Murray, Cantwell Introduce Resolution To Overturn A.I.-Driven Program That’s Overruling WA Doctors & Delaying Care for Seniors

WA hospitals report extended delays for authorization under WISeR pilot program & WA seniors report crippling pain while they wait for treatment

GAO confirmed WISeR pilot program is currently functioning illegally across 6 states and requires oversight from Congress

Washington, D.C. - Today, U.S. Senator Patty Murray (D-WA), Vice Chair of the Senate Appropriations Committee and a senior member and former chair of the Senate Health, Education, Labor and Pensions (HELP) Committee and U.S. Senator Maria Cantwell (D-WA), a senior member of the Senate Finance Committee and ranking member of the Senate Committee on Commerce, Science, and Transportation, introduced a Congressional Review Act (CRA) resolution to overturn a new pilot program that's using artificial intelligence (AI) to conduct prior authorization in Traditional Medicare to deny or delay certain procedures for seniors.

Under the Wasteful and Inappropriate Service Reduction (WISeR) model, which began on January 1, 2026, and is set to run for six years, Traditional Medicare patients across six states-Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington-are subject to prior authorization requirements for several types of procedures or treatments, meaning that a claim needs to run through an opaque A.I.-driven system that may deny it with limited explanation, starting the whole approval process over again and setting the patient back weeks in the process. Several of the procedures newly subject to prior authorization under the WISeR model are treatments for patients experiencing debilitating pain, who are now having to wait to receive necessary care. Before this model, patients would have been able to receive care within the same week, or even day, in most cases. Prior authorization requirements are used routinely by Medicare Advantage plans and private insurers, but rarely in Traditional Medicare-which is often one of the reasons seniors choose it for their coverage. While CMS has described the model as voluntary, it is effectively mandatory for providers and their patients with Traditional Medicare in the selected states.

Each participating state is operating the pilot through a different for-profit company that contracts with CMS to use AI technology to process authorizations and conduct reviews for the specific services subject to WISeR. These participants are compensated based on a share of "averted expenditures." In other words, they are financially incentivized to deny prior authorization requests, as they profit from denied services.

Last week, a decision commissioned by Sen. Murray and other Senate Democrats from the Government Accountability Office (GAO) confirmed that the WISeR model meets the definition of a rule subject to CRA's requirements, and was supposed to be submitted to Congress and GAO before it could take effect, making it eligible for this joint resolution of disapproval.

"President Trump came into office saying that he wouldn't cut Medicare-but that's effectively what the WISeR model does by delaying and denying claims using AI-and the consequences are serious," said Sen. Murray. "I constantly hear from patients who are suffering because they are not getting the care they need soon enough thanks to a rushed and inappropriate deployment of this harmful model. Prior authorization-especially when dictated by AI-creates major burdens and delays for patients and their doctors, and expanding it to Traditional Medicare forces seniors to wait longer and navigate mountains of paperwork to get the care they are entitled to. AI should not get to decide what health care patients can and can't receive. I will keep fighting to stop this administration from cutting seniors' benefits and threatening the care people need."

"For Washington's seniors, WISeR is overriding doctors to delay care and deny treatment. My constituents should not have to suffer through bureaucratic delays disguised as modernization. This pilot program should never have been implemented without congressional oversight, and I call on my colleagues to stand up for Medicare patients and put a stop to WISeR," Sen. Cantwell said.

The resolution introduced today was led by U.S. Senator Ron Wyden (D-OR). In addition to Sens. Cantwell and Murray, it's being co-introduced by U.S. Senators Richard Blumenthal (D-CT), Kirsten Gillibrand (D-NY), Cory Booker (D-NJ), Ruben Gallego (D-AZ), Ed Markey (D-MA), Tammy Duckworth (D-IL), Tammy Baldwin (D-WI), Andy Kim (D-NJ), Mark Kelly (D-AZ), Bernie Sanders (I-VT), Elizabeth Warren (D-MA), Mark Warner (D-VA), Tina Smith (D-MN), Ben Ray Luján (D-NM), Jeff Merkley (D-OR), and Dick Durbin (D-IL). Following the resolution's introduction, Senators will begin gathering signatures from 30 members for a discharge petition to force the resolution to the floor for a vote. Passage will require a simple majority.

In December, Sen. Murray led her colleagues in introducing the Seniors Deserve SMARTER Care Act which would prohibit CMS from implementing the WISeR model. Specifically, the bill reads: "The Secretary of Health and Human Services shall not implement the innovative payment and service delivery model described in the notice titled "Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model" (90 Fed. Reg. 28749 (July 1, 2025)), or any substantially similar model." Sen. Cantwell is an original cosponsor of the bill.

In September, Sen. Murray and other Senate Democrats sent a letter to CMS Administrator Dr. Mehmet Oz and Centers for Medicare and Medicaid Innovation (CMMI) Director Abe Sutton, urging CMS to halt implementation of the model until a full analysis is conducted of the program's impact on patient access-which, they argued, should include input from beneficiaries and their families, consumer and patient advocates, health care providers and suppliers. The senators' letter asked CMS for more information on the rationale for the selected six states, the plan for collaborating with the third-party vendors on AI, the reason for a lack of notice-and-comment rulemaking, and more. CMS has yet to respond to the letter. There have been very few details even to this day about the WISeR model rollout and implementation. Sens. Murray and Cantwell are also original cosponsors of the bipartisan Improving Seniors' Timely Access to Care Act of 2025 to streamline and crack down on prior authorization practices in Medicare Advantage plans.

READ MORE:

The Seattle Times: Murray pushes to halt federal pilot adding AI to Medicare approvals

The Seattle Times: WA patients agonize as Medicare AI program continues to delay care

The Spokesman Review: Cantwell warns RFK Jr. his agency's AI program is delaying, denying Medicare for seniors in Washington state

A snapshot report released last month by Sen. Cantwell's office included data from the Washington State Hospital Association (WSHA) showing 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.

Sen. Cantwell grilled Health and Human Services Secretary Robert F. Kennedy, Jr., about the WISeR rollout during a Finance Committee hearing in April. Video of their exchange isHERE;a transcript isHERE. Sen. Cantwell followed up the hearing with a letter to RFK Jr. demanding changes to the program. That letter can be read in full 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

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