Democrats Introduce Resolutions to End Medicare AI Pilot Program

Democratic lawmakers have introduced resolutions in both the House and Senate to repeal the Wasteful and Inappropriate Services Reduction model, known as WISeR. The pilot program uses artificial intelligence to review prior authorization requests for select services under traditional Medicare.

It operates in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington and is scheduled to run through 2031. Private contractors evaluate medical necessity and receive payment based on a share of averted expenditures.

DelBene stated that WISeR denies care to Medicare patients so companies can profit. Representative Ami Bera said these decisions should be made by doctors, not by algorithms designed to cut costs. Senate Finance Committee ranking member Ron Wyden said Americans are tired of abusive prior authorization tactics that put needed health care out of reach.

& Medicaid Services said the model aims to reduce wasteful or unnecessary care and lower costs by targeting low-value services. Under the Congressional Review Act, Congress has a 60-day window to act on the resolutions. Both chambers must pass the measure and the president must sign it for the program to end.