plans it licensed, directed federal officials to write the rules those plans must follow, and funneled your taxpayer money to them. Consider the structure:

Real insurance was made illegal for most people. Federal law restricts true catastrophic coverage — a private major medical indemnity policy that pays out when something terrible happens and otherwise stays out of the way — to people under 30 or those granted a hardship exemption (42 U.S. Code § 18022(e)). Everyone else must buy a comprehensive prepaid plan whether they want one or not. A prepaid plan makes you pay upfront for a bundle of coverage you may never use—and didn’t choose. Congress zeroed out the tax penalty for being uninsured in 2019, but that didn’t change what they’re allowed to sell: if you are over 30 and want to buy real catastrophic coverage, no company may legally sell it to you. The restriction compounds. Because the ACA also lets adults stay on a parent’s plan until 26, the eligible window for catastrophic coverage runs roughly from 26 to 29 — four years. A market that small is barely worth entering, so fewer insurers offer the product at all.

Federal money flows to the companies, not to you. Advance premium tax credits are paid by the U.S. Treasury directly to the health plan. Roughly 87 percent of 2026 healthcare.gov enrollees receive a subsidy, per KFF. Most of the revenue in this government exchange is federal money moving into corporate accounts, with your name on the paperwork – yet you never see this money.

The profit cap rewards higher costs. The ACA lets a health plan keep only 15 to 20 percent of your premium: the rest must go to medical claims or quality improvement activities. That sounds like a limit on greed. It is the opposite. A percentage cap on a number the company helps set gives it one reliable way to earn more — make the number bigger.

Economists Steve Cicala, Ethan Lieber, and Victoria Marone studied what happened when the rule took effect and published their findings in the American Economic Journal: Applied Economics in 2019. Medical claims rose to fill the space the rule created — about 7 percent in the individual market. Premiums did not fall. Tell a teenager he can have one bowl of ice cream and he does not reach for the smallest bowl. He reaches for the mixing bowl. A health plan allowed to keep a fixed slice of your premium has the same incentive —to grab the biggest bowl and to fill it with as much of your money as it can.

Premiums rise, and the argument is always for more of the same. Benchmark ACA premiums rose roughly 22 to 26 percent for 2026, depending on the measure. To lower costs for enrollees, the answer offered after every increase is more federal money into the same companies.

This is not a free market, and it never was. Congress outlawed real insurance, mandated the corporate product, and then wrote the checks directly to the health plans they put in place. Americans are wrongly told to blame the “market” for prices the government engineered.

Congress Shackled Your Doctor’s Office

The costs did not stop at the premium. They went into your clinic.

Billing. Once a company stands between the patient and the doctor, someone must file the claim, code the visit, appeal the denial, and argue for the treatment the doctor already prescribed. Researchers at Duke University measured the cost of that work in an academic health system with a certified electronic health record and published the results in JAMA in 2018. Billing and insurance-related costs ran $20.49 for a primary care visit and $215 for an inpatient surgical procedure — 3 to 25 percent of professional revenue, or roughly $99,581 per primary care physician per year. None of it treated a single patient. You pay every dollar of it.

The record. Congress mandated electronic health records (EHRs) through the Health Information Technology for Economic and Clinical Health (HITECH) Act, signed February 17, 2009. HITECH paid doctors to install federally certified EHR systems and to demonstrate “meaningful use,” a checklist of behaviors written by the Centers for Medicare & Medicaid Services (CMS). Doctors who did not comply by 2015 lost 1 percent of their Medicare payments, and that later rose to 3 percent. The federal government had paid out $28.1 billion in taxpayer dollars by the end of 2014. The payments did not cover the cost. Independent practices routinely spent more on installation, licensing, and ongoing support than they ever received in federal grants, and those that could not absorb the costs sold their practices to hospital systems.

Nobody designed these computerized systems for the patient or the doctor. They were designed to produce structured data that flows to CMS, to health plans, to registries, and to the data industry. Doctors were required to provide outsiders with unconsented patient’s data, as HIPAA allows (see previous article).

Christine Sinsky, MD, and colleagues observed 57 physicians for 430 hours and published their findings in the Annals of Internal Medicine in 2016. Physicians spent 27 percent of the office day on direct face time with patients and 49.2 percent on data entry and desk work. For every hour of patient care, nearly two additional hours went to the screen. American Medical Association survey data for 2024 shows physicians reporting a 57.8-hour week: 27.2 hours of direct patient care, 13 hours of indirect patient care, and 7.3 hours of administrative tasks including prior authorization and completing health plan forms.

Add that up. To satisfy government requirements, a doctor now employs billers and coders to satisfy the health plans and staff to feed the record system. The clinic day is built around the checklist, because the checklist is what pays. No doctor chose that. The overhead costs land in the price of each visit.

THIS is why cash is cheaper. A DPC clinic that accepts no health plans and no government payment employs none of these people. The $205 CT scan is not a discount. It is what a scan costs once the billing apparatus, the reporting requirements, and the incentive to inflate are stripped out.

More Government Is Not the Way Out

The notion of cutting out the corporations and letting the federal government run your health care entirely is preposterous. Look at what happens when a government owns the only door into the doctor.

Canada. The Fraser Institute has surveyed Canadian physicians on wait times since 1993. Its December 2025 report found a median wait of 28.6 weeks from a family doctor’s referral to treatment — more than triple the 9.3-week wait recorded in 1993. That same year, an estimated 1.4 million procedures sat in the queue. The median wait for an MRI reached 18.1 weeks. SecondStreet.org obtained government data showing at least 23,746 patients died between April 1, 2024, and March 31, 2025, while waiting for surgery or a scan. Alberta and parts of Manitoba supplied no data, so the true figure is higher.

Canadians largely cannot pay their way out. The British Columbia Court of Appeal upheld the province’s ban on patient charges and on private coverage for publicly insured services, and the Supreme Court of Canada declined to hear the appeal on April 6, 2023. Health Canada deducted from seven provinces more than $76.4 million in March 2023 over patient charges for medically necessary diagnostic services.

Health Canada’s Sixth Annual Report on Medical Assistance in Dying, released November 28, 2025, reported 16,499 MAID deaths in 2024 — 5.1 percent of all deaths in Canada. Cancer was the most frequently reported underlying condition in nearly every age group. A system that makes patients wait 28.6 weeks for treatment while offering death without delay has told patients which one it would prefer they choose.

England. The National Health Service (NHS) constitution states patients referred for non-urgent, consultant-led treatment should begin within 18 weeks, and that 92 percent of patients should meet this standard. The NHS last met this standard in 2016. NHS England reported 7.11 million people on the elective waiting list in March 2026, with 65.3 percent treated within 18 weeks. Roughly 105,000 had been waiting more than a year.

Canada rations by time. England rations by time. American health plans ration by network and by permission slip (prior authorization requirements)— which is another way of rationing time. Three mechanisms, one result: someone other than the patient and the doctor decides. Patients who don’t have time on their side sadly pay the ultimate price.

The Way Out Is CCHF’s 3-C Solution

Cash, Catastrophic Coverage, and Charity.

Cash. Patients pay directly for routine and minor care and know the price before they walk in. Prices fall to the cash level because clinics stop employing staff to navigate the complex health plan system, and because patients can shop around and compare.

Catastrophic coverage. Real insurance covers the large events that have not happened yet — the coma, the cancer, the car crash—or expensive chronic conditions. Major medical indemnity policies pay the patient directly, the same way homeowners and auto insurance pay out when a tornado takes the roof off a house. The patient then chooses the doctor and the hospital. Permission is not required. Nobody insures a house already on fire, and nobody should be forced to buy a pricy prepaid plan to be protected from a fire that has not started.

Charity. Charity care covers the patients who truly cannot pay, without inflating prices for everyone else.

Cash restores affordable pricing. Catastrophic coverage restores affordable protection. Charity restores the mission of medicine. NONE of the three require a network, prior authorization, or a place in line.

Join Us on October 1^st as we Make the Case for Health Freedom

Rick Baker founded Timely Medical Alternatives in Vancouver, British Columbia, in 2003 and has spent 22 years finding care outside the queue for Canadians whose government owns the only door into medical care. He calls the United States “Canada’s other health care system.” His work has appeared in the Wall Street Journal, and on 20/20 with John Stossel. He joins CCHF as the evening’s keynote speaker.

Making a Case for Health Freedom begins at 6 p.m. on Thursday, October 1, 2026 at the DoubleTree Hotel, Bloomington, Minnesota, just 10 minutes from the Minneapolis airport.

Register HERE.

CCHF has worked since 1998 to protect patient and doctor freedom. Your ticket and your generosity fund this fight.

