Latest news with #goldcard
Medscape
07-07-2025
- Health
- Medscape
‘Gold Card' Programs to Reduce Prior Auth ‘Underwhelming'
'Gold card' programs were supposed to make it easier for frustrated physicians to deal with insurers' burdensome prior authorization demands. The idea: Insurers would reward doctors whose past prior authorization requests were typically approved by exempting them from red tape in the future. At least 10 states have required insurers to establish gold card programs amid mounting concerns nationwide that overuse of prior authorization jeopardizes patient health. Last month, leading insurers joined with the White House in a voluntary pledge to reduce their use of the practice, which they contend is necessary to control costs and minimize unnecessary care. But Texas' experience with gold card programs may signal the limits of that approach. Only 3% of Clinicians Qualified The Lone Star State was an early adopter, passing a 2021 law enabling health providers with a high prior authorization success rate to earn a 'gold card' exemption from insurers. But statewide, only 3% of providers met that bar, according to a testimony provided by the Texas Department of Insurance earlier this year. 'I think it's safe to say that the impact of this law on prior authorizations for our physicians is underwhelming,' said Ezequiel 'Zeke' Silva III, MD, a San Antonio-based interventional radiologist who chairs the Texas Medical Association's Council on Legislation. 'We would have hoped for a greater percentage of our physicians to have been granted the 'gold card' status.' At least nine other states have enacted gold card laws, according to the National Conference of State Legislatures (NCSL). Care Delayed and Denied Physicians maintain that excessive prior authorization paperwork impedes timely patient care, with clinicians and staffers devoting 13 hours weekly to documentation, according to a 2024 American Medical Association survey. Insurers view the review as a guardrail against unnecessary care driving up costs. Studies show that restricting prior authorization could boost premiums by 5.6%-16.7%, a Texas Association of Health Plans official testified during the legislative session. In June, Texas Gov. Greg Abbott signed a revised version of the state's 'gold card' law — part of an emerging national attempt to streamline the prior review process. Cigna, Humana, UnitedHealthcare, and other large insurers have voluntarily committed to reducing the scope of claims involved, according to the America's Health Insurance Plans trade group. Meanwhile, federal officials have finalized requirements that direct some insurers, including Medicaid and Medicare Advantage programs, to speed up responses to prior authorization requests, among other measures. Some of those requirements begin in 2026. Gold Card Designs As in other states, Texas' 'gold card' legislation applies only to state-regulated insurers, which comprise about one fifth of the state's market. Under HB 3812, which takes effect on September 1, insurers will evaluate health providers based on a year of prior authorization requests rather than 6 months under the 2021 law. To be evaluated, providers must have submitted at least five requests for a specific health service during that period. To achieve 'gold card' status, insurers must approve at least 90% of requests, the same threshold as set by the 2021 law. But the new law stipulates that insurers review a broader pool of requests, including those made directly to the health plan as well as any related affiliates, according to the Texas Department of Insurance. The new law continues to limit exemptions only to 'top-performing physicians' who repeatedly provide cost-effective care, said Blake Hutson, director of public affairs at the Texas Association of Health Plans. 'Even with the change to 1 year, and the bill also adds in a broader array of claims that will be looked at, you still have to meet 90%.' A key addition requires insurers to release an annual report detailing how many exemptions they have granted or denied, making decisions more transparent to the public, Silva said. 'Not just what's being approved and what's not being approved, but to potentially evaluate for trends that presently we just have no ability to evaluate,' he said. Gold card laws vary from state to state, and some exclude prescription drugs, according to an NCSL legislative summary. Other states with gold card programs include Arkansas, Colorado, Illinois, Louisiana, Michigan, New Mexico, Vermont, West Virginia, and Wyoming. In Illinois, legislation passed last year targeted hospital services for Medicaid patients, as denial rates were routinely higher in that population, said Dave Gross, senior vice president of Government Relations and Communications at the Illinois Health and Hospital Association, Naperville, Illinois. 