Wyden, Gillibrand, Blumenthal Lead Calls to Halt Experiment to Undermine Traditional Medicare

Wyden, Gillibrand, Blumenthal Lead Calls to Halt Experiment to Undermine Traditional Medicare

Ranking Members Lead 18 Senate Democrats as Trump Administration Moves Ahead with WISeR Experiment, Which Hands Health Care Decisions to AI and Private Health Insurance Companies for Doctors and Seniors in Traditional Medicare

Washington, D.C. - Senate Finance Committee Ranking Member Ron Wyden, D-Ore., Senate Special Committee on Aging Ranking Member Kirsten Gillibrand, D-N.Y., and Senate Permanent Subcommittee on Investigations (PSI) Ranking Member Richard Blumenthal led 18 Senate Democrats in a call for the Trump administration to halt a Medicare experiment that would allow private insurance companies and artificial intelligence to deny care to seniors enrolled in Traditional Medicare across six states.

"We fear that the approach of this demonstration will put up roadblocks for patients seeking necessary care using technology like artificial intelligence that Americans do not want involved in health care decisions," the senators wrote. "This amounts to importing the most unpopular elements of Medicare Advantage, namely the frequent use of prior authorization, into Traditional Medicare. As such, we urge CMS to halt implementation of this demonstration until a full analysis of the program's impact on patient access is conducted that includes input from beneficiaries and their families, consumer and patient advocates, health care providers and suppliers."

Under the WISeR model, participants are third-party vendors who will use artificial intelligence (AI) to determine whether patients in Traditional Medicare would be covered for certain procedures. Although described as a voluntary model, WISeR is functionally mandatory for health care providers, suppliers and seniors in the six selected states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Clinicians that do not submit prior authorization requests for the selected services will face mandatory pre-payment medical reviews, adding administrative burden and potential care delays for people with Traditional Medicare.

The WISeR model's burden on physicians and other health care providers is immense, particularly for those working in small or marginalized or low-income settings. Most important is the lack of clarity this demonstration provides about how beneficiaries will be notified, supported, or protected if prior authorizations are denied. Without strong patient-centered protections and appeals guidance, the model could unintentionally restrict access to necessary care.

The letter can be found here.

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