Sources

• KFF, marketplace benchmark premiums, 2026

• Cicala, Lieber, and Marone, “Regulating Markups in US Health Insurance,” American Economic Journal: Applied Economics 11(4), October 2019

• Tseng et al., “Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System,” JAMA, February 2018

• Sinsky et al., “Allocation of Physician Time in Ambulatory Practice,” Annals of Internal Medicine, 2016

• American Medical Association physician workweek survey data, 2024

• Health Information Technology for Economic and Clinical Health (HITECH) Act, February 17, 2009

• Fraser Institute, Waiting Your Turn: Wait Times for Health Care in Canada, 2025, December 9, 2025

• SecondStreet.org, Died on a Waiting List, 2025 Edition, November 26, 2025

• Health Canada, Sixth Annual Report on Medical Assistance in Dying in Canada, November 28, 2025

• Health Canada, Canada Health Act Annual Report 2022–2023

• NHS England referral-to-treatment statistics, March 2026

• 42 U.S. Code § 18022(e)

_{Source: CCHF}

On August 3, CCHF, the organization I lead, sent President Trump a letter thanking him and his administration for cutting grants issued by the Agency for Healthcare Research and Quality (AHRQ). We also requested that he ask Congress to shut down the agency entirely.

Most Americans have never heard of AHRQ (pronounced “ark”). Its history explains why this agency matters to every patient and doctor.

Congress created AHRQ’s predecessor, the Agency for Health Care Policy and Research, in 1989. The purpose was to “enhance the quality, appropriateness, and effectiveness of health care services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical practice and in the organization, financing and delivery of health care services.”

In short, the agency was empowered to conduct research and use it to influence treatment decisions. AHCPR released 19 clinical practice guidelines between 1992 and 1996.

One of these guidelines addressed low-back pain. The 1994 guideline led to strong opposition from the medical industry and helped expose the agency’s development and use of federal treatment protocols to direct the practice of medicine.

The House Budget Committee also accused the agency of performing an “advocacy role” for President Bill Clinton’s failed health care reform plan. Republican members of Congress placed the agency on a hit list for elimination in 1995.

Despite Republicans being in the majority, it was not eliminated.

Lawmakers narrowly preserved the agency, and in 1999 renamed it the Agency for Healthcare Research and Quality.

_{AHRQ Headquarters. Source: Wikicommons}

AHRQ backed away from directly writing federal clinical practice guidelines, but it continued promoting government-issued treatment protocols and government-defined “quality” measurements.

Compliance with these quality measures often determines how much a doctor or practice is paid. Once a quality measurement or treatment protocol is published, or programmed into an electronic health record, hospital system or payment requirement, it can control what a doctor documents, orders and does in the exam room. The patient’s individual needs can take second place to satisfying a standardized federal metric.

Until it lost federal funding in 2018 under the first Trump administration, AHRQ also operated the National Guideline Clearinghouse, a federal website that collected and promoted clinical practice guidelines. In 2023, under the Biden administration, AHRQ announced funding to create a “reimagined” National Guideline Clearinghouse.

But now, the Trump administration has stopped the next annual installments of a list of multi-year AHRQ grants. AHRQ notified researchers of the decision on July 15. At least 104 grants were affected, representing approximately $100 million in taxpayer-funded grant commitments, according to a KFF Health News report (based on an AcademyHealth tabulation).

These cuts in grant funding are an important step to disempowering the agency, but President Trump cannot eliminate AHRQ by executive action alone.

Congress established the agency in federal law, and only Congress can shut it down. CCHF’s letter asks President Trump to call on Congress to repeal Title 42, Section 299 of the United States Code, the law that established AHRQ and its work.

You can help. Call the White House at 202-456-1414 (switchboard) or 202-456-1111 (comments line) and thank President Trump for everything he’s done to disempower the agency. Then, for the protection of patients and medical ethics, call the U.S. Capitol Switchboard at 202-224-3121 and ask your members of Congress to eliminate AHRQ, root and branch.

Read CCHF’s press release on this here.

FreedomFest 2026 brought liberty-minded Americans to Las Vegas last week to celebrate 250 years of American independence. A renewed pride shaped this event — an honest, positive look at America's history and how Americans built the freest nation on earth. This pride came with resolve: a determination to tear down, or step around, the systems of control built to stifle that freedom.

Nowhere is this resolve more needed than in restoring the patient-centered mission of medicine.

CCHF President and Co-Founder Twila Brase took the main stage as a panelist on “Health Care in America.” Health economist John Goodman — president of the Goodman Institute for Public Policy Research — moderated. Her fellow panelists were Andrew Langer, president of the Institute for Liberty, and Andy Schoonover, founder and CEO of CrowdHealth.

The panelists discussed leaving the third-party payment system — where employers, corporate health plans, and government agencies pay the bills and control the decisions — completely behind.

Twila laid out her vision for a parallel system of health care built on CCHF’s 3-C Solution: Cash, Catastrophic Coverage, and Charity. Patients pay cash for everyday care, carry true insurance for major medical events, and rely on charity to fill the gaps. The audience’s enthusiastic applause confirmed what we’ve known for years: Americans are ready for something better.

Earlier that same day, Twila led a breakout session on artificial intelligence (AI) in the exam room — the ambient-listening technology now recording conversations between doctors and patients. Directly after the session, she signed copies of her eight-time award-winning book, Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records, now in its fourth printing.

Interest carried directly from the breakout session to the CCHF booth. Attendees picked up our “Privacy Please” door hangers, a tool patients can use to push back against ambient listening in the exam room.

Three topics came up most often: artificial intelligence in health care, Medicare, and the 3-C Solution.

More Americans are recognizing that control over medical decisions, private information, and the patient-doctor relationship is central to individual freedom.

CCHF also connected with national leaders in education, media, and public policy about future opportunities to bring the message of medical freedom to new audiences. We will share more as these plans develop.

Stay tuned — exciting things are ahead.

by Twila Brase, RN, PHN, President and Co-founder of Citizens’ Council for Health Freedom

America’s founders, which included four dedicated physicians, gave us a great gift.

We will have to fight with all our might (and God’s grace) to keep it. The fight for health freedom is a huge part of that battle.

In 1994, when I started an organization to protect patient and doctor freedom, I had this one thought in mind: “If they take over health care, they’ll take over the country.”

During Covid, we saw that happen. We saw Americans bow to the decrees of public health officials. We saw them stay home, hug loved ones through plastic, keep six feet of distance, wear masks, and get injected. Many of them voluntarily. We saw them shame family members and neighbors. We saw parents tell unvaccinated grandparents to stay away. We saw them report each other using government “snitch” lines.

This tragedy unfolded because most Americans believed the lies they were being told. Most Americans had also forgotten that our constitutional rights overrule the abusive public health directives that were destroying lives, families, education, businesses, our way of life, and access to medical care.

Twila in the early years at a speaking engagement in Minnesota

I wasn’t thinking about these abusive public health powers when I started a health freedom organization. That would come later.

I was thinking about Bill and Hillary Clinton.

When President Clinton addressed the nation over the airwaves of the four major national TV networks on September 22, 1993, he discussed his Health Security Act of 1993 and held up a “health security card” his administration would issue to all of us. I knew this must never happen. That night is when the idea of an organization to protect health freedom first emerged. Today it is called Citizens’ Council for Health Freedom, or CCHF.

The Clinton plan would have placed all of us into a regional network of government -controlled health maintenance organizations (HMOs). Private insurance would be no more. The 3,200-page bill also included treatment protocols issued by the federal government, national ID numbers for patients and doctors, and a national electronic health record system.

C. Everrett Koop and Hillary Rodham Clinton promoting universal health insurance

Source: Wikicommons

The plan failed in 1994, but the Clinton plan is well on its way to completion — with a lot of help from President Obama. His 2010 Affordable Care Act eliminated real health insurance — major medical, catastrophic coverage for insurable events. It forced everyone into a “qualified health plan,” today’s name for the Clintons’ HMO.

In1996, Congress imposed four national ID numbers using HIPAA. However, the Unique Patient ID (UPI) has been stopped by former Congressman Ron Paul (R-TX), U.S. Senator Rand Paul (R-KY), and CCHF, through our ongoing work focused on stopping a national patient ID.

In 2009, the national electronic health record system was established. Check if your doctor participates in the federally funded eHealthExchange.org. The 2009 American Recovery and Reinvestment Act, signed by President Obama just four weeks after his first inauguration, included another smaller (407-page!) act, the HITECH Act (Health Information Technology for Economic and Clinical Health Act), which included a mandate that doctors and hospitals digitize data and use government-approved electronic health records (EHRs).

Barack Obama signs American Recovery and Reinvestment Act of 2009 on February 17. Source: Wikicommons. Photo by: Pete Souza.

The mandate included a threat. Doctors and facilities that fail to use a government-certified EHR – CCHF calls it a “Government EHR” – for purposes defined by the government in its “meaningful use” rule, will receive lower or no Medicare payments. Those computers in your exam rooms are there by government dictate, not your convenience or physician preference.

The EHR mandate had a bigger purpose. The mandate to socialize the health DATA system through digitization was enacted as part of Obama’s plan to socialize the entire health CARE system. Through a national digitized patient data system, all patients could be profiled and all physicians controlled—and AI could standardize and ration care to everyone with no one for patients to blame except the computer.

This way Congress can promise access to every health care treatment under the sun while guaranteeing access to nothing.

What would America’s Founding physicians think of the 21^st century version of health care?

NOTE: they probably would not even understand the word. They practiced medicine, not “health care.”

John Trumbull’s painting, Declaration of Independence. Source: Wikicommons.

