HHS wants to deregulate.

The White House is clear: slash the number of federal regulations. Executive Order 14192 demands a “10-for-1” repeal ratio. Another order aims to deconstruct the “overbearing and burdensome administrative state” (Ensuring Lawful Governance). So when HHS issued a Request for Information (AHRQ-2025-0001) asking how to “dramatically deregulate,” the responses on (PA) were telling.

is pure administrative friction. A request for a patient’s MRI can take 72 hours and three phone calls to resolve. Physician Margaret Chustecki reports clinicians spend an average of 13 hours per week on PA-related tasks (0020). The American Medical Association (AMA) finds that for 29% of physicians, a PA delay has led to a “serious adverse event, including hospitalization, disability, or death” (0490). The Community Oncology Alliance notes these delays are especially pressing for cancer patients, where “the opportunity for effective intervention is narrow” (0614).

So, when asked how to fix this through deregulation, the commenters presented a paradox: to reduce the daily burden of PA, they are asking HHS to write new regulations.

Two Kinds of Friction

The public comments draw a sharp line between two sources of regulatory pain.

1. Government-Mandated PA (The Simple Case)

This is the straightforward stuff. Sometimes, a rule in the Code of Federal Regulations (CFR) directly requires PA for a service in traditional, fee-for-service (FFS) Medicare.

• Enovis Corporation points to the 2015 FFS rule requiring PA for five specific orthotics codes, arguing the administrative cost “of at least $17.60” per claim outweighs any savings (0538).
• The AMA targets the FFS rule mandating PA for certain hospital outpatient (OPPS) services, arguing it has “tenuous statutory authority” and causes “delays in medically necessary care” (0490).

The solution here is classic deregulation: repeal the federal rule. This is a clean win for the White House’s “10-for-1” agenda.

2. Plan-Imposed PA (The Real Problem)

But here’s the thing: most of the pain isn’t coming from FFS Medicare. It’s coming from private Medicare Advantage (MA) plans, which have become powerful quasi-regulators themselves. RetireSafe is blunt: “Many health plans, specifically Medicare Advantage plans, require advanced approval” (0108).

MA plans use their flexibility under the law to create their own labyrinthine PA systems. To a clinician, a plan’s internal policy is the regulation. And the proposed fix isn’t to ask for less federal oversight. It’s to ask for more.

The comments are a study in this contrast:

• The AMA and the Community Oncology Alliance want HHS to prohibit MA plans from using step therapy for Part B drugs, a policy the American Academy of Hospice and Palliative Medicine calls “practicing bad medicine” (0490, 0614, 0541). This requires a new federal rule.
• MaineHealth asks HHS to adopt a standard process for appealing MA denials (0491). This requires a new federal mandate.
• The National Council for Mental Wellbeing wants to eliminate restrictive PA for mental health services in MA and Medicaid plans, which can cause patients to “experience decompensation” while waiting for care (0627). This requires a new federal carve-out.
• Mayo Clinic highlights that MA plans often require PA for SNF placement even when a 3-day hospital stay should guarantee coverage under 42 CFR 409.30, creating “long discharge delays” (0078). The fix is stronger enforcement and clarification.

These are not calls to repeal regulations. They are calls to write new ones to stop private plans from creating their own suffocating bureaucracy.

(De)regulation Paradox

This puts HHS in a bind. The administration’s stated policy is to reduce the volume of federal rules. But to achieve the RFI’s goal of letting “providers and caretakers focus on preventing and treating chronic diseases instead of having to do unnecessary or burdensome paperwork,” HHS is being asked to impose more federal rules on private plans.

So how can this be squared with the Executive Order?

The goal of the deregulatory initiative isn’t just to have fewer lines in the CFR. It’s to “alleviate unnecessary regulatory burdens placed on the American people.” A single, sharp federal regulation that prohibits 500 different MA plans from imposing their 500 different, burdensome PA protocols is a profound net deregulatory action in practice.

It’s using a public, transparent regulatory tool to dismantle a thousand opaque, private ones.

This is the central challenge for HHS. The path to less friction in the clinic may require more regulation at the plan level. I’ve linked to the comments directly. You can see the pattern for yourself in the RFI docket.

What would you do?