Democrats are pushing to shut down a new Medicare pilot program using artificial intelligence to approve or deny certain medical services under a new prior authorization model.
The pilot initiative, known as the Wasteful and Inappropriate Services Reduction (WISeR) model, uses AI-assisted prior authorization in traditional Medicare, but lawmakers say it could delay or deny care for seniors.
In the new resolution, Democrats are asking Congress to disband the WISeR model, which launched this year in Washington, New Jersey, Ohio, Oklahoma, Texas and Arizona.
Why It Matters
The use of AI in Medicare decision-making marks a major shift in how healthcare is delivered to millions of Americans.
The Medicare debate centers on whether algorithms should help decide whether patients get care. Many worry AI could delay or deny necessary treatments and financial incentives may encourage cost-cutting over patient care
What to Know
The WISeR model uses AI tools to review prior authorization requests and applies to select services under traditional Medicare.
So far, it operates in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The program launched this year, with the pilot’s end date set for 2031.
Under the initiative, private contractors use AI to evaluate medical necessity and approve or deny services. Contractors are paid based on a share of “averted expenditures” or cost savings.
However, a large and growing group of lawmakers is concerned it will lead to delays in care and more barriers for seniors in receiving healthcare.
“WISeR is a dangerous program that is denying care to Medicare patients so companies can profit,” Representative Suzan DelBene, a Washington Democrat, said in a statement. “This program implements the same flawed prior authorization scheme from Medicare Advantage into traditional Medicare. If scaled up, it would be a back door to privatizing Medicare.
Why Democrats Are Trying to Stop It
Democratic lawmakers have introduced resolutions in both the House and Senate to repeal the program.
Their concerns mainly center around the fear that AI may override doctors’ medical judgment and payment structure could incentivize denials of care. The program could also add bureaucratic red tape, lawmakers said.
“These decisions should be made by doctors, not by algorithms designed to cut costs,” Representative Ami Bera, a California Democrat, said in a statement. “We should be working to strengthen Medicare, not layering on more red tape that threatens access to timely, high-quality care.”
Concerns About Delayed or Denied Care
Lawmakers and advocates warn that the model could have real-world consequences for patients.
Potential risks:
- Delays in treatment approvals
- Worsening health conditions while waiting
- Denial of medically necessary care
“Americans are sick and tired of abusive prior authorization tactics putting needed health care out of reach,” Senate Finance Committee ranking member Ron Wyden, an Oregon Democrat, said in a statement. “The last thing seniors need is even more AI denying the care they need.”
Why the Program Was Created
The Centers for Medicare & Medicaid Services said the model is designed to reduce wasteful or unnecessary care and improve efficiency using AI.
They also are looking to lower costs for the larger Medicare system, specifically targeting services considered “low value” or vulnerable to misuse.
“While the addition of AI is supposed to create a faster, more efficient process for approving or denying certain claims, the fear by some legislators and beneficiaries is that the new process could ultimately lead to more denials and mistakes if not implemented properly,” Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek.
“At a time when AI usage is gaining more negative traction with large swaths of the American public, the prospect of expanding its integration with Medicare to all 50 states is likely to cause genuine concern.”
What Happens Next
- Lawmakers are using the Congressional Review Act to try to repeal the program
- A recent government ruling opened a 60-day window for Congress to act
For the program to be stopped, both the House and Senate must pass the resolution and the president must sign it into law.
“AI is a tool we have been using in one form or another for the past two decades, and it is here to stay,” Drew Powers, the founder of Illinois-based Powers Financial Group, told Newsweek. “The real issue here is using a for-profit company that gets paid more when it denies more authorizations for treatment. This completely disincentivizes serving seniors on Medicare in order to maximize profits.”
