By Lauren Sausser, Darius Tahir, KFF Health News

Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.

The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions. It will affect Medicare patients, and the doctors and hospitals who care for them, in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, starting Jan. 1 and running through 2031.

The move has raised eyebrows among politicians and policy experts. The traditional version of Medicare, which covers adults 65 and older and some people with disabilities, has mostly eschewed prior authorization. Still, it is widely used by private insurers, especially in the Medicare Advantage market.

And the timing was surprising: The pilot was announced in late June, just days after the Trump administration unveiled a voluntary effort by private health insurers to revamp and reduce their own use of prior authorization, which causes care to be “significantly delayed,” said Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services.

“It erodes public trust in the health care system,” Oz told the media. “It’s something that we can’t tolerate in this administration.”

But some critics, like Vinay Rathi, an Ohio State University doctor and policy researcher, have accused the Trump administration of sending mixed messages.

On one hand, the federal government wants to borrow cost-cutting measures used by private insurance, he said. “On the other, it slaps them on the wrist.”

Administration officials are “talking out of both sides of their mouth,” said Rep. Suzan DelBene, a Washington Democrat. “It’s hugely concerning.”

Patients, doctors, and other lawmakers have also been critical of what they see as delay-or-deny tactics, which can slow down or block access to care, causing irreparable harm and even death.

“Insurance companies have put it in their mantra that they will take patients’ money and then do their damnedest to deny giving it to the people who deliver care,” said Rep. Greg Murphy, a North Carolina Republican and a urologist. “That goes on in every insurance company boardroom.”

Insurers have long argued that prior authorization reduces fraud and wasteful spending, as well as prevents potential harm. Public displeasure with insurance denials dominated the news in December, when the shooting death of UnitedHealthcare’s CEO led many to anoint his alleged killer as a folk hero.

And the public broadly dislikes the practice: Nearly three-quarters of respondents thought prior authorization was a “major” problem in a July poll published by KFF, a health information nonprofit that includes KFF Health News.

Indeed, Oz said during his June press conference that “violence in the streets” prompted the Trump administration to take on the issue of prior authorization reform in the private insurance industry.

Still, the administration is expanding the use of prior authorization in Medicare. CMS spokesperson Alexx Pons said both initiatives “serve the same goal of protecting patients and Medicare dollars.”

Unanswered Questions

The pilot program, WISeR — short for “Wasteful and Inappropriate Service Reduction” — will test the use of an AI algorithm in making prior authorization decisions for some Medicare services, including skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy.

The federal government says such procedures are particularly vulnerable to “fraud, waste, and abuse” and could be held in check by prior authorization.

Other procedures may be added to the list. But services that are inpatient-only, emergency, or “would pose a substantial risk to patients if significantly delayed” would not be subject to the AI model’s assessment, according to the federal announcement.

While the use of AI in health insurance isn’t new, Medicare has been slow to adopt the private-sector tools. Medicare has historically used prior authorization in a limited way, with contractors who aren’t incentivized to deny services. But experts who have studied the plan believe the federal pilot could change that.

Pons told KFF Health News that no Medicare request will be denied before being reviewed by a “qualified human clinician,” and that vendors “are prohibited from compensation arrangements tied to denial rates.” While the government says vendors will be rewarded for savings, Pons said multiple safeguards will “remove any incentive to deny medically appropriate care.”

“Shared savings arrangements mean that vendors financially benefit when less care is delivered,” a structure that can create a powerful incentive for companies to deny medically necessary care, said Jennifer Brackeen, senior director of government affairs for the Washington State Hospital Association.

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And doctors and policy experts say that’s only one concern.

Rathi said the plan “is not fully fleshed out” and relies on “messy and subjective” measures. The model, he said, ultimately depends on contractors to assess their own results, a choice that makes the results potentially suspect.

“I’m not sure they know, even, how they’re going to figure out whether this is helping or hurting patients,” he said.

Pons said the use of AI in the Medicare pilot will be “subject to strict oversight to ensure transparency, accountability, and alignment with Medicare rules and patient protection.”

“CMS remains committed to ensuring that automated tools support, not replace, clinically sound decision-making,” he said.