'We're not seeing this problem in the commercial space,' he noted. Real-World Implications To some degree, the 'gold card' concept makes intuitive sense, recognizing physicians who have a track record of getting their medical care requests approved, Ravi Gupta, MD, an assistant professor of medicine at Johns Hopkins University School of Medicine, Baltimore, who has studied prior authorization patterns, said. But Gupta raised equity concerns. Physicians in large medical groups and hospital systems will have access to staff and other resources to better navigate the prior approval process than those in smaller private practices. Plus, he added, there's the potential that physicians who achieve exemptions may become 'more indiscriminate' about the services that they recommend. Insurers' stated aim is to reduce unnecessary and low-value medical care through prior authorization gatekeeping, Gupta said. But a study he helped conduct, assessing policies across five Medicare Advantage insurers, found a significant lack of consensus on what treatments should be included. Treatments comprising only 12% of Medicare spending would have required prior authorization by all five insurers. Most of that consensus, he wrote, 'was devoted to a small number of costly services.' The administrative burdens affect patients as well. Two thirds of patients with cancer in one 2023 study become personally involved, including calling the insurer or appealing a denial. The patients also reported less trust in insurers and the health system overall, which could have worrisome downstream effects, Fumiko Chino, MD, the study's lead author and an assistant professor of radiation oncology at Houston's MD Anderson Cancer Center, said. 'If you don't trust healthcare,' she said, 'why on earth would you get a vaccine or get cancer screening or get your blood pressure checked?' More than X Percent? Gupta views the leading health insurers' pledge as encouraging in concept — but he notes that they are voluntary commitments without any accountability. In the interim, gold carding remains no more than a workaround, he said. 'Gold cards aren't really fixing that [prior authorization] problem,' he said. 'They're just rewarding certain clinicians who can demonstrate that they have been able to get through the prior authorization process successfully for X amount of time before they're rewarded with a gold card.' In Illinois, regulators are still hashing out gold card rules, including whether the required 90% approval threshold will be based on a specific hospital service or a broader pool of services, Gross said. The hospital association also will closely watch whether Illinois' experience begins to mirror that in Texas, he said. 'We have some of the best hospitals in the country here in Chicago,' he said. 'If we end up with a 3% approval rating of gold cards, we're going to have to go back to the legislature.'
Bloomberg
29-06-2025
- Business
- Bloomberg
The Price of Trump's Gold Card and Where Else You Can Live
The US has had a version of an investment visa since the early 20th century, so what's new about President Trump's "gold card" and how does it compare with other countries' investment immigration programs? LSE's Kristin Surak explains different incentives of countries' golden visa and passport programs and why some countries have shut them down. New Zealand's Former Minister of Economic Development Stuart Nash explains country's revamped investment immigration program. Cato Institute's Alex Nowrasteh takes a different approach to immigration and says that the market is best placed to determine the right price of immigration. (Source: Bloomberg)
Yahoo
15-06-2025
- Business
- Yahoo
Trump's ‘gold card' visa scheme is pure gilded nonsense
President Donald Trump announced, back on February 25, that his administration would soon debut a 'gold card,' an immigration program that would allow wealthy foreigners, for the low, low price of $5 million, to become lawful permanent residents of the United States. At the time, Trump touted the program as a 'great' and 'fantastic' revenue generation strategy that would help reduce the national deficit, which approached $2 trillion during the most recent fiscal year. Shopify just killed UX design 'No Kings Day' map, speakers, cities: Everything to know about today's protests Ram Trucks fires up a near-perfect brand apology ad 'Wealthy people will be coming into our country by buying this card, they'll be wealthy and they'll be successful, and they'll be spending a lot of money and paying a lot of taxes and employing a lot of people,' Trump said. He told reporters that gold card buyers would not be required to pay tax on their income outside the United States; that the program was 'totally legal' and 'all worked out from the legal standpoint'—and that he expected it to go live within two weeks. 