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The hospital industry has been automating nursing and medical decision-making for years, reducing people to a list of symptoms which are then interpreted by technology that is racially and ethnically biased and often excludes relevant details about an individual patient.2 The hospital industry uses this automated approach to justify reducing the number of licensed health care professionals providing patient care and then profits from the reduced labor costs. The hospital industry has used the Covid-19 public health emergency to further exploit the desire to normalize automated care and to shift care to the home.

Finally, the apparent corporate influence on the program is extremely troubling. In November 2020, the Trump administration launched the AHCaH program outside the normal rulemaking process and in record time: CMS senior leadership worked with industry insiders to take “the waiver from concept approval to publication in 8 days[.]”3 CMS acted without a detailed public evaluation of any evidence justifying the program nor any opportunity for the public to review or comment on it, while hospital administrators who wanted the program were closely consulted.4 Indeed, the American Hospital Association (AHA) took credit for CMS’s expansion of the program, stating: “[As urged by the AHA, CMS expanded on its Hospitals Without Walls program by introducing the AHCaH program.”5 Despite the irregular implementation, the AHCaH program grew rapidly. As of July 27, 2022, CMS has approved AHCaH rollouts in 110 health systems, with 245 hospitals in 36 states.