Experts agree that AI is theoretically capable of expediting what has been a cumbersome process marked by delays and denials that can harm patients’ health. Health insurers have argued that AI eliminates human error and bias and will save the health care system money. These companies have also insisted that humans, not computers, are ultimately reviewing coverage decisions.

But some scholars are doubtful that’s routinely happening.

“I think that there’s also probably a little bit of ambiguity over what constitutes ‘meaningful human review,’” said Amy Killelea, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University.

A 2023 report published by ProPublica found that, over a two-month period, doctors at Cigna who reviewed requests for payment spent an average of only 1.2 seconds on each case.

Cigna spokesperson Justine Sessions told KFF Health News that the company does not use AI to deny care or claims. The ProPublica investigation referenced a “simple software-driven process that helped accelerate payments to clinicians for common, relatively low-cost tests and treatments, and it is not powered by AI,” Sessions said. “It was not used for prior authorizations.”

And yet class-action lawsuits filed against major health insurers have alleged that flawed AI models undermine doctor recommendations and fail to take patients’ unique needs into account, forcing some people to shoulder the financial burden of their care.

Meanwhile, a survey of physicians published by the American Medical Association in February found that 61% think AI is “increasing prior authorization denials, exacerbating avoidable patient harms and escalating unnecessary waste now and into the future.”

Chris Bond, a spokesperson for the insurers’ trade group AHIP, told KFF Health News that the organization is “zeroed in” on implementing the commitments made to the government. Those include reducing the scope of prior authorization and making sure that communications with patients about denials and appeals are easy to understand.

‘This Is a Pilot’

The Medicare pilot program underscores ongoing concerns about prior authorization and raises new ones.

While private health insurers have been opaque about how they use AI and the extent to which they use prior authorization, policy researchers believe these algorithms are often programmed to automatically deny high-cost care.

“The more expensive it is, the more likely it is to be denied,” said Jennifer Oliva, a professor at the Maurer School of Law at Indiana University-Bloomington, whose work focuses on AI regulation and health coverage.

Oliva explained in a recent paper for the Indiana Law Journal that when a patient is expected to die within a few years, health insurers are “motivated to rely on the algorithm.” As time passes and the patient or their provider is forced to appeal a denial, the chance of the patient dying during that process increases. The longer an appeal, the less likely the health insurer is to pay the claim, Oliva said.

“The No. 1 thing to do is make it very, very difficult for people to get high-cost services,” she said.

As the use of AI by health insurers is poised to grow, insurance company algorithms amount to a “regulatory blind spot” and demand more scrutiny, said Carmel Shachar, a faculty director at Harvard Law School’s Center for Health Law and Policy Innovation.

The WISeR pilot is “an interesting step” toward using AI to ensure that Medicare dollars are purchasing high-quality health care, she said. But the lack of details makes it difficult to determine whether it will work.

Politicians are grappling with some of the same questions.

“How is this being tested in the first place? How are you going to make sure that it is working and not denying care or producing higher rates of care denial?” asked DelBene, who signed an August letter to Oz with other Democrats demanding answers about the AI program. But Democrats aren’t the only ones worried.

Murphy, who co-chairs the House GOP Doctors Caucus, acknowledged that many physicians are concerned the WISeR pilot could overreach into their practice of medicine if the AI algorithm denies doctor-recommended care.

Meanwhile, House members of both parties recently supported a measure proposed by Rep. Lois Frankel, a Florida Democrat, to block funding for the pilot in the fiscal 2026 budget of the Department of Health and Human Services.

AI in health care is here to stay, Murphy said, but it remains to be seen whether the WISeR pilot will save Medicare money or contribute to the problems already posed by prior authorization.

“This is a pilot, and I’m open to see what’s going to happen with this,” Murphy said, “but I will always, always err on the side that doctors know what’s best for their patients.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By STAN CHOE, AP Business Writer

NEW YORK (AP) — U.S. stocks are drifting around their records on Tuesday after the price of gold topped $4,000 per ounce for the first time.

The S&P 500 ticked down by 0.1%, coming off its latest all-time high and a seven-day winning streak. The Dow Jones Industrial Average was down 66 points, or 0.1%, as of 11 a.m. Eastern time, and the Nasdaq composite was 0.1% lower.

