Schakowsky, Pocan Introduce Resolution Condemning Prior Authorization Use in Medicare

Full Text of Resolution (PDF)

WASHINGTON - Today, U.S. Representatives Jan Schakowsky (IL-09) and Mark Pocan (WI-02) introduced a resolution condemning the Trump administration's plan to implement a new Medicare requirement, dubbed the Wasteful and Inappropriate Service Reduction (WISeR) Model, to force recipients of traditional Medicare to receive prior authorization, including through the use of artificial intelligence (AI), before being able to receive some forms of medical care.

"Every year, millions of seniors on Medicare Advantage are unfairly denied the care they need because of burdensome prior authorization rules. Now, the Trump Administration plans to implement these same requirements on certain traditional Medicare services - threatening access to care for millions more. This is unacceptable," said Congresswoman Jan Schakowsky. "That is why I am proud to be joining Congressman Pocan in introducing this resolution calling for the termination of the Wasteful and Inappropriate Service Reduction (WISeR) Model. We must protect traditional Medicare."

"It is not an exaggeration to say that the requirement of prior authorization for traditional Medicare services will kill seniors," said Congressman Mark Pocan. "Not only that, but the use of AI in determining whether or not treatment is necessary is extremely reckless. Unlike Medicare Advantage plans that already use AI in prior authorization decisions, traditional Medicare is supposed to cover you, no questions asked. This is a disastrous idea of epic proportions and should be immediately rescinded."

The WISeR Model requires Medicare beneficiaries in pilot states - Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington - to increase the number of Medicare services requiring pre-approval by 30%, primarily using AI to do so. This means that patients' medical decisions - from what medications they can take to which procedures they can undergo - will be made by a bot run by private contractors who prioritize profits over patient safety.

Most Medicare Advantage plans primarily require prior authorization to receive any care, leading to countless delays and denials, resulting in thousands of deaths every year. However, when those denials are appealed, a significant portion of them are overturned, resulting in needless delays and bureaucracy. Moreover, some Medicare Advantage plans that already use AI in prior authorization decisions have been found to have error rates as high as 90%.

Representatives Lloyd Doggett (TX-37), Maggie Goodlander (NH-02), Greg Landsman (OH-01), Alexandria Ocasio-Cortez (NY-14), Rashida Tlaib (MI-12), and Bonnie Watson Coleman (NJ-12) co-sponsored the resolution.

Endorsing Organizations: Center for Health and Democracy, Just Care USA, Labor Campaign for Single Payer, National Nurses United, Physicians for a National Health Program, Social Security Works.

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