'Two weeks,' confirmed Department of Commerce Secretary Howard Lutnick, standing behind Trump in the Oval Office. When Trump estimated that the government could raise an easy $5 trillion by selling 'maybe a million' gold cards, Lutnick was unable to suppress a chuckle of delight. 'Wow!' he said. Today, though, anyone hoping to relocate to a budding police state where riot cops might shoot you point-blank for looking at them is still waiting for the chance to cut a check. In mid-March, Lutnick said during a podcast interview that gold cards would be available in 'about two weeks,' and claimed he'd presold 1,000 already. (I assume these sales, to the extent they exist, are handshake deals, since the alternative would involve the Secretary of Commerce personally collecting $5 billion and stashing it God knows where.) On April 3, Trump showed reporters a physical gold card bearing his scowling face and seismogram signature, and (again) said it would be out in 'less than two weeks.' But the delays kept coming. On April 11, Lutnick announced that gold cards would be available 'within a week and a half.' On May 21, he moved the goalposts even further, revealing that a website where 'people can start to register' for gold cards would be online in 'about a week.' On Thursday—three weeks after that update, for those keeping score— at last went live. Trump celebrated the launch on Truth Social as a way to 'ride a beautiful road in gaining access to the Greatest Country and Market anywhere.' On Fox Business, Lutnick claimed to have logged 25,000 sign-ups in 15 hours. But he also acknowledged that these are waiting list spots, and that the administration is still 'getting everything set up.' The website itself most closely resembles an especially lazy phishing attempt; its only content is a contact submission form assuring prospective buyers that the gold card is 'coming,' and urging them to provide their email addresses to 'get notified the moment access opens.' The White House's struggles to get this initiative off the ground demonstrate just how unprepared Trump is for the basic work of governing, on the rare occasions that he expresses any interest in engaging in it. A key part of his pitch to voters has always been that, as an outsider to politics, only he has the Business Guy Mindset necessary to transform the federal government from a bureaucratic morass into a slickly branded, profitable enterprise. But fulfilling his more ambitious promises is always harder than he expects. As a result, an idea that Trump once suggested would single-handedly wipe out this country's $36 trillion national debt is, four months later, still taking the form of a bare-bones website that looks like it is soliciting interest in a new over-the-counter erectile dysfunction medication. At the announcement earlier this year, Trump explained that gold cards would replace the existing EB-5 visa program, which allows immigrants to obtain green cards if they invest at least $800,000 (and usually more) in a new business, and create at least 10 full-time jobs in the United States. In a Cabinet meeting, Lutnick clarified that the gold card program would technically 'modify' the EB-5 visa program, allowing buyers to obtain a 'license' from the Department of Commerce that would entitle them to make a 'proper' EB-5 investment. In response to a question from reporters, Trump asserted that the program does not require legislation because it allows buyers to obtain lawful permanent resident status and a 'very strong path to citizenship,' but does not directly confer U.S. citizenship. In news I am sure will astonish you, Trump and his handlers do not appear to have a firm grasp on the legal intricacies here. Congress, not the president, has the authority to create, modify, or end visa programs like EB-5. Federal law limits EB-5 visas to around 10,000 per year, which is of course nowhere near the million units Trump and Lutnick imagine selling in short order. The amount of the required capital investment, too, is set by statute, and nothing in the law would allow Trump to increase it to $5 million just because he feels like it. His distinction between programs that confer citizenship and programs that only confer lawful permanent resident status is nonsensical, as is Lutnick's reference to a 'license' from the Department of Commerce. Depending on what he has in mind, Trump's promise that gold card holders will enjoy some form of VIP treatment—'green card privileges plus,' he called it—probably also hinges on Congress's willingness and ability to pass a law to that effect. Absent congressional action, Trump's best bet for making this work might involve using his statutory authority to allow gold card buyers to enter the United States on the grounds that doing so entails a 'significant public benefit,' since a willingness to fork over $5 million to the Treasury Department arguably qualifies as such. But this status—the product of a