As a reminder, as American patriots first, and physicians second, they pledged to each other their Lives, Fortunes and sacred Honor.

These men were no shrinking violets. They committed treason against England to establish a constitutional republic in America for themselves, their posterity, and generations to come, including us.

Of the 56 signers of the Declaration of Independence, four were practicing physicians: Benjamin Rush of Pennsylvania, Josiah Bartlett and Matthew Thornton of New Hampshire, and Lyman Hall of Georgia. A fifth signer, Oliver Wolcott, studied medicine but never practiced.

Let’s look at each of them. Of key importance:

• Dr. Bartlett never stopped practicing, despite becoming chief justice and governor.

• Dr. Hall, keen on serving the people, went from preacher to physician to governor.

• Dr. Rush, the only one with a formal medical degree, became Treasurer of the U.S. Mint under President John Adams.

• Dr. Thornton was a country doctor, who served in New Hampshire’s government and judiciary.

Dr. Josiah Bartlett (1729–1795) — New Hampshire

Dr. Josiah Bartlett. Source: Wikicommons.

Dr. Bartlett was a physician who never stopped practicing, the founder of the physician-led New Hampshire Medical Society, and the first delegate to vote to adopt the Declaration of Independence.

Key points

• Began studying medicine at age 16, trained under local doctors, and built his own practice in Kingston, New Hampshire.

• The first delegate to vote for adoption of the Declaration of Independence.

• One of the most influential members of the Continental Congresses.

• Later served as chief justice and governor of New Hampshire.

• His interest in medicine never abated during his long public career. In 1791 he secured a charter from the state legislature for the New Hampshire Medical Society — a physician-led, state body, not a federal one.

Dr. Lyman Hall (1724–1790) — Georgia

Dr. Lyman Hall. Source: Wikicommons.

Dr. Hall was a noted career-changer. He was a preacher who left the pulpit for the practice of medicine and later served as governor of Georgia.

Key points

• Began as a preacher in Connecticut, then left that to study and practice medicine.

• Moved with a group of New England Congregationalists to Georgia, where he practiced medicine before becoming a delegate to the Continental Congress.

• Later served as governor of Georgia.

Dr. Benjamin Rush (1745–1813) — Pennsylvania

Dr. Benjamin Rush. Source: Wikicommons.

Dr. Rush was the best-known of the four physicians, and the only one with a formal medical degree. About liberty, he said, “Without this there can be no virtue, and without virtue there can be no liberty, and liberty is the object and life of all republican governments.”

Key points

• Probably the best-known American physician of his day.

• Graduated from the College of New Jersey (Princeton), trained six years under a Philadelphia physician; earned a medical degree at the University of Edinburgh in 1768.

• Organized a medical school at the University of Pennsylvania in 1791.

• Served as surgeon general of the Continental Army, 1777–1778; left over differences with George Washington.

• Appointed by President John Adams as Treasurer of the United States Mint (1797-1813).

• Often called the father of American psychiatry; his 1812 treatise was the first American work on diseases of the mind.

• A prison-reform, anti-slavery, and education reformer.

Dr. Matthew Thornton (1714–1803) — New Hampshire

Dr. Matthew Thornton. Source: Wikicommons.

Dr. Thornton was a country doctor and the second New Hampshire physician among the signers.

Key points

• A delegate from New Hampshire.

• Signed the Declaration later — he was not present on August 2, 1776, and added his name afterward.

• Served in New Hampshire’s provincial government and judiciary.

What would these doctors think of medicine today?

These four independent-minded physicians risked their lives to vote for and sign a document declaring their right to escape the British monarchy and establish a constitutional system of self-governance in America.

Then they went home and practiced medicine as independent men answerable only to their patients—and God.

If they returned today to the U.S. for a visit, they would probably be shocked to see:

• the mission of medicine taken over by the business of health care.

• the growth of health care administrators vs. the growth of physicians

• federal government ruling over the practice of medicine through payment schemes and hundreds of thousands of rules and regulations.

• medical decisions under corporate and federal control.

• exploitation of patients, doctors, and medical data for the purposes of self-serving third parties.

• third-party payment making care unaffordable and inaccessible — and being used to take patients and doctors out of the driver’s seat.

I think, however, that they would be relieved and delighted to see CCHF, our organization, and other free-market institutions operating in the U.S. to bring the mission of medicine back to America. They would likely appreciate CCHF’s 3-C solution to restore to America an affordable, patient-centered, privacy-focused, ethical, free-market system of:

• Cash

• Catastrophic Coverage

• Charity

On July 4^th, we celebrate America’s Independence Day and the 250^th anniversary of our founding—one of the riskiest and most important endeavors in world history. Let us, like the Founding Fathers, dedicate our lives, fortunes, and sacred honor to making sure that future Americans can celebrate in freedom the 500^th anniversary of that historic day when inspired leaders of the American colonies claimed the God-given right to be free!

In 1776, securing freedom began with a radical idea (independence), a pen, a piece of parchment, and 56 brave men, including four physicians.

In 2026, and the years to come, defending freedom is up to everyone who is blessed to be able to say these words: ‘I am an American.”

Happy American Independence Day!

Notable History:

Today, July 2^nd, marks the day John Adams believed Americans would remember forever. After the Continental Congress voted for independence on July 2, 1776, Adams wrote to his wife Abigail: “The Second Day of July 1776, will be the most memorable Epocha, in the History of America.” He was right about the day’s importance, but Independence Day in America came to be celebrated on July 4^th, the day the Continental Congress approved the Declaration’s final text and sent it to be published. The engrossed parchment copy was signed a month later, on August 2, 1776.

Our previous article, “AI Has Entered Your Doctor’s Office — and It’s Recording,” examined how ambient listening tools are turning private exam room conversations into digital records, often without your permission.

This second article follows the record after the visit, showing how patient data can be sold, fed into AI systems, used in coverage decisions, and exposed through the government-mandated electronic health record infrastructure.

Once AI turns a doctor’s visit into data, the health care system can move, sell, analyze, and use that record long after the appointment ends.

Your Patient Records Are Being Sold

AI scribes are one data pipeline into the health AI industry. They are not the only ones.

Patient records are already feeding commercial AI development. The Mayo Clinic transferred de-identified patient data to 16 companies over two years for commercial development of health AI products. Truveta launched a project to pair genetic data from up to 10 million consented with existing health records. Other companies buy de-identified patient records from hospitals and resell them to AI developers and researchers.

The Health Insurance Portability and Accountability Act (HIPAA) — the 1996 law that led to the 2003 federal “HIPAA rule,” which patients believe protects their privacy — is the legal mechanism that makes the sharing of your data possible. We have written extensively about HIPAA’s role as a permissive data-sharing rule, not a privacy law.

The U.S. Department of Health and Human Services (HHS) acknowledged in a 2010 rule that HIPAA permits 2.2 million entities to access patient data. It also allows patient data stripped of obvious identifiers to be sold without consent if those who hold your data choose to sell it. HHS has acknowledged that so-called “de-identified” data could be re-identified.

In 2009, Congress used the HITECH Act to push electronic health record (EHR) adoption across hospitals and clinics through federal incentives and penalties tied to “meaningful use.” These networked systems collect, store, and transmit patient data electronically. They then extended that network further through creation of the eHealth Exchange data system and nationwide interoperability requirements, including the Trusted Exchange Framework and Common Agreement (TEFCA).

AI now sits on top of this entire architecture — ingesting records that patients never agreed to share, at a scale no previous technology could achieve. That data doesn’t just move through the system – it is increasingly used to make decisions about your care.

AI Is Denying Your Care

Created by CCHF

The data flowing through EHRs does more than feed AI training sets and consumer health apps. Health insurers are feeding it into AI systems that are used to decide whether patients receive treatment at all.

Prior authorization is the process by which a health plan must approve a treatment, medication, or procedure before a patient can receive it. Health plans have begun to automate this gatekeeping function using AI. Physicians are already seeing the effects. Three out of five physicians — 61% — report concern that health plans’ use of AI is increasing prior authorization denials, producing systematic care refusals with little or no human review. AI tools have been accused of producing denial rates in some cases 16 times higher than typical.

The outcome data is striking. A January 2026 study in Health Affairs cited by Stanford researchers found 82% of appealed prior authorization denials in Medicare Advantage plans are ultimately overturned in the patient’s favor. This figure does not mean AI is identifying fraud or preventing unnecessary care —it means patients who have the time and determination to fight a denial win more than four out of five times. The catch is that barely 0.2% of denied prior authorization decisions are appealed, leaving most denials unchallenged.

Thus, health plans running AI systems across millions of prior authorization requests face almost no challenge to the denials generated by their technology—and reap all the financial benefits.

The AMA survey also found that more than one in four physicians claim prior authorization requirements have led to a serious adverse event for a patient — including hospitalization, permanent impairment, or death. More than 90 percent of physicians reported that prior authorization has a negative impact on patient clinical outcomes.