The bond market and stock indexes overseas were also making relatively modest moves. Markets are taking a pause following a rush higher for many investments on hopes that the economy will remain resilient and that the Federal Reserve will continue to cut interest rates.

With the U.S. government stuck in another shutdown, several high-profile economic reports have been delayed, such as the monthly update on the job market. Without those reports, which often move the market, some strategists say Wall Street could remain in its upward trend for a while.

One of the biggest trends guiding Wall Street has been the frenzy around artificial-intelligence technology, which has vaulted the market to record after record but also raised worries that prices have potentially shot too high.

IBM rose 4% after announcing a partnership that will integrate Anthropic’s Claude AI chatbot into some of its software products. Dell climbed 2% after executives talked up the company’s opportunity for growth because of AI at a conference with investors and analysts. Advanced Micro Devices rallied another 4.5%, adding to its surge from the day before when it announced a deal where OpenAI will use its chips to power AI infrastructure.

Much is riding on expectations that the AI investment boom will pay off, make the global economy more productive and drive more growth. Without that increased efficiency, inflation could push higher due to upward pressure coming from the mountains of debt that the U.S. and other governments worldwide are building.

That has optimists on Wall Street buying tech stocks and pessimists buying gold, according to Thierry Wizman, a strategist at Macquarie Group.

Investors have traditionally seen gold as offering protection from high inflation. Its price has soared more than 50% this year not only because of governments’ huge debt loads but also because of political instability worldwide and expectations for lower interest rates from the Fed.

Investors looking to “hedge” themselves, meanwhile, may be buying both tech stocks and gold, Wizman wrote in a research report.

Elsewhere on Wall Street, Constellation Brands climbed 1.9% after the beer and wine company reported results for the latest quarter that several analysts said were better than they expected. Sales of beer still dropped from a year earlier, though, as CEO Bill Newlands highlighted a “challenging socioeconomic environment that has dampened consumer demand.”

Intercontinental Exchange, the company behind the New York Stock Exchange, added 0.8% after saying it had agreed to invest up to $2 billion in Polymarket.

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Polymarket offers prediction markets that allow customers to profit from making predictions on events across politics, financial markets and popular culture, such as who will become New York City’s next mayor or whether the U.S. government will announce that aliens exist this year.

On the losing end of Wall Street was Tesla, which fell 1.2%. It gave back some of its 5.4% leap from Monday, when speculation rose that postings to social media by the electric-vehicle maker hinted at a possible product unveiling coming on Tuesday.

In Toronto, shares of Trilogy Metals more than tripled after the White House said late Monday that it’s taking a 10% equity stake in the Canadian company while allowing the Ambler Road mining project in Alaska to go forward.

President Donald Trump late Monday ordered the approval of a proposed 211-mile road through an Alaska wilderness to allow mining of copper, cobalt, gold and other minerals used in production of cars, electronics and other technologies. Trilogy is seeking to develop the Ambler site along with an Australian partner, and its stock soared 216%.

In Europe, France’s CAC 40 edged up by less than 0.1% a day after slumping due to the latest political upheaval in Paris. France’s prime minister abruptly resigned on Monday.

In the bond market, the yield on the 10-year Treasury eased to 4.14% from 4.18% late Monday.

AP Business Writers Yuri Kageyama and Matt Ott contributed.

A ranch vacation means shedding your cares — and your “g”s — as country hospitality and wide-open spaces often stir up a hankerin’ for fishin’, shootin’, ridin’ and ropin’.

A newfound dialect and kindled love for outdoor adventure aren’t the only discoveries one can gain by thinking outside the box, or more to the point, outside the hotel or ship. There’s also the opportunity to make deeply textured memories woven from moments of connection, exploration and authenticity.

While luxury cruises and horseless resorts promise comfort and convenience, guest ranches — often casually dubbed “dude ranches” — invite active engagement with the land, making them among the most enriching outdoor escapes available.