legal process known as parole—is typically temporary, and is not even considered a form of 'admission' to the United States. It also would not make gold card buyers lawful permanent residents or give them a path to citizenship, which are things that people who pay that much would reasonably expect to get in return. Given that the Trump administration has spent the last several months gleefully repudiating the very concept of parole, I understand not wanting to pay seven figures for the right to be in the country for as long as Stephen Miller feels like allowing it. The lingering uncertainty around the program's specifics has resulted in a gold card market that is likely cooler than Trump might have imagined. Earlier this month, NPR interviewed several immigration attorneys who said they'd fielded inquiries from wealthy foreigners who are eager to pay up—which is, to be fair, exactly what I would say if I were an immigration lawyer contacted by a national publication for comment about a program aimed at potential clients who have at least $5 million in cash. Other experts, though, told NPR they anticipate sales in the low thousands; one explained that callers often lose interest once they find out that the $5 million is not an EB-5-style investment that they might recoup, but a de facto donation to the U.S. government. (As London School of Economics professor Kristin Surak points out, if you're a rich person looking to pick up another passport, why pay $5 million for a glorified green card when you can buy Maltese citizenship, and thus the right to live anywhere in the European Union, for about a fifth of the cost?) Nuri Katz, a Canada-based immigration consultant, told Bloomberg that he would expect a grand total of '50 to 200' applicants for Trump gold cards; more recently, in Forbes, he hypothesized that the White House is 'backpedaling' on the proposal because it realized it would 'have to expend a lot of political capital in order to get this done.' Perhaps there was a time when more than a handful of people might have been interested in ponying up for 'green card privileges plus,' whatever that may entail. But regardless of the legal form that Trump gold cards eventually take, the basic challenge of selling them will be that that they are branded with the face of an unabashed xenophobe whose administration is waging a global trade war, trying to bar foreign-born students and academics from entering the country, torpedoing international educational exchange programs, attempting to end birthright citizenship, and snatching noncitizens (and sometimes citizens) off the streets. Chances are that if you are privileged enough to be able to pay $5 million for the right to live in the United States, you are wise enough to decide that that money is better spent on something else. This post originally appeared at to get the Fast Company newsletter: Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Fast Company
13-06-2025
- Business
- Fast Company
Trump's ‘gold card' visa scheme is pure gilded nonsense
President Donald Trump announced, back on February 25, that his administration would soon debut a 'gold card,' an immigration program that would allow wealthy foreigners, for the low, low price of $5 million, to become lawful permanent residents of the United States. At the time, Trump touted the program as a 'great' and 'fantastic' revenue generation strategy that would help reduce the national deficit, which approached $2 trillion during the most recent fiscal year. 'Wealthy people will be coming into our country by buying this card, they'll be wealthy and they'll be successful, and they'll be spending a lot of money and paying a lot of taxes and employing a lot of people,' Trump said. He told reporters that gold card buyers would not be required to pay tax on their income outside the United States; that the program was 'totally legal' and 'all worked out from the legal standpoint'—and that he expected it to go live within two weeks. 'Two weeks,' confirmed Department of Commerce Secretary Howard Lutnick, standing behind Trump in the Oval Office. When Trump estimated that the government could raise an easy $5 trillion by selling 'maybe a million' gold cards, Lutnick was unable to suppress a chuckle of delight. 