Congressional Democrats try to force a vote to end Medicare AI prior authorization pilot
Senate and House Democrats introduced resolutions to overturn Medicare’s AI-driven prior authorization pilot program, WISeR, citing delays in care for seniors in states like Washington, while a GAO ruling found the program violated Congressional approval requirements. Critics argue the program incentivizes care denials and risks privatizing Medicare, with lawmakers like Wyden, Murray, and DelBene leading the opposition.
Senate and House Democrats introduced resolutions on May 20, 2026, to block Medicare’s AI-based prior authorization pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) program. The move follows a Government Accountability Office (GAO) ruling last week stating WISeR should have required Congressional approval before its January 2026 launch. The program, currently operational in Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington, uses AI to approve or deny certain medical supplies and procedures, excluding emergency services and inpatient-only treatments. Senator Ron Wyden (D-Ore.) led the Senate resolution under the Congressional Review Act, joined by 19 other Democrats, including Patty Murray (D-Wash.), Maria Cantwell (D-Wash.), Richard Blumenthal (D-Conn.), and Kirsten Gillibrand (D-N.Y.). House Representatives Suzan DelBene (D-Wash.) and Greg Landsman (D-Ohio) introduced a parallel resolution, following DelBene’s earlier 2025 bill to halt the program. Both chambers’ resolutions cite reports of delayed care for Medicare patients, with Cantwell highlighting Washington state hospitals facing AI-driven denials in April hearings. The WISeR program targets specific supplies and procedures flagged for potential fraud, requiring providers to submit requests to contractors using AI for approvals. Contractors are paid based on an undisclosed formula tied to denial rates, raising concerns that the system incentivizes care denials. Experts and lawmakers, including DelBene, warn the program risks expanding privatized Medicare models while worsening patient outcomes and long-term costs. Critics argue WISeR replicates flawed prior authorization schemes from Medicare Advantage, with DelBene calling it a ‘dangerous program’ that ‘denies care to Medicare patients so companies can profit.’ The GAO’s ruling underscores procedural violations, as WISeR bypassed required Congressional review. With bipartisan opposition growing, the resolutions aim to force a vote to terminate the pilot before its potential nationwide expansion.
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