On January 1, 2026, the Centers for Medicare and Medicaid Services (CMS) expanded AI’s role to the care of senior citizens in Original Medicare. CMS launched the Wasteful and Inappropriate Service Reduction (WISeR) Model, introducing AI-assisted prior authorization for select services in six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — affecting nearly 1 in 5 Original Medicare beneficiaries nationwide. Patients have no way to know if AI drove the decision that denied their care. No obligation exists for Medicare or its AI contractors to disclose whether AI or algorithms were used in any coverage determination.

WISeR was a topic of focus in an April 22^nd Senate Finance Committee Hearing. U.S. Senator Maria Cantwell (D-WA) released a report based on data from 16 hospitals in Washington state, which showed that patients are waiting two to four times longer for medically necessary procedures than they were before the release of the WISeR pilot program.

Sen. Cantwell also pointed out that the government is paying private companies that use AI to authorize or deny claims — and that these companies are paid a percentage of savings from each denial. She told U.S. Health and Human Services Secretary Robert F. Kennedy Jr. that “AI is being used as a denial device for the CMS system.” The data AI uses to make these determinations come from the Electronic Health Record — the government-mandated digital record system. Patients have not meaningfully consented to having their records be used this way.

The Vulnerabilities Caused by Digital Data

Every electronic health record (EHR) sitting inside every hospital, clinic, and health system in the United States runs on software. Software contains vulnerabilities. Until recently, finding and exploiting those vulnerabilities required rare skill and months of work. AI is making that process quicker and easier.

Anthropic — an AI company — revealed in early April 2026 that it had developed a new AI model called Claude Mythos. Testing showed it could identify software vulnerabilities at a speed and scale beyond what human security teams could match — identifying thousands of high-severity flaws in major operating systems and web browsers, including some that had gone undetected for decades. Anthropic decided the model was too dangerous for public release.

The concern is not limited to Claude Mythos. Anthropic’s own offensive cyber research team concluded that within six to twelve months, AI with comparable capability could be broadly distributed — including by actors outside the United States. The direction is clear; the time requirements and specialized skills required to find and exploit software vulnerabilities are shrinking. What previously demanded rare technical expertise will soon demand far less.

Health care is among the most exposed sectors. The Chief Security Officer of the Health Information Sharing and Analysis Center said AI tools of this class could shrink the window for a cyberattack from months or days down to hours and minutes. A successful attack on a hospital’s EHR system does not only expose patient and financial data; it can shut down the entire facility, leaving doctors in the dark and patients in dire straits.

This is the reality. An interconnected, government-mandated, digital health record infrastructure, networked across institutions, accessible to thousands of entities, now feeding AI systems for documentation, research, data sales, and care denials — faces a cybersecurity environment where the cost of an attack is falling and the scale of exposure grows with every new connection point.

AI did not create this digital health record infrastructure. Congress and federal agencies did, first by pushing electronic health record adoption across hospitals and clinics, then by expanding nationwide interoperability requirements that move patient records across institutions. AI is now being layered onto that system, using the data it collects, stores and exchanges.

Patients who want to escape this vulnerable system can find direct-pay, independent physicians at JoinTheWedge.com (click on video below). They can also do internet searches for “direct primary care (DPC),” or “cash-based doctor,” or “private practice.” Practices operating independently (outside corporate health systems, outside corporate EHR networks and outside state, national, and corporate health information exchanges (HIEs) have a much smaller data footprint. What is said in the exam room is more likely to stay there.

This exploitative system was built without your consent — and those who built it, and are profiting from it, have no intention of asking for your consent now.

To protect themselves better, patients can ask direct questions: Is a device going to record our conversation? Is my record shared through a health information exchange? Can my data be sold or used for AI development? Does this practice use AI in documentation, billing, prior authorization, or care decisions?

Patients were never asked as this system was built around them. They should start asking now.

Photo by: Twila Brase

On March 5, 2026, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing titled “Transforming Health Care with Data.” What stood out wasn’t conflict or debate. It was an alignment.

Republicans and Democrats, regularly divided on nearly every topic, moved in the same direction here. The goal was clear and repeatedly affirmed:

• Expand the flow of medical data

• Connect systems across the country

• Integrate artificial intelligence

• Accelerate the transition to a fully interoperable digital health infrastructure

The language used to describe this push to expand and connect medical data systems was reassuring. They framed the effort as “patient empowerment,” improved coordination, and better outcomes. But for those listening closely, a different picture emerges — one that only makes sense if you understand how this system was built in the first place.

Electronic Health Records (EHRs) were not simply adopted to improve care; they were pushed into place through federal policy and mandates. Beginning in 2009, the government used financial incentives, followed by penalties, to force hospitals and physicians into government certified electronic systems. Today, nearly all hospitals are using EHRs — not because the market naturally evolved that way, but because opting out promised to be financially untenable and debilitating.

These systems were never designed just to digitize paper charts. They were structured to collect standardized data, facilitate reporting, and allow that information to move across networks. What began as recordkeeping has steadily become infrastructure.

This infrastructure is now being connected at alarmingly accelerated rates

During the hearing, Dr. Thomas Keane, M.D., who leads federal health IT efforts as the National Coordinator for Health Information Technology (ONC) described his office’s top priority using a phrase that came up repeatedly — “data liquidity,” with the goal to make health information move seamlessly across systems, providers, and platforms.

Screenshot: Senate HELP Committee Republicans, “Transforming Health Care with Data: Improving Patient Outcomes Through Next-Generation Care,” March 5, 2026, video

The federal government’s Trusted Exchange Framework and Common Agreement — TEFCA — now links approximately 70,000 health care locations and enables the exchange of more than 500 million patient records. When Dr. Keane first took office, the number was closer to 10 million. The expansion has been rapid and is ongoing.

TEFCA functions as a nationwide data-sharing backbone. Once organizations connect, information can move between them under a common framework. The system is designed to operate continuously, and in many cases, invisibly to the patient.

The assumption underlying this nearly 50-fold expansion is that more data sharing is inherently beneficial. That assumption went largely unchallenged during the hearing.

HIPAA was referenced as a safeguard, but its actual role is often misunderstood. HIPAA doesn’t protect you from this. The 1996 Health Insurance Portability and Accountability Act permits 2.2 million entities to access your medical records without your consent if those who hold your records choose to share them.

In practice, once data is inside the system, it can be distributed broadly, depending on how the organizations holding it choose to use it. TEFCA does not alter that framework; it extends it by making data exchange faster and more comprehensive.

The hearing made the endgame clear.

Dr. Keane described his vision:

“In the not so distant future, an individual with multiple chronic conditions can keep all of their health information in one secure digital place and share it instantly with a new provider, a caregiver, or even a secure, trusted app, no matter where they live or where they receive care.”

What he described is a national health dossier on every American that is accessible and shareable — operating as the ONC’s own roadmap states, “in the background” and without your written permission.

As the system expands, so does the range of participants.

Senator Tim Kaine (D-VA) applauded the fact that financial incentives pushed 96 percent of hospitals into electronic health records. He then complained that the incentives hadn’t yet reached behavioral health providers, long-term care facilities, and social services agencies. Dr. Keane assured him they’re working on it. They’ve already built a data set that allows exchange between traditional health providers, behavioral health providers, occupational providers, vocational service agencies, and housing assistance agencies.

Screenshot: Senate HELP Committee Republicans, “Transforming Health Care with Data: Improving Patient Outcomes Through Next-Generation Care,” March 5, 2026, video

When a patient is discharged from a behavioral health or substance use crisis, Dr. Keane said,

“we want to make sure that their medical information as well as their social needs are properly communicated to social service agencies, vocational health agencies, and the like.”

Read that again. Your mental health records, substance use history, and social needs — shared with housing agencies and vocational services.

Senator Kaine said the goal of the hearing was to “knock down silos that keep patient data separate.” These silos aren’t failures. These silos are the last remnants of medical privacy in America. Knocking them down doesn’t empower patients. It exposes them.

Then came the AI conversation.

Chairman Bill Cassidy (R-LA) asked the right question: When a patient uploads their medical data to an AI platform, does HIPAA protect them? Dr. Keane’s answer was clear. If a patient downloads their records and uploads them to an AI tool, that falls outside the purview of HIPAA. The AI platform is not a covered entity. HIPAA does not apply. The federal government cannot regulate what patients do with data they’ve chosen to release. Given how broadly your medical data is already shared inside HIPAA-regulated systems, this is a moot point.

Screenshot: Senate HELP Committee Republicans, “Transforming Health Care with Data: Improving Patient Outcomes Through Next-Generation Care,” March 5, 2026, video

Senator Cassidy suggested a pop-up warning might help.

A pop-up. That’s the protection Congress is considering for the most sensitive personal information Americans possess?

Here’s what was missing from the entire hearing— PATIENT CONSENT. The word appeared only in the context of what patients have already given up, or in the context of why the federal government can’t regulate data after the fact. Nobody asked whether patients had consented to having their records flow through TEFCA. They didn’t ask whether patients had agreed to become nodes in a federal health data network connecting housing agencies, vocational services, insurance companies, and AI platforms.

Senator Alsobrooks (D-MA) asked one good question in relation to AI: “Are we strengthening guardrails or weakening them?” She noted that innovation without accountability doesn’t build trust, and in health care, trust is everything. Dr. Keane assured her that the Assistant Secretary for Technology Policy office is “absolutely forensic” in examining AI. He is putting out an RFI.

