Every clinician can attest to the annoyance, stress, and worry that manifests when we think about paperwork. Even the likes of a snake oil salesman currently in charge of CMS, Dr. Oz, penned a piece noting this very real strain on physicians across the U.S. due to prior authorizations. Research has shown that physicians on average are spending up to 13 hours per week on this odious task and the costs are staggering, nearly $34,000 and 700 hours a year per health care provider that could otherwise be spent caring for patients. Unfortunately, when we consider that these insurance-related tasks often cause delays in care, lead to prolonged hospitalizations or overutilization of an already strained and underfunded public health system across this country, our system is failing patients, their families, and our sacred oaths as clinicians tasked with stewarding health and wellness. It is often said that systems yield results they are designed for, so none of the ills of our current system are surprising. In the midst of all this, it is disconcerting that now alongside the hassles of prior authorizations and various other bureaucratic processes, the federal government is now adding another big task in the laps of doctors and clinicians, to prove medical frailty for Medicaid recipients so they can opt out of mandatory work requirements or lose their health insurance.
Just picture it, a poor person, already experiencing the stigmas and afflictions of poverty, now must beg medical providers to document proof that they are too frail. If they cannot provide this documentation every 6 to 12 months, they will lose their health care benefits. This is yet another blow to the poor people living with illness. From the most recent guidance by this federal administration from June 2026, “even for a disease as grave as cancer, [it] isn’t enough to claim an exemption from the 80-hour requirement, unless beneficiaries submit additional proof that they physically can’t work.” As is being litigated in court at this very moment, this new set of rules being implemented will cause more bloat in our system, overwhelm doctors’ offices, and create a culture of hostility for everyone involved, those seeking paperwork and those having to complete it.
Since Medicaid is run 50 different ways across this country, every state will have to figure out its own process, and given the lack of support from federal agencies already gutted under the horrific Project 2025, Americans are not ready for the aftermath. I wonder if these changes being implemented under the Trump administration’s Orwellian One Big Beautiful Bill will help Americans. Again, the pressures being placed on poor people and those who must help them through health and sickness: Is this right? I am not a proponent of fraud, and agree that some individuals abuse our social safety net, but to create punishments for millions for the crimes of thousands: Is that fair? To save millions of dollars, but spend trillions on wars, military weapons, and billions on funding genocide, ballrooms, aircraft, pool renovations: Is this justified? As a physician who will undoubtedly bear witness to the horrors of cruel policies and politics in the faces of my patients, folks struggling to make ends meet, afford food, medications, and their foothold on life, I can only hope some humanity finds its way into our ethos, our society, and our hearts.
Sameen Farooq is a Muslim physician in New York City. He is an assistant professor of medicine at Albert Einstein College of Medicine, and his work spans both inpatient hospital medicine and community-based hospice care. He is board certified in internal medicine, addiction medicine, palliative and hospice medicine, and obesity medicine.
His scholarly work spans serious illness care, substance use disorders, and the ethics of decision-making for patients without advocates. He is the lead author of a Palliative Care Network of Wisconsin Fast Fact on serious illness considerations for the unrepresented and adult orphans, and a coauthor of research in Substance Abuse on a pilot overdose education and naloxone distribution program for hospitalized general medical patients.
Outside his work as a doctor, he is always trying to figure out how to make the perfect cup of Pakistani chai, incorporate walking and spiritual reflection into his daily routine, and enjoy his time with family and friends.