'Wow!' he said. Today, though, anyone hoping to relocate to a budding police state where riot cops might shoot you point-blank for looking at them is still waiting for the chance to cut a check. In mid-March, Lutnick said during a podcast interview that gold cards would be available in 'about two weeks,' and claimed he'd presold 1,000 already. (I assume these sales, to the extent they exist, are handshake deals, since the alternative would involve the Secretary of Commerce personally collecting $5 billion and stashing it God knows where.) On April 3, Trump showed reporters a physical gold card bearing his scowling face and seismogram signature, and (again) said it would be out in 'less than two weeks.' But the delays kept coming. On April 11, Lutnick announced that gold cards would be available 'within a week and a half.' On May 21, he moved the goalposts even further, revealing that a website where 'people can start to register' for gold cards would be online in 'about a week.' On Thursday—three weeks after that update, for those keeping score— at last went live. Trump celebrated the launch on Truth Social as a way to 'ride a beautiful road in gaining access to the Greatest Country and Market anywhere.' On Fox Business, Lutnick claimed to have logged 25,000 sign-ups in 15 hours. But he also acknowledged that these are waiting list spots, and that the administration is still 'getting everything set up.' The website itself most closely resembles an especially lazy phishing attempt; its only content is a contact submission form assuring prospective buyers that the gold card is 'coming,' and urging them to provide their email addresses to 'get notified the moment access opens.' The White House's struggles to get this initiative off the ground demonstrate just how unprepared Trump is for the basic work of governing, on the rare occasions that he expresses any interest in engaging in it. A key part of his pitch to voters has always been that, as an outsider to politics, only he has the Business Guy Mindset necessary to transform the federal government from a bureaucratic morass into a slickly branded, profitable enterprise. But fulfilling his more ambitious promises is always harder than he expects. As a result, an idea that Trump once suggested would single-handedly wipe out this country's $36 trillion national debt is, four months later, still taking the form of a bare-bones website that looks like it is soliciting interest in a new over-the-counter erectile dysfunction medication. At the announcement earlier this year, Trump explained that gold cards would replace the existing EB-5 visa program, which allows immigrants to obtain green cards if they invest at least $800,000 (and usually more) in a new business, and create at least 10 full-time jobs in the United States. In a Cabinet meeting, Lutnick clarified that the gold card program would technically 'modify' the EB-5 visa program, allowing buyers to obtain a 'license' from the Department of Commerce that would entitle them to make a 'proper' EB-5 investment. In response to a question from reporters, Trump asserted that the program does not require legislation because it allows buyers to obtain lawful permanent resident status and a 'very strong path to citizenship,' but does not directly confer U.S. citizenship. advertisement law limits EB-5 visas to around 10,000 per year, which is of course nowhere near the million units Trump and Lutnick imagine selling in short order. The amount of the required capital investment, too, is set by statute, and nothing in the law would allow Trump to increase it to $5 million just because he feels like it. His distinction between programs that confer citizenship and programs that only confer lawful permanent resident status is nonsensical, as is Lutnick's reference to a 'license' from the Department of Commerce. Depending on what he has in mind, Trump's promise that gold card holders will enjoy some form of VIP treatment—'green card privileges plus,' he called it—probably also hinges on Congress's willingness and ability to pass a law to that effect. Absent congressional action, Trump's best bet for making this work might involve using his statutory authority to allow gold card buyers to enter the United States on the grounds that doing so entails a 'significant public benefit,' since a willingness to fork over $5 million to the Treasury Department arguably qualifies as such. But this status—the product of a legal process known as parole—is typically temporary, and is not even considered a form of 'admission' to the United States. It also would not make gold card buyers lawful permanent residents or give them a path to citizenship, which are things that people who pay that much would reasonably expect to get in return. Given that the Trump administration has spent the last several months gleefully repudiating the very concept of parole, I understand not wanting to pay seven figures for the right to be in the country for as long as Stephen Miller feels like allowing it. The lingering uncertainty around the program's specifics has resulted in a gold card market that is likely cooler than Trump might have imagined. Earlier this month, NPR interviewed several immigration attorneys who said they'd fielded inquiries from wealthy foreigners who are eager to pay up—which is, to be fair, exactly what I would say if I were an immigration lawyer contacted by a national publication for comment about a program aimed at potential clients who have at least $5 million in