Screenshot: Senate HELP Committee Republicans, “Transforming Health Care with Data: Improving Patient Outcomes Through Next-Generation Care,” March 5, 2026, video

An RFI. A request for information. With more than 500 million health records already flowing through a federal network, and more added over time, the government is only now going to ask about the security of the data?

Warnings that CCHF has shared for nearly three decades are now undeniable: the government’s electronic health record was never primarily about patient care. HIPAA opened the door to broad data sharing without written patient consent. Federal EHR policy pushed doctors and hospitals into government-certified electronic systems. TEFCA is now connecting those systems into a nationwide exchange. This hearing showed the next step: more data movement, more participants, more AI and less patient control.

You may get some convenience. They get control.

State legislators can still act. States with medical privacy laws that are stronger than HIPAA — laws that actually require patient consent for data sharing — can stop some of this. Minnesota’s Health Records Act has done it. Montana’s genetic privacy law has done it. The fight is not over.

CCHF has developed model legislation to restore patient privacy and consent, including genetic privacy protections and patient consent requirements for data sharing. If you are interested in bringing this model legislation to your state, please contact us. See CCHF’s Genetic Privacy One-Pager and the Patient Privacy and Consent One-Pager for more information. But you need to know what is being built. This hearing showed you the blueprint.

Last July, a patient walked into a San Diego clinic for a routine physical and left believing the conversation with his doctor had been private. A recording device captured the entire visit without his knowledge, transmitting the audio to a third party that generated the clinical note. Only later, when he reviewed his patient portal, did he discover the record claimed he had been informed and had agreed to the recording. He had not agreed to the recording; in fact, he didn’t know about it at all. He subsequently filed a lawsuit.

This case is now one of several. Patients in California and Illinois have raised similar claims against health systems using AI recording platforms in exam rooms without clear notice or meaningful consent.

What these cases reveal is not a one-off failure. They reveal a shift that has already taken place. AI is no longer being tested at the edges of health care. It is inside the exam room itself, layered onto a data infrastructure that was built without patient consent as its foundation.

The Quiet Expansion of “Ambient Listening”

Hospitals and clinics describe these tools as AI scribes. These computer systems function as always-on listeners, converting conversations into structured records to reduce burden on physicians.

Patients now pay the price: their most vulnerable conversations may be recorded, transcribed and processed by AI programming.

In one clinic, a physician walked into the room holding his phone and casually mentioned that he would be recording the visit. When the patient objected, he hesitated and explained that the documentation would not be “as complete.” The patient held her ground. Only then did he turn it off and put it away.

Another patient went through an entire appointment without any mention of recording. Only at the end did the clinician add, almost as an afterthought, that the visit had been recorded. When challenged, the explanation was simple: he had meant to ask but forgot.

Some exam rooms do not include a direct request for consent at all. Instead, signs on the wall inform patients that “ambient listening” is in use and that remaining in the room constitutes consent. The patient, vulnerable and in need of medical care, is forced to make a choice the patient should not have to make. Walking out is often not an option, and by staying, they are treated as having consented. A signature on a consent form is not really consent. It’s a form of coercion.

This is what “consent” now looks like in many places.

A peer-reviewed study indexed by the National Library of Medicine found that patients can unknowingly agree to AI scribe recordings through consent language buried in documents they do not fully read. Patient visits can then be turned into raw material for commercial AI development.

The AI-generated note that enters the electronic health record (EHR) — the government-mandated digital record system, now present in virtually every clinic and hospital — may contain errors, misattributions, or fabrications that researchers call “hallucinations.” A MedStar Health study found errors in 70% of AI-generated draft notes.

What Gets Recorded?

The assumption behind ambient listening tools is that they capture pertinent information. In reality, they capture everything that is said. Every word.

This distinction matters more than it sounds.

A medical visit is not a scripted exchange. It includes side conversations, emotional reactions, and moments when patients are not carefully choosing their words. It includes what happens when the clinician steps out of the room, and the patient speaks privately with a spouse or a parent.

Words said during these private, unguarded moments are now at risk of being recorded, transcribed, and encased in a permanent record.

One of the concerns raised in discussion of AI scribe recordings is not theoretical. Imagine a parent in the emergency room with a child, speaking candidly with a spouse while waiting for the doctor to return. A comment made in frustration or fear — something that would never have been documented in the past — is now captured. Once it is in the record, it can be accessed, interpreted, and potentially used in ways the patient never anticipated, including in interactions with authorities.

Another scenario is more mundane but no less consequential. A patient involved in a car accident is careful when speaking to the doctor, but less guarded when speaking privately to a family member. If both conversations are recorded, the difference between them may become discoverable in a legal dispute. Imagine if what was once an off-the-record moment becomes part of a formal record.

AI scribes do not distinguish between what is clinically relevant and what is not. They simply collect. Everything.

When the Record Changes the Story

Recording is only the first step. The next is interpretation.

AI scribes convert speech into structured notes, organizing conversations into categories like symptoms, history, and treatment plans. This process forces AI systems to make judgment calls about what was said, what it meant, and in what order it happened.

These judgment calls are not always correct.

Physicians who have worked with ambient listening tools describe a pattern that is easy to miss if you are not looking for it. Much of what the AI recording platform produces appears accurate, which builds trust, until a detail is inserted that is simply not true. AI fills in gaps, smooths inconsistencies, and occasionally fabricates connections that were never there. But how will you know?

Everyday errors can be inconvenient. A medical record error becomes part of the patient’s documented history. It is deemed to be “truth.”

At that point, the responsibility for catching the error shifts to the patient, who may not know the recording occurred and may not even think to review the note or may be given only a summary of the full note. The error may go unnoticed until years later, if ever.

What Patients Can Still Do

Today, patients can ask a simple question: Is anything or any device in this room recording our conversation?

Simply asking changes the dynamic. It makes the invisible visible, at least for a moment. It puts the advance of ambient listening in question. Anyone who hears the question won’t forget. The ethical and moral element inserted by that question cannot be ignored.

Some clinicians may respond by turning off the device. Others may not have this flexibility. But you need to know, and they need to know that you know. Knowing changes everything.

Some independent practices operate outside large, interconnected data systems. Their documentation is often more limited, and the flow of information more contained. They are not the norm, but they do exist. Asking the question will encourage other practices to join them.

What Has Already Changed

There was a time when the doctor’s office was understood to be private by default. This assumption no longer holds.

Today, there may be a device listening, a software system processing, and a third party receiving the result — all without a direct conversation with the patient about that reality or what this means.

AI did not force its way into the exam room. It entered through a system that had already made room for it.

AI is now in the room, and it is not simply observing.

It is recording, organizing, and increasingly shaping what happens next.

Your Question:

What is the organization’s position on the Save America Act? I know we are working to resist and encourage people to resist the lure of real ID. But when I look at the provisions of the Save Act, it looks like top on the charts, as far as being able to register and being able to vote, is to get a real ID.

CCHF Answer:

It is helpful to have a bit of background on the Save Act to avoid potential confusion.

• There are two “SAVE” acts. Both were introduced by Congressman Chip Roy (R-TX).

• The first is the SAVE Act (H.R. 22), introduced in the House in January 2025. It passed the House and has been sitting in the Senate since April 2025.

• The second is the SAVE America Act (H.R. 7296). It was introduced in January and was referred to the House Committee on Administration.

First, please keep in mind that this bill is focused on registering to vote in a federal election, not voting itself. Congress has constitutional authority to act based on federal elections, not state elections. However, most elections have both state and federal candidates on the ballot.

Both bills have identical provisions regarding what documentation is needed to register to vote for an “election for federal office.” The Save America Act is the one receiving media attention.

Importantly, there is a common misconception that a REAL ID is sufficient under either bill to prove U.S. citizenship. Both bills state that a REAL ID that “indicates citizenship” is sufficient to register to vote for a federal election.

But this language refers to a specific type of REAL ID, an Enhanced Driver’s License (EDL).

The EDL has an American flag and is available only in five northern border states—Michigan, Minnesota, New York, Vermont, and Washington (Ohio’s legislature has authorized the EDL, but the state has not begun issuing them). The EDL acts as a passport permitting travel between the U.S. and Canada, Mexico, and many Caribbean nations by sea or air.

A “standard” REAL ID (not the EDL) is not proof of citizenship for any purpose, including registering to vote under the Save America Act.

Thus, individuals who present a REAL ID to register to vote must also provide proof of citizenship. For most, this means showing a birth certificate, certificate of naturalization, or a U.S. passport. But note that a U.S. passport is a government-issued photo ID that proves citizenship, so if a person has one, there is no need to provide a REAL ID. A passport book or passport card will suffice.

To cast a vote once registered, you only need a photo ID. Currently, a registered voter would only need to reregister if they had a triggering life event, such as a move or name change.

Let your family, friends, and neighbors know these critical facts:

• The SAVE America Act is solely about voter registration for federal elections (Congress and the U.S. President)

• REAL ID by itself is insufficient for voting registration under the proposed bill, unless it’s an Enhanced Driver’s License or Enhanced ID.