Of course, personal fulfillment is a subjective measure, no matter how expansive a ranch’s immersive, nature-based offerings may be. To wit, those who’ve maxed out their REI Co-op Mastercard might not be shouting “yippie-ki-yay” quite as freely as someone who puts the giddy in giddy-up by being less seasoned in alfresco adventures. And, whoa, Nellie — if there’s any place to connect with one’s inner cowboy or cowgirl, it’s a guest ranch or, for a gutsier subset, a dude ranch.

Before we mosey to three of these saddle-up sanctuaries across the West, here’s a fine time to clarify an inklin’ that might be stirrin’ in the old thinkin’ corral. Guest ranches and dude ranches might seem synonymous to some, but they’re cut from different denim. A dude ranch leans into the rugged, communal spirit of the Old West, offering immersive horseback adventures, cowboy camaraderie and cattle drives. Think “City Slickers,” the 1991 dogie-punching comedy starring Billy Crystal. A guest ranch, while still Western at heart, often blends those traditions with refined luxury. Think upscale accommodations, spa treatments, gourmet dining and tailored experiences in a more intimate setting.

Concentrating on comfort and cocktails over chores and chaps, out West are three guest ranches that serve up soft beds, hearty meals and adventures backdropped by breathtaking beauty. Each one of these rustic retreats fosters frontier living without roughing it — though your boots may still warrant a critter check before you hit the trail.

The Ranch at Rock Creek

When asked precisely where Scarlett Johansson’s outdoor wedding took place on the 6,600-acre Ranch at Rock Creek some 11 years ago, staff at the enviable Montana resort offered only a polite nod toward a nondisclosure agreement — one that kept the location as hushed as the ceremony itself.

If only the marriage had lasted as long as the NDA.

The country-kissed vows Johansson exchanged with her second husband unraveled in under 2 1/2 years. But while the “Avengers” star may have a spotty record with spouses — she’s on No. 3 at press time — her taste in wedding venues is impeccable.

Glamping is living the high life in high country at The Ranch at Rock Creek. (Photo by David Dickstein)

The Ranch at Rock Creek (theranchatrockcreek.com), Forbes Travel Guide’s first five-star ranch, is well deserving of its stellar rating and reputation for providing plush pastures to the rich and famous along with splurging everyday folks. A working ranch since the 1800s and a luxury guest retreat since 2007, the spot for Rock Creek chic is a gem even without the active sapphire mining that’s glittered upstream for over 130 years.

As one would suspect of an all-inclusive, elite destination that offers more than 40 well-run adventures year-round, a vacation on the ranch just outside Philipsburg doesn’t come cheap. Grab the reins and grit your teeth because we’re going to talk numbers. A two-bed glamping cabin can cost upwards of $55,000 double occupancy (fees and taxes included) over five summer nights. That’s a bargain compared to a couple staying in the four-bedroom Sara Jane’s Cottage costing roughly $100K for a handful of days. A tad more approachable is a five-night stay in a “Classic Lodge Room,” the lower end of the ranch’s 31 distinct and lavish units, that starts at $14,145 for a couple visiting in the off-season (Jan. 3-April 13 and Nov. 1-Dec. 20).

At least you get what you pay for in this pinch-me place. Besides lux lodging on or near the banks of crystal-clear Rock Creek, there’s tasty vittles and bevvies to wash them down with, hootenannies that include a rousing ranch rodeo, and super-convenient airport shuttle service courtesy of a ranch hand. Despite being a 90-minute drive away, Missoula International Airport is the most convenient as it offers better flight availability than closer Bert Mooney Airport in Butte.

But of course, the heart of any guest ranch vacation is adventure — and here, guests can enjoy two tailored experiences each day. Premium-grade gear and guides come standard with every outing, from horseback riding, fly fishing, rifle shooting, wildlife viewing, archery and other classic pursuits, to the more offbeat, such as frontier survival skills, pistol shooting, disc golf and paintball.

Golf, float trips, ice fishing and other off-ranch activities are available in season for an additional fee, making them reasonable exceptions to the resort’s “all-inclusive” approach.

Speaking of extras, one of the ranch’s standout spa treatments is a creekside massage inside a covered wagon — modeled after those that once rumbled along the Montana Trail in the mid-1800s. With deep pockets comes deep tissue, as an hour of pioneer-style pampering is priced at $425 plus tip.