cash. Other experts, though, told NPR they anticipate sales in the low thousands; one explained that callers often lose interest once they find out that the $5 million is not an EB-5-style investment that they might recoup, but a de facto donation to the U.S. government. (As London School of Economics professor Kristin Surak points out, if you're a rich person looking to pick up another passport, why pay $5 million for a glorified green card when you can buy Maltese citizenship, and thus the right to live anywhere in the European Union, for about a fifth of the cost?) Nuri Katz, a Canada-based immigration consultant, told Bloomberg that he would expect a grand total of '50 to 200' applicants for Trump gold cards; more recently, in Forbes, he hypothesized that the White House is 'backpedaling' on the proposal because it realized it would 'have to expend a lot of political capital in order to get this done.' Perhaps there was a time when more than a handful of people might have been interested in ponying up for 'green card privileges plus,' whatever that may entail. But regardless of the legal form that Trump gold cards eventually take, the basic challenge of selling them will be that that they are branded with the face of an unabashed xenophobe whose administration is waging a global trade war, trying to bar foreign-born students and academics from entering the country, torpedoing international educational exchange programs, attempting to end birthright citizenship, and snatching noncitizens (and sometimes citizens) off the streets. Chances are that if you are privileged enough to be able to pay $5 million for the right to live in the United States, you are wise enough to decide that that money is better spent on something else. The final deadline for Fast Company's Next Big Things in Tech Awards is Friday, June 20, at 11:59 p.m. PT. Apply today.
Yahoo
12-06-2025
- Business
- Yahoo
Trump 'gold card' website opens. Here's how to join the $5 million waitlist
President Donald Trump's long-touted "gold card," which offers foreigners a path to U.S. citizenship after paying $5 million to the government, is open for business. But even if you have the money, there's a waitlist at And read the fine print carefully: Your $5 million doesn't buy you immediate citizenship. Trump has said that he is not seeking approval from Congress as he is not providing gold card buyers with citizenship - only a path to citizenship. The path to citizenship requirements for card buyers are unclear and White House officials have said more details will be provided soon. The most common path to U.S. citizenship through naturalization is being a lawful permanent resident for at least five years. It requires the applicant to be least 18 years old when they apply, be able to read, write, and speak basic English (depending on age) and be of "good moral character." Trump has described the card, which he has also dubbed the Trump card, as 'somewhat like a green card, but at a higher level of sophistication.' 'FOR FIVE MILLION $DOLLARS, THE TRUMP CARD IS COMING!,' President Donald Trump announced on Truth Social on June 11. 'Thousands have been calling and asking how they can sign up to ride a beautiful road in gaining access to the Greatest Country and Market anywhere in the World.' The website shows an image of the gold-colored card, emblazoned with a likeness of Trump's face, and asks a few questions including name, region, email address and if an applicant is applying for themselves or as a business. The new website asks interested people to fill out a form that specifies eight regions: Europe, Asia (including Middle East), North America, Oceania, Central America, South America, Caribbean and Africa. Other countries also offer immigration programs that offers permanent residency or citizenship to foreign investors in exchange for investment. Portugal, for example, offers residency and a path to EU citizenship after five years. When he first floated the idea in February, Trump said the card would replace the "EB-5" immigrant investor green card visa program, The EB-5 visa allows immigrant investors the option to invest between $800,000 and $1.05 million to obtain a green card. The investment money is used to help create or preserve U.S. jobs. 'Wealthy people will be coming into our country by buying this card,' Trump said in February. 'They'll be wealthy, and they'll be successful, and they'll be spending a lot of money, and paying a lot of taxes and employing a lot of people.' 'It's a road to citizenship for people and essentially people of wealth or people of great talent where people of wealth pay for those people of talent to get in,' he said. Swapna Venugopal Ramaswamy is a White House correspondent for USA TODAY. You can follow her on X @SwapnaVenugopal This article originally appeared on USA TODAY: Trump 'gold card' is open for business. Waitlist is open