• REAL ID would not be necessary to vote or to register to vote. There are other options.

• The REAL ID is a biometric federal ID under federal control that is being digitized and put on phones by state DMVs.

• Federal law allows REAL ID to be required for purposes far beyond flight in the future.

• If you have a REAL ID, switch back to a standard state driver’s license to limit federal power over your movement and transactions, and to protect your 10^th Amendment rights. Only five states require REAL ID and do not give you the right to switch back (Florida, Georgia, Mississippi, Texas, and Wyoming)

• Use a passport or passport card to fly. There are also 15 other TSA-acceptable identification options (see TSA.gov)

Frances Walter broke her left shoulder in a fall and underwent surgery. During her recovery, her Wisconsin Medicare Advantage plan relied on an algorithm to set a strict limit of 16.6 days in a nursing facility. When day 17 arrived, coverage stopped, even though medical records showed she was still unable to dress herself, use the bathroom without help, or control her pain.

A federal judge later criticized the decision as “at best, speculative.” But by that point, Frances had already exhausted her savings to qualify for Medicaid. She passed away in December 2022, after spending her final years fighting for the care she needed.

Now, the Trump administration and Republicans in Congress want to automatically place every new Medicare recipient into a plan just like the one that denied Frances—for three years. Without consent.

These private health plans under government contract follow different rules than Original Medicare, allowing denial of care per health plan criteria, not treatment per doctor’s orders.

H.R. 3467, introduced by Congressman David Schweikert (R-AZ) in May 2025, would place every new Medicare beneficiary without their consent into the lowest-premium Advantage plan in their ZIP code at enrollment.

The bill includes an opt-out option but provides no specifics on when the opt-out option ends, how seniors will be informed it exists, or what it would take a senior to switch from Medicare Advantage (MA) enrollment to Original Medicare.

It appears that anyone who does not opt out may be locked in for three years — unable to switch plans or return to Original Medicare unless the federal government determines they qualify for a hardship exemption. But since there is no opt-out language in the bill, we do not know how it would ultimately work.

Now, the Trump administration is weighing a similar policy through executive action, potentially spurred on by the fact that Medicare is projected to be insolvent by 2033 — just seven years from now. Trump’s Medicare administration may also be influenced by the auto-enrollment recommendation in the Heritage Foundation’s Project 2025, which states on page 465: “Make Medicare Advantage the default enrollment option.”

Medicare Advantage does not function like Original Medicare. Original Medicare, sometimes called “fee-for-service Medicare” (because payment is based on each service provided), rarely requires prior authorization, the lengthy process that often leads to denials of care.

Instead, the doctor determines what care is medically necessary for the patient, the Medicare administration pays its allotted portion, and the patient pays the rest. In short, Original Medicare is the “freedom version” of Medicare. Patients can go to any doctor, hospital, or facility anywhere that takes Medicare. This includes about 98% of all doctors and facilities.

Medicare Advantage is an entirely different operation. The Medicare Administration pays these government-favored health plans a fixed monthly amount to manage each enrollee’s care, otherwise known as “per member, per month” or PMPM payments, approximately $1,000 to $1,200 per member per month, per KFF, or around $12,000 to $14,000 per year.

As Donald Berwick, MD, MPP, and former administrator of the Centers for Medicare & Medicaid Services (CMS) once put it:

Despite three government reports issued since 2015 by the HHS Office of Inspector General on rationing by Medicare Advantage plans, the denial of medically necessary, Medicare-approved care continues. The 2018 report found if denials are appealed, 75% of the denials are overturned, but only 1% of denials are appealed because it’s a burdensome process. It turns out that denying medically necessary care is a lucrative strategy.

Now, consider the possible damage from auto-enrolling seniors into Advantage plans.

Seniors may fail to opt out in time to get the care they need. According to Keith Armbrecht, founder of Medicare on Video, the lower the premium, the more restrictive the plan tends to be. This means smaller networks, fewer hospitals, and tighter controls on what gets approved. Furthermore, health plans often require ‘step therapy’ – forcing patients to try (and fail) cheaper treatments first, before it will finally cover the treatment that works, causing added expense, additional office visits, and delayed care. Health plans also restrict which doctors and hospitals a patient may use. Seniors who see specialists outside the plan network may get stuck with the entire bill.

UnitedHealth Group is currently facing a federal lawsuit brought in part by the estate of Gene Lokken, a 91-year-old who fractured his leg and ankle in May 2022. His Medicare Advantage plan cut off physical therapy coverage after 19 days. His family paid approximately $150,000 to continue the care his doctor had ordered. He died in July 2023. The lawsuit alleges UnitedHealth used an artificial intelligence (AI) tool with a 90% error rate to make coverage decisions — and kept using it knowing that only 0.2% of patients ever appeal a denial of care.

According to the American Medical Association, 29% of physicians have watched this kind of denial lead to a patient’s hospitalization, disability, or death.

Despite claims that health plans reduce costs, these corporate health plans do not save money. Medicare is projected to spend $76 billion more on Medicare Advantage enrollees this year than it would if those same patients were enrolled in Original Medicare — a 14% overpayment funded by taxpayers.

This raises Medicare premiums for every senior. Medicare recipients, including those who choose Original Medicare, pay approximately $175 more per year in Medicare Part B premiums because Congress overpays MA plans. KFF’s graphics show how much more costly MA really is.

One way health plans pad their own pockets is through a fraudulent practice called upcoding. Plans add extra diagnosis codes to make patients appear sicker on paper (riskier to the plan’s bottom line), which increases how much the government pays them under the Affordable Care Act (ACA) programs called “risk adjustment” and “risk corridors.”

Eight of the 10 largest Medicare Advantage organizations were found to be coding at higher rates than expected in 2024. The U.S. Department of Justice is now investigating UnitedHealth Group for possible fraud tied to these practices. Previously, Sutter Health Inc. paid $90 million to resolve allegations of submitting unsubstantiated, higher-risk diagnosis codes.

Thus, American workers and Medicare recipients are spending more every year on a program that gives seniors less access to care — and that access is shrinking by the day. For example, hospitals and health systems across the country are dropping Medicare Advantage plans, leaving patients with fewer doctors, fewer hospitals, and fewer real choices.

This reduced access has real consequences. Medicare Advantage cancer patients with complex diagnoses are 1.5 to 2 times more likely to die within 30 days of surgery compared to patients in Original Medicare, according to 2022 study published in the Journal of Clinical Oncology by researchers at City of Hope.

Let’s look at what could happen if Congressman Schweikert’s bill (H.R. 3467) becomes law.

A senior citizen auto-enrolled on January 1 who discovers in February that her oncologist is out of network will likely not be allowed to switch plans, and she will likely not be allowed to switch to fee-for-service, go-to-any-doctor Original Medicare until October. She may be forced to wait up to three years, unless she can prove a qualifying hardship or unless yet unwritten federal regulations allow it. We have no idea what kind of regulations might be written.

Rep. Schweikert himself acknowledged at a July 2025 House hearing that MA has become a “bastardized” program, with lawmakers from both parties calling out the industry for upcoding and care denials.

So why on earth would Congress pass H.R. 3467 to auto-enroll seniors into this same program and close the door behind them? Is the purpose to lock the door and leave seniors trapped in Medicare Advantage for at least three years?

This is the camel’s nose under the Original Medicare tent. Ultimately, the goal is to collapse Original Medicare and force every senior into the care-denying MA program.

This is not a free-market proposal. Free markets require the ability to choose and to leave. Auto-enrollment with a three-year lock removes both.

If President Trump and Congress want to stop the race into Medicare insolvency, why not let seniors voluntarily opt out of Medicare and purchase real health insurance, the affordable major medical indemnity policies that pay solely for catastrophic and insurable events?

Today, seniors are essentially forced to stay in Medicare due to a 1993 Clinton policy that ties access to Social Security benefit with enrollment in Medicare Part A.

Congress should set seniors free. Their lives depend on it.

What You Can Do

Read Citizens’ Council for Health Freedom’s Medicare How-To Guide, which contains information and analysis found nowhere else, including how to avoid 10 Medicare traps.

Contact U.S. Representative David Schweikert (R-AZ) at 202-225-2190. Contact the House Committee on Ways and Means at 202-225-3625. Tell your own U.S. Representative and U.S. Senator to oppose H.R. 3467 and any proposal that defaults senior citizens into MA plans or locks them in for any period of time. Freedom demands exit ramps, not locked doors.

Freedom also demands independent doctors that work for patients, not payers. Whether you are in Medicare, privately insured, or uninsured, find an independent, cash-based physician that works for you at JoinTheWedge.com.

Frances Walter and Gene Lokken deserved better. We cannot allow America’s seniors to be locked into a program which threatens their lives with no way out.

After our first post — 23 Years Without Medical Privacy in America — your questions started coming in immediately.

Diane wants to know if a physician can legally refuse to see her if she refuses to sign the HIPAA form—and what alternatives she has.

Suzette has already signed and wants to know if she can take it back.

Debbie asked how to find an app to opt out of consent.

Ian asked how he can deny access to his vital data.

These are questions every patient should be asking. So, let’s answer them.