From rub to grub, food is another epic adventure at The Ranch at Rock Creek, be it cooked on a wood-fire grill or elevated to gourmet levels using local grass-fed beef, fish sourced from the namesake creek and foraged ingredients. Everything coming out of the ranch’s kitchens was a winner during a recent stay, but top honors went to the Montana beef Wellington as perfectly paired with a hard huckleberry lemonade that was frontier finesse in a glass — bold, balance and just unruly enough.

Tanque Verde Ranch

Nothing says “Arizona guest ranch” quite like sipping a prickly pear margarita on the back porch of a Western saloon while a roadrunner scuttles across the dust toward a cactus-studded horizon bathed in sunset gold.

That dreamlike, desert-set scenario can become a daily ritual when staying at Tucson’s treasured Tanque Verde Ranch, which has welcomed guests from around the world for over 150 years.

Tanque Verde Ranch offers guided rides with a backdrop of towering saguaros and desert sky. (Photo by David Dickstein)

Blessed with the most majestic of neighbors — the Catalina Mountains to the north, Saguaro National Park to the south, the Rincon Mountains to the east and Tucson proper to the west — the ranch is a satisfying blend of rugged desert beauty, Old West authenticity, refined Southwestern charm and modern luxury. It also sports some of the finest horses and wranglers this side of the Pecos.

Many of the property’s 69 well-maintained rooms, suites and haciendas feature fireplaces, patios and million-dollar views year-round. Even better, the units don’t come close to costing that much. In the blazing Tucson summer, a five-night, all-inclusive stay for two well-sunscreened adults goes for as low as $3,267 (including fees and taxes).

Twenty-five room categories, two distinct seasons (peak being October through April), multiple meal packages and a catalog’s worth of à la carte activities create a dizzying number of ways to spend more or save more. Let’s not beat around the tumbleweed — chasing a calf through cactus brush is easier than booking through the ranch’s current website (tanqueverderanch.com). Unless you’re going all-inclusive, skip the hassle and call them at 800-234-3833.

Making the most of your stay by going full-board covers three sumptuous meals a day, horseback riding and a wide range of other activities — from mountain biking, hiking and fishing to tennis, swimming and pickleball. Most experiences lean toward the great outdoors, of course, though there’s no shortage of indoor fun. Kids on the all-inclusive plan have their own lineup of supervised adventures, including trail rides, arts and crafts, and close-up encounters with slithering and crawling desert critters at the nature center.

Also on-site — but not part of the all-inclusive package, just like airport transfers — are La Sonoran Spa and the Dog House Saloon. Few things beat a full-body massage or the ranch’s signature prickly pear margarita after a long day spent riding, hiking and biking in the Arizona sun.

Greenhorn Ranch

Tucked into the pine-covered folds of the northern Sierra Nevada, Greenhorn Ranch sits just outside Quincy, a California mountain town 90 minutes from Reno and lovingly sandwiched between the Tahoe and Plumas national forests.

Established in 1962 and deliberately maintaining a more rustic than refined atmosphere, Greenhorn Ranch (greenhornranch.com) has strong appeal for families, the more multigenerational the better with the variety of bond-making activities. Even couples hankering for thrills without the frills — and a few bucks left in their saddlebags—might tip their Stetsons to Greenhorn Ranch over fancier digs like Alisal Ranch in Solvang (alisalranch.com).

Greenhorn Ranch guests test their archery skills. (Photo by David Dickstein)

Greenhorn Ranch trades spas and sitters for simple comforts and spirited activities fit for all ages, though the saloon’s hooch is best left to grown-ups. Beyond such classic ranch offerings as trail rides and fishing — with lessons available if needed — guests can kayak, skeet shoot, ride electric mountain bikes and practice archery at elevations above 4,500 feet.

Open from May through October, Greenhorn Ranch offers three packages, starting with a bed and breakfast tier of around $370 nightly for one to two guests. The “Grand Adventure” package includes lodging, two guided activities per day and, when the weather’s right, a mouth-watering feast of baby back ribs, grilled chicken and ranch-style sides best enjoyed on a picnic bench beside a peaceful pond under the Sierra sky.

