Cantwell Presses RFK Jr. on New A.I. Filter Blocking Care for Medicare Patients

Cantwell Presses RFK Jr. on New A.I. Filter Blocking Care for Medicare Patients

NEW DATA: A.I.-driven pilot program called WISeR is leading to longer wait times, opaque claim denials, & worse health outcomes for thousands of WA seniors; Cantwell in Senate committee hearing: "If we really think we're going to put A.I. in charge of deciding [care] instead of doctors, I think we're going to have some real problems"

WASHINGTON, D.C. - Today, U.S. Senator Maria Cantwell (D-WA), a senior member of the Senate Finance Committee and the ranking member of the Senate Committee on Commerce, Science, and Transportation, questioned U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. about a new artificial intelligence tool that's delaying or even overturning doctor recommendations for Medicare patients.

Under RFK Jr.'s leadership, HHS launched the Wasteful and Inappropriate Services Reduction (WISeR) model on Jan. 1, 2026 across six states. In those states -- Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington - Medicare patients are subject to prior authorization requirements for 13 types of procedures or treatments, meaning that a claim needs to run through an opaque A.I. driven system that may deny it with no explanation, starting the whole process over again and setting the patient back weeks in the process.

A new snapshot report compiled today by Sen. Cantwell's office including new data from the Washington State Hospital Association shows that patients dealing with WISeR are waiting two to four times longer to get the care recommended by their doctors - from a previous average of around two weeks to the current average of four to eight weeks.

"A.I. is being used as a denial device for the CMS system. And it's apparently had some problems where, it's not taking a few days to find out whether you're going to get covered or not -- it's basically taking weeks to find out that you're denied, on things that never were a prior denial before," Sen. Cantwell told RFK Jr. in a hearing of the Senate Finance Committee today.

"We have hospitals calling me about this, I have doctors calling me about this, I have patients calling me about this. So, I would appreciate if you take a look at it."

RFK Jr. responded: "That kind of delay is unacceptable, and we will work with you on it."

Sen. Cantwell said: "The scary thing about A.I. is that if we really think we're going to put A.I. in charge of deciding [care] instead of doctors, I think we're going to have some real problems."

Video of their exchange is HERE; a transcript is HERE.

In their survey of three hospital systems with 16 hospital locations spanning across the State of Washington, WSHA heard directly from its members how WISeR has impacted care for Medicare patients since Jan. 1:

• Authorization times for many medically necessary procedures have gotten longer (from about 2 weeks to 4-8 weeks)
• Delays mean patients are experiencing prolonged pain and reduced mobility, and some are turning to alternative treatment methods (For example: One of the most common procedures that now requires prior authorization under WISeR is an epidural steroid injection for back pain. Facing long approval delays and dealing with pain/limited mobility, some patients - who previously had no problem getting the procedure approved under Medicare - are now turning to opioids to help manage the pain)
• Claims are being sequenced based on authorization timing rather than clinical need
• Denials are often inconsistent with clinical criteria and lack clear reasoning

"Across our system, physicians are concerned about the lack of clear information and predictability surrounding the WISeR program. Uncertainty about what services may be denied and how to navigate the review process is creating operational challenges and could place additional cost pressure on providers that are already struggling. Our priority is ensuring patients can continue to receive timely, medically appropriate care while clinicians are able to spend their time focused on patients, not navigating complex administrative processes," said Susan Stacey, RN, Chief Executive of Providence Inland Northwest in Spokane.

"I am concerned that some of our patients, as they are wading through the morass of WISeR, may turn to pain control alternatives that are harmful and addictive long-term," said Dr. Andrew Jones, CEO of Confluence Health in Wenatchee, Washington. "The WISeR program is making pain management harder, which could lead to unintended and dangerous consequences."

"We are seeing instances where automated decision making may interfere with timely access to medically appropriate services that Medicare patients have long relied on," said Tammy Buyok, President of Yakima Memorial Hospital and MultiCare Yakima Region Market Leader. "We have growing concerns about WISeR's approach and its impact on patient care… Our patients are our top priority, and we are concerned that adding for-profit technology company layers between clinicians and care decisions can unintentionally create barriers for the people the system is meant to serve."

Sen. Cantwell's full snapshot report with more exclusive date on the impacts of WISeR is HERE.