Can a physician refuse to see me if I won’t sign the HIPAA form?

HIPAA does not require you to sign the acknowledgement statement, and no law or rule instructs or permits your doctor to deny care if you refuse.

So, the short answer is no. However, some clinics and doctors may refuse to see you because their attorneys have told them they can be charged by the federal government with a very expensive HIPAA violation if they do not get your signature. However, this is not true.

Here are the facts:

The federal HIPAA rule only requires providers to make a “good faith effort” to obtain your signature on the Notice of Privacy Practices (NPP) acknowledgement statement (“HIPAA form”). As the Notice of Privacy Practices web page on the U.S. Department of Health and Human Services (HHS) website states:

The same HHS page adds: “If you refuse to sign the acknowledgment, the provider must keep a record of this fact.”

The federal rule requires THE STAFF to document your refusal; YOU don’t need to do anything. The rule also says nothing about allowing doctors to deny care.

When a chiropractor told a patient “It’s the law” after she refused to sign, she was turned away. It wasn’t the law; it was a misrepresentation of the law — one that HHS’s own website contradicts.

The best way to get the care you need without signing the statement is to go to the HHS web page and show it to the staff on your phone. Once they see bullet #1 (the law does not require) and bullet #4 (if you refuse), their demands and claims of denial usually disappear. Find the HHS web page at: https://bit.ly/HIPAAHHS.

If a provider denies you care because you refuse to sign, you can file a HIPAA complaint with the HHS Office of Civil Rights. That is the only federal remedy.

But won’t refusing to sign just hurt me?

Many people assume that signing the HIPAA form ensures that their medical data is kept confidential between themselves and their doctor. This is not the case.

The Notice of Privacy Practices is a notice of disclosure practices — a list of all the ways your data can be shared without your consent. Signing it doesn’t stop any sharing of your information. It only confirms that you received the notice. Refusing to sign doesn’t change the outcome either, because HIPAA permits the sharing whether you sign or not—unless your state has passed a state medical privacy law that protects you from HIPAA.

What signing does accomplish is simple: you are exercising your right to refuse to participate in the government’s deliberate deception called HIPAA.

I already signed. Can I take it back?

Once you have signed an acknowledgement of receipt, you cannot un-sign it. This is of no concern. The acknowledgement only states that you received the notice — it doesn’t grant new permissions for your data that didn’t exist before. Your data was already subject to HIPAA’s permissive sharing rules the moment you became a patient (unless your state has passed a state medical privacy law). Getting you to sign it is simply part of the ruse to convince you that you have privacy when you have none.

The practical next step is to refuse to sign going forward. The form or acknowledgment statement appears at registration — not just once, but at each new doctor’s office, annual visits, and hospital admissions. Each visit is a new opportunity to refuse.

The CCHF Refuse to Sign HIPAA card is a wallet-sized reference you can carry and present at check-in, but the “show them the HHS website on your phone” method works the best!

How do I actually refuse in the exam room?

The request to sign the HIPAA form almost never happens in the exam room itself. However, when it comes to actually refusing to sign in the front office, take these steps:

As noted above, the simplest method is to use your phone.

Open the HHS Notice of Privacy Practices page at https://bit.ly/HIPAAHHS or screenshot it before you go.

• Show the staff the first bullet: “The law does not require you to sign the ‘acknowledgement of receipt of the notice.”

• Show the fourth bullet: “If you refuse to sign the acknowledgment, the provider must keep a record of this fact.”

For many front-desk staff, seeing it on the government’s own website ends the argument.

Where is the HIPAA form found?

The form—actually the Notice of Privacy Practices (NPP) acknowledgement statement—can appear in different ways. Typically, you are being asked to say that you have either understood, received, or read the NPP. In all the following forms or technologies, look for the words “Notice of Privacy Practices”:

A separate paper form with a single line asking you to acknowledge the NPP. Decline to sign and explain why (show on your phone).

A consolidated consent form where the NPP acknowledgement is buried alongside consent for treatment, consent to be billed, data sharing agreements, and much more—with only one signature line. Cross out the NPP statement specifically. Take a photo before and after.

The full NPP document listing all the ways your data can be shared without your consent (often 2-4 pages long) where you’re asked to sign at the bottom of each page. Decline to sign any page.

An electronic tablet where you’re asked to click “I agree.” Take the tablet to the clerk and tell them you respectfully opt out. If they say the system won’t allow registration without the click, ask for paper forms instead. If they refuse to give you paper forms, ask for the manager. If the manager refuses, ask for the supervisor. By this time, you should have the HHS web page on your phone, ready to share.

An electronic signature pad, the small, 5x5-inch pad where staff hand you a stylus and tell you it’s the HIPAA form. Tell the clerk you never sign anything you haven’t read. Ask for a paper copy and then refuse to sign it. They must give you a paper copy. They cannot force you to sign sight unseen.

In every scenario: take a photo of the blank form, cross out only what you refuse, take a photo after, and ask for a copy of what you signed. Consider sending a copy of the blank form to CCHF (info@cchfreedom.org).

What does signing actually do to my data?

Practically speaking, nothing.

David Brailer, the first-ever and now former National Coordinator for Health IT, said this about HIPAA: “You can’t force a covered entity to give your data to someone you choose, and you can’t stop them from giving it to someone they choose.”

Whether you sign the HIPAA acknowledgement form or not, your private data can be shared in every way listed in the Notice of Privacy Practices (often with your name, address and more), unless your state legislature has enacted a state medical privacy law that protects you from HIPAA.

The signature request is part of a clever ruse. HIPAA permits the sharing of your data regardless of your signature. HIPAA allows you to request restrictions on data sharing, but providers generally do not have to honor the request (45 C.F.R. § 164.522).

Under HIPAA, 2.2 million entities can access your medical records without your consent if those holding your records choose to share them (Federal Register, Vol. 75, No. 134, July 14, 2010, pages 40872, 40906–40911). That number includes health plans, business associates, researchers, lawyers, corporations, and others whose connection to your care may be indirect or nonexistent. Government agencies can access your data under the rule’s 12 National Priority Purposes.

So, are there any benefits to not signing?

Yes.

First, you exercise a legal right that most patients don’t know they have.

Second, you refuse to participate in the deception that HIPAA and the NPP protect your privacy. Signing it signals — to the clinic, to the system, to the public — that what the federal government has told us is true, is actually patently false. HIPAA eviscerated privacy rights.

Third, you inform clinic and hospital staff of the truth. Many front-desk employees genuinely believe your signature is required by federal law. When patients refuse and show them HHS’s NPP website, it changes forever what those employees know and what they might tell their team and the next patient. They may even do the right thing and change the form to tell you your signature is not required, as some clinics have.

Fourth, you prevent the clinic from using the signed form against you. If your confidential information is later shared without your knowledge, a practitioner can point to your signature and say you were notified. You were told you have no privacy. It’s your fault you shared confidential information. Refusing to sign removes that argument.

Fifth, every patient who refuses is part of a larger effort to restore patient privacy and consent rights in America. CCHF is working to rescind the HIPAA rule, forcing practitioners and health care corporations to abide by the longstanding, legally-enforceable privacy laws and consent requirements that were in place in every state before HIPAA. This effort is stronger when patients refuse to participate in the deception.

How can we stop access to our data?

Under HIPAA as currently written, full stoppage is not possible.

But you can take four meaningful steps.

1. Pay cash when possible. Federal law gives you one binding privacy right over your data. Under 45 C.F.R. § 164.522(a)(1)(vi), a covered entity must agree to restrict disclosure of your health information to a health plan if the service was paid for in full out of pocket and the disclosure would be for “payment” or “health care operations.” That means if you pay the full cost of a visit or service directly — no insurance or government billing — and you request the information not be disclosed, your doctor cannot send that information to your health plan.

NOTE: this restriction only applies to your health insurer, not to government agencies. Your doctor can still share information with the federal government under other regulatory or HIPAA provisions.

2. Find a doctor outside the network. Doctors who maintain paper records, have direct-pay relationships only, operate outside corporate health systems, and are not connected to state health information exchanges (HIEs) or the national eHealth Exchange have more limited data-sharing infrastructure.

CCHF’s direct-pay physician directory, JoinTheWedge.com, connects patients with independent, cash-based practices nationwide.

3. Ask your state legislators for a real state privacy law. State medical privacy laws supersede HIPAA, in essence, protecting you from HIPAA. The federal HIPAA rule explicitly yields to stronger state laws (45 C.F.R. § 160.202). Most state legislatures have not enacted stronger laws because legislators incorrectly assume HIPAA already protects patient privacy. Contact your state legislators and ask for a state medical privacy law — one that requires patient consent before data is shared.

4. Refuse to answer unrelated questions. Questions about housing, food access, social relationships, gun ownership, and mental health that appear at clinic check-in are not medical questions. They are data collection tools, often created by corporations or the federal government. Some questions may be part of the government initiative to collect Social Determinants of Health (SDOH) data on every patient. You have no legal obligation to answer them. Politely decline.

Is CCHF working to reverse this?

Yes.

