What WA Health Care Leaders Are Saying About Trump’s New Medicare Red Tape

Starting in January 2026, Washington seniors and other beneficiaries enrolled in traditional Medicare will face new prior authorization for their health care. As an NBC News article puts it, the new program "amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions." Prior authorization, more common in Medicare Advantage and one of the reasons beneficiaries choose traditional Medicare, often needlessly delays or denies lifesaving care.

Recently, DelBene led a group of 17 House Democrats in a letter to CMS Administrator Oz, raising concerns about the new proposal and asking several important questions about how the model will be implemented. Most concerning is that Medicare Advantage plans will be the ones providing the prior authorization services, potentially profiting from denying care, and using AI to make decisions about what kinds of treatments are approved.

Washington health care leaders are speaking out about how the new concerns will delay or deny care and force providers to spend more time on the phone and less with their patients.

"As clinicians, our goal is to always ensure our patients receive the care they need as soon as possible. A new requirement to obtain 'prior authorization' for traditional Medicare patients will delay patient care," said Tim Dellit, MD, UW Medicine CEO, Dean of the School of Medicine, University of Washington. "Though almost all of our current prior authorization requests from private insurers and Medicare Advantage are ultimately approved, the process adds a significant burden on the patient and the physician. Moreover, adding the use of AI to make prior authorization decisions means fewer trained clinicians will have eyes on the process, and the opinions of our highly trained and experienced physicians could be overruled by an algorithm. The result will be additional burden and delays for those needing vital healthcare deemed necessary by their doctors."

"As a public hospital, EvergreenHealth is accountable to providing all community members with access to the highest quality care, including our senior population largely covered by Medicare," said Ettore Palazzo, MD, FACP, EvergreenHealth CEO. "Over the past several years, we have seen patient volumes and acuity in our Geriatric Care practice increase significantly, and we anticipate that expanding prior authorization requirements will create detrimental outcomes, by creating unnecessary delays and barriers to care while adding cost."

"It is well documented that prior authorization often results in delayed services for patients and additional burden for providers. We are concerned that the WISeR model provides an incentive for insurers to deny services and worry that the model would set a precedent for expanding prior authorization into traditional Medicare. We should be working to ensure all seniors have access to care, not adding new barriers that make it health care more difficult for Medicare patients," said Cassie Sauer, CEO, Washington State Hospital Association.

"CMS's new WISeR pilot is a step in the wrong direction. At a time when patients and physicians are calling for relief from the harmful delays and burdens of prior authorization, this program expands them-using untested AI and prepayment reviews that risk putting cost savings ahead of patient care. Physicians are deeply concerned that this will limit access, increase administrative waste, and undermine recent progress toward reform," said John Bramhall, MD, PhD, President, Washington State Medical Association.

"Family physicians consistently identify prior authorization as one of the most burdensome administrative tasks they and their staff face daily. These requirements continue to expand in scope and complexity, pulling time and attention away from patient care and delaying necessary care," said Sonal Patel, MD, MPH, President, Washington Academy of Family Physicians. "Of particular concern is this model's dependence on artificial intelligence vendors, whose financial incentives are tied to increased denial rates. While physician-led reviews of procedures with high rates of overuse may benefit the health care system by reducing unnecessary interventions and costs, the expansion of prior authorization denial into Traditional Medicare with AI as the gatekeeper raises serious concerns about who is making medical care decisions. Extending prior authorization into Traditional Medicare will divert limited physician and Medicare resources, decreasing the time and resources available for patients."