’Pardners — when the campfire’s cracklin’, the barbecue’s smokin’ and music’s drifting over the fishin’ hole, eatin’ inside is like watchin’ the sunset through a screen door.

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By GARY GERARD HAMILTON, Associated Press

NEW YORK (AP) — A Biblical series reaching No. 1 on a major streaming service may seem as unlikely as a shepherd boy killing a 9-foot giant with a single stone from his slingshot. But Michael Iskander demonstrates that believing in something can turn the seemingly impossible into reality.

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“The story of David is pretty wild, and I think there’s a reason why it’s resonated for so many years,” said the former Broadway actor, who, in his first major TV role, plays the “House of David” titular character. “People have come up to me from all walks of life — not just Christians — and they talk about how much they love it.”

“House of David,” which loosely follows the life of the shepherd boy and the well-known events familiar to religious believers, like his fight with a lion, killing Goliath and ascending to become king of Israel, sling-shot its way to the top of Prime Video after debuting in February without much social media fanfare or extensive press. The streaming service says more than 44 million viewers worldwide have watched the series based on the heroic character recognized in the Christian, Jewish and Islamic faiths.

The series is part of a growing number of Hollywood faith-based projects reaching beyond religious audiences thanks to stunning cinematography, high-impact action sequences and suspenseful plots. A lane for “House of David” was created thanks to the major success of “The Chosen,” a series based on the life of Jesus Christ, and more are coming: “Joseph of Egypt,” based on the popular story of the boy who was sold into slavery by jealous brothers before rising to ruler or Egypt, is in the works.

“We see these Biblical figures and we think they’re so much larger than life,” said the 23-year-old Egyptian-born actor, who recently converted to Catholicism from Coptic Orthodoxy. “My personal goal was to bridge that gap and to show people … they make mistakes just like us.”

While “House of David” originally premiered on Prime Video, season two will debut Oct. 5 exclusively on the new Wonder Project subscription service that costs an additional $8.99. The season will eventually arrive on the main platform at a later date.

Iskander spoke to The Associated Press about his upcoming album, the debate about roles devout religious actors should take, and cantankerous sheep. This interview has been edited for clarity and brevity.

AP: What drew you to the role of David?

ISKANDER: David is known for being the Psalm writer, and the poet. But he was also a warrior. He became a king. And so, this man has so many aspects to his life.

Famously Bathsheba: cheating on his eight wives with the wife of one of his soldiers, and then covering that up by killing that soldier. And yet, that guy is known as the man after God’s own heart. How does David get that title? You discover that the whole point of the story of David is about the heart, how a heart after God can lead you to defeating giants.

AP: How did you train to become a shepherd for this role?

ISKANDER: The sheep hated me, like, they wanted nothing to do with me. They saw me from like a mile away and they started running. And the shepherd would have to kind of calm them down. And eventually, they weren’t too scared.

Him giving me advice on how to take care of sheep, it informed me about the types of things that David would do. And so, even that, I started to understand David more.

AP: There’s always the discussion about the content of roles that devout followers should take, whether they involve sex scenes or gratuitous violence. Have you thought about future projects?

ISKANDER: My faith always comes first. That’s No. 1. And so, I guess I look at everything through that lens. I don’t see why there should be a separation between art and faith. I’m very lucky with David. I get to worship when I go to work — that’s a blessing. I hope more people are inspired by faith in their art.

I think humans are very complex beings and we can’t tell our story without telling some of our downfalls. I have a line that I don’t cross, but I don’t think we should be afraid to dive into the complete nature of humanity.

AP: Can you tell me about your upcoming album based on music from the show?

ISKANDER: It’s been one of my dreams for the longest time to bring the Psalms to life and to put them to the original language.

I sent a little sample to the to the producers of the show and I was like, ‘Hey, can we do the show and the music of the show in Hebrew?’ And they loved it. Out of it arose these Psalms in Hebrew that were kind of sprinkled throughout the show, and they started to really resonate with people. And they were like, we want an album.

AP: Are you prepared to be known as David for the rest of your life?

ISKANDER: I don’t mind at all. If I’m known as David, then that would be a blessing.

Follow Associated Press entertainment journalist Gary Gerard Hamilton at @GaryGHamilton on all his social media platforms.