CCHF has been working to expose HIPAA as a permissive disclosure rule, not privacy protection. Our efforts have led Americans across the country to refuse to sign the HIPAA form or acknowledgement statement. As a result, more clinics are learning the truth about HIPAA and the truth about your right not to sign the statement or participate in the deception.

Increasingly, clinic forms either explicitly say that you are not required to sign the NPP acknowledgement statement, or they include a section for the staff to record your refusal. Over the past five years, CCHF has received fewer complaints of Americans being denied access to care for refusing to sign the statement.

The HIPAA deception is deep, but in an encouraging sign, more people across the country refusing to sign is bringing truth and the right not to sign to the surface.

CCHF advocates at the federal level for rescission of the HIPAA rule and restoration of the legal protections every patient had before HIPAA took away their privacy rights. At the state level, CCHF supports legislation requiring true consent before health data is shared. The CCHF online legislative library provides model legislation states can use to write their own medical privacy laws.

April is Truth About HIPAA Month at CCHF.

Every year, CCHF uses this month to educate patients, equip them with tools, and push back against the now 23-year-old deception that “HIPAA” and “privacy” mean the same thing. The momentum is building. Join the movement by refusing to sign HIPAA.

CCHF Resources

• Refuse to Sign the HIPAA Form — How-To Guide

• CCHF Discharge Instructions

• 20 HIPAA Harms

• Find an Independent, Cash-Based Doctor — JoinTheWedge.com

• File a HIPAA Complaint with HHS

Most Americans still believe their medical records are private.

You’d be forgiven if you thought the information you shared in the exam room (or with your doctor) was just between the two of you — protected by the confidentiality that has defined medicine for centuries.

That assumption is no longer true.

Over the past two decades, federal policy quietly transformed the American health care system into a massive data collection network built around the government-mandated electronic health record (EHR). What was sold as modernization has created something very different: a system where patient data is routinely digitized, analyzed, shared, and mined far beyond the exam room.

And patients never meaningfully consent to it. Typically, there’s no choice.

As one patient reported, she went to see a chiropractor and refused to sign the HIPAA form. The nurse informed the doctor, who came out of his office and said, “It’s the law.” The patient pushed back: “So you don’t want me?” He repeated himself. The patient was turned away

The Collapse of Medical Confidentiality

For thousands of years, medicine rested on a simple principle.

Hippocrates wrote:

Confidentiality wasn’t a bureaucratic formality. It was the foundation of trust between patients and physicians.

It allowed patients to speak frankly to their doctor.

Today, that trust is under threat.

Under modern federal policy, medical records are no longer simply clinical notes used by physicians. They have become data assets that can be extracted, aggregated, analyzed, and repurposed by governments, corporations, insurers, researchers, and technology companies.

The Government Electronic Health Record Mandate

The shift away from confidentiality began when Congress ended medical privacy rights with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and pushed the nationwide adoption of online-accessible electronic health records (EHRs) nearly 20 years later.

Rather than allowing medical technology to develop a privacy-centric model, the government mandated interconnected, standardized digital record systems using federal rules, incentives, and penalties. They wanted the data.

Most doctors who do not adopt and use government-certified electronic health records face financial penalties through reduced Medicare reimbursements.

These systems were designed not only for patient care but also support functions such as:

• federal reporting requirements

• performance metrics

• data collection

• research registries

• administrative monitoring of patients and doctors

Under the federal HIPAA regulation, the expansive “health care operations” definition includes activities such as quality assessment, data analysis, business planning, and administrative functions (45 C.F.R. § 164.501).

In practice, this framework connects the exam room to a broader network of entities involved in oversight, administration, and data use.

Frustrated Doctors Say the System is Hurting Care

Many physicians and nurses now say the system is undermining medicine itself.

Electronic records demand constant clicking, reporting, and documentation that shifts attention away from the patient and toward the computer.

In one large health system, after implementing the Epic Systems platform, operational costs rose by approximately $400,000 per month. Nurses were spending 47 minutes per shift on duplicate documentation, while physicians received up to 240 inbox messages per day, requiring more than 2 hours daily to manage.

Medication reconciliation increased from 6 minutes to 18 minutes per patient, and physicians spent 25 minutes reviewing charts that previously took 8 minutes, as information became spread across dozens of screens and tabs.

You’ve probably experienced the doctor clicking away and never watching your face.
Instead of listening closely, clinicians must navigate software interfaces, menu options, and mandatory fields.

This digital layer:

• interrupts the natural flow of clinical thinking

• distracts physicians during examinations

• delays care

• introduces new medical errors

• erodes the personal relationship between patient and doctor

Some physicians have left traditional practice entirely rather than comply.

Patients Are Becoming Data Subjects

The EHR system also allows patient information to be extracted and transmitted to large databases.

As standard health care consent forms often state, patient information may be used and disclosed for “treatment, payment, and health care operations,” including data analysis, quality assessment, business planning, and administrative oversight—without requiring additional patient authorization.

For example, medical specialty organizations maintain massive registries built directly from electronic health records.

One such system—the National Cardiovascular Data Registry—includes data from thousands of hospitals and outpatient providers worldwide, capturing patient demographics, procedures, clinical guidelines, risk factors, and provider performance (American College of Cardiology).

These registries are not isolated systems. They are used for quality measurement, research, and reporting, and many are integrated into federal programs administered by the Centers for Medicare & Medicaid Services (CMS), including the Merit-based Incentive Payment System (MIPS). Under these programs, data collected through EHRs and registries can be used to evaluate physician performance, determine reimbursement, and support federal oversight of health care delivery.

While patients may assume their information is anonymized, this so-called de-identified data can often still be traced back to individuals or combined with other datasets. Just as bad, it can be used to build a case against the patient or the doctor leading to denied access to care.

In effect, the medical system increasingly treats patients not only as individuals needing care but also as sources of data.

When Big Tech Came Calling

In 2018, a revealing report highlighted how Facebook explored partnerships with major U.S. hospitals to access patient data.

The initiative, first reported by CNBC, involved combining anonymized hospital data with Facebook’s own user data to identify patients who might need additional medical care.

The project was abandoned following public scrutiny in the wake of the Cambridge Analytica scandal, which exposed how personal data could be used in ways users never anticipated.

But the episode revealed something significant.

Large technology companies increasingly view health care data as one of the most valuable datasets in the world—and have actively explored ways to access, analyze, and integrate it at scale.

The Consent Problem

One of the most troubling aspects of this system is the lack of meaningful patient consent.

Many Americans assume that privacy laws like HIPAA protect their medical information.

But HIPAA actually functions as a permissive disclosure regulation, not a privacy law. Those who have access to your medical data, like doctors, hospitals, and labs can share it if they want to. They don’t need your consent.

In fact, federal estimates indicate that up to 2.2 million entities—including approximately 1.5 million “business associates”—may have access to patient medical information under HIPAA’s framework if those who hold your data choose to share it (Federal Register, Vol. 75, No. 134, July 14, 2010, pp. 40872, 40906–40907, 40911).

The law permits broad categories of unconsented data use under “health care operations,” including quality assessment, data analysis, business planning, and administrative functions.

As a result:

• Patient data can be widely circulated within health care systems

• 1.5 million business associates could have access, per HHS

• Information can be shared across large databases, including through the eHealthExchange (ehealthexchange.org), a national data exchange system

• Data-based research on patients may occur without direct patient approval

Most patients never realize how extensively their confidential information may travel or how many people may have accessed it.

The Rise of Medical Surveillance

The digitization of medicine has also introduced a new form of intrusion.

Doctors are now monitored through the same systems that record patient data.

Electronic records track physician decisions, compliance metrics, and adherence to government rules and clinical guidelines. For example, federal programs administered by CMS—such as the Merit-based Incentive Payment System (MIPS)—measure whether physicians follow specific care protocols and quality measures, with payment adjustments tied directly to those scores.

These measures can include treatment decisions, documentation requirements, and other standardized criteria embedded into electronic systems.

This creates pressure for doctors to practice medicine according to checklists and system prompts rather than individualized clinical judgment.

The result is a growing system of digital surveillance in health care—not only of patients, but of physicians themselves.

A Warning from Inside Medicine

Some health care professionals see the consequences firsthand.

As one registered nurse put it: “The government electronic health record is a clinical disaster… It steals time, interrupts flow, creates a barrier, constricts thought processes, and forces eyes and hands to turn away from the patient.”

They describe exam rooms where clinicians must divide attention between the patient and the computer screen.

Where time once spent listening or observing is replaced by typing and clicking.

Where data entry takes priority over human connection.

In their view, medicine risks losing its core purpose.

Not because technology exists — but because it has been imposed in ways that serve administrative and data collection goals instead of patient care.

What Happens Next

Health care will inevitably involve digital systems. No one disputes that.

But something fundamental has changed.

For generations, the answer was clear: medical information belonged within the confidential relationship between patient and doctor. That principle protected patients and preserved physician independence.

Today, that protection has been weakened.

Who controls the data — and who benefits from it?

Is medical information primarily a clinical tool meant to serve patients?

Or is it a vast dataset for governments, corporations, and researchers to analyze and monetize, and use for purposes that may ultimately harm patients?

Until Americans fully understand how the system works, that question will continue to be answered without them.