Concerns about the potential for AI-driven solutions to reinforce inequities are valid, especially when similar technologies have already faced scrutiny. When UnitedHealth’s AI-driven claims system denied care to Medicare Advantage patients, it wasn’t a technological glitch—it was a warning. Across the U.S., health innovation is advancing rapidly, from AI-driven decision-making and automated claims processing to telehealth and digital health tracking. While these developments promise efficiency, they also risk reinforcing inequities, eroding patient trust, and concentrating power among insurers, health systems, and private tech firms. The question is: who controls the future of health care and will it serve people or corporate interests?

The ongoing threat of further privatization of Medicaid and Medicare, especially through artificial intelligence that governs prior authorizations and claims denials, is of grave concern. The billions in bonuses for corporations do not translate into better care for patients; instead, they bring about increased restrictions, denials, and corporate profit-making at the expense of necessary care. The resounding public outcry in December 2024 underscores this sentiment—people want better access to care, not more barriers.

Health innovation is not neutral. It is shaped by policies, incentives, and power structures that determine how care is delivered and who benefits.

With a second Trump administration now in motion, an aggressive push to deregulate health care, weaken consumer protections, and privatize essential services is already underway. Recently, the administration announced a $500 billion investment into AI, raising critical questions about the direction of this innovation. While there are aspirations related to the use of AI—including the introduction of AI nurses to address rural health disparities—we must ask: will this investment truly address disparities or will it exacerbate existing ones and create new inequities?

The erosion of public trust is accelerating as patients face rising barriers to care and a system that prioritizes corporate profits over patient needs. Without immediate action, these changes will embed inequities into the very infrastructure of health care for decades to come.

This is not speculation—it is already happening. Insurers increasingly use AI to make claims determinations, fueling a surge in wrongful denials. Health systems deploy predictive analytics to flag high-risk patients, yet these models often rely on biased historical data that deprioritizes Black and Brown communities. Digital health tools, from telemedicine platforms to wearable devices, assume universal broadband access and digital literacy—leaving millions behind. The consequences are clear: care is being rationed, decision-making is becoming less transparent, and those with the greatest health needs are facing new barriers to access.

Communities must be at the center of health innovation. Yet, too often, Asian, Black, Indigenous, Latinx, Pacific Islander communities, people with disabilities and complex health needs, LGBTQ+ individuals, immigrants, older adults, and women are excluded from shaping policies that directly affect them. Instead of co-creating solutions with these communities, the health system deploys technology that increases barriers to care rather than removing them.

Technology itself is not the problem. The issue is who wields it, how it is governed, and whether it is designed to advance equity or efficiency alone. Historically, medical breakthroughs—from clinical trials to reimbursement models—have disproportionately benefited privileged populations while leaving others behind. Without intervention, the latest wave of digital health transformation will repeat these patterns, further entrenching disparities in access and outcomes.

We have seen this fight before. Four decades ago, people living with HIV mobilized to demand a voice in their care, leading to the Denver Principles, which laid the foundation for patient rights and community-driven health care. Those same principles must guide today’s battle over the future of health innovation. Decision-making power cannot be concentrated in the hands of insurers, health systems, and Silicon Valley executives. Transparency, accountability, and racial equity must be embedded in the governance of health innovation.

Organizations like Community Catalyst are already demonstrating what this could look like. In collaboration with partners across the country, they are advancing community-led, people-centered models that ensure health innovation serves the people it’s meant to help. This includes equitable telehealth strategies, ensuring digital health tools are accessible across diverse populations, integrating services based on lived experiences, and shifting payment models to prioritize patient outcomes rather than just cost savings.

When communities lead, health innovation becomes more effective, equitable, and sustainable.

To ensure that technology serves patients rather than profits, we must shift decision-making power to the communities most impacted—regardless of the political climate in Washington. State agencies, health systems, and advocacy coalitions must step up where federal protections may erode. States can adopt community oversight boards to guide the development of AI-driven care models and digital health policies, ensuring local governance over how new technologies impact patient care. Health systems and insurers must be held accountable by external review panels—led by patient advocates and community organizations—before deploying new predictive models or automation tools.

Even as federal agencies scale back equity-driven initiatives, state policymakers, health system leaders, and private funders can embed racial equity standards into research grants, reimbursement models, and contracting requirements. Consumer protection laws at the state level can be leveraged to push for transparency and accountability in AI-based care decisions. Where government action stalls, philanthropy and impact investors must fill the gap by funding community-led oversight initiatives that safeguard patient rights in an era of deregulation.

Public trust in health innovation is already fraying. The only way forward is through localized action, coalition-building, and holding both public and private institutions accountable—regardless of who is in the White House.

Transparency must be a baseline requirement, not an afterthought. The algorithms used to allocate resources, approve or deny coverage, and drive care decisions that should be publicly auditable and explainable. Just as clinical trials require diverse representation and public reporting, digital health tools should be held to similar standards to prevent bias and exclusion. AI-driven claims denials should not be allowed without clear justification and a patient-friendly appeals process.

Public and private institutions must be held accountable for the consequences of health innovation. Policymakers must ensure that federally funded health innovation projects undergo rigorous oversight to prevent them from widening disparities. Insurers and health systems must ensure that technology supports, rather than replaces, provider decision-making. Impact investors and philanthropic funders must direct resources toward initiatives that put patient rights and racial equity at the center of health innovation, rather than backing untested, profit-driven tech experiments. 

The future of health care will be shaped by how we choose to deploy technology—not just the tools themselves.

We can either allow unchecked, corporate-driven innovation to define the system, or we can demand that public institutions reclaim their role in shaping technology for the public good. In a political climate where health equity is increasingly under attack, we must stand firm, by confronting a fundamental question: Are technological advancements developed on communities, for communities, or with them? This question should guide our work and efforts moving forward. It embodies the essence of meaningful innovation—where the voices of the very people impacted by these technologies are at the forefront of decision-making. The stakes are high: our health care system must prioritize the needs and rights of patients, not the profit motives of corporations. If we fail to ensure that communities are not only considered but actively engaged in shaping the innovations that affect them, we risk deepening the very disparities we seek to eradicate. 

Now is the time to reclaim health innovation for the people it is meant to serve, making community involvement the standard rather than an afterthought.