ICYMI: Warren, Murray, Wyden, Gillibrand Lead Democrats in New Bill to Halt Medicare's New AI Approvals Process

As Republicans double down on health care sabotage, Senators lead effort to protect Medicare benefits from an AI experiment

Bill Text (PDF)

Washington, D.C. - Senator Elizabeth Warren (D-Mass.) joined Senator Patty Murray (D-Wash.), Vice Chair of the Senate Appropriations Committee; Senator Ron Wyden (D-Ore.), Ranking Member of the Senate Finance Committee; Senator Kirsten Gillibrand (D-N.Y.), Ranking Member of the Senate Aging Committee; and their colleagues in introducing the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, legislation that would prohibit the Centers for Medicare and Medicaid Services (CMS) from implementing the Wasteful and Inappropriate Service Reduction (WISeR) model.

The Trump administration's WISeR model will introduce prior authorization requirements into Traditional Medicare for the first time ever-allowing private companies to use artificial intelligence (AI) to decide whether to approve or deny certain medical procedures for patients on Traditional Medicare. The model will impose new burdensome requirements on health care providers, especially those working in small or low-resource settings, and create new roadblocks for patients-meaning that AI will get to decide what care patients receive, even after their doctors have recommended a particular procedure or medication.

Most concerningly, the third-party AI companies involved in the program will be compensated based on a share of "averted expenditures"-rewarding companies based on the volume or cost of care they deny to seniors on Medicare. According to CMS, human clinicians will review any denials made by AI-but the Trump administration has failed to provide clear guidance to providers and the public about what this will look like, despite implementation being mere weeks away. The Trump administration has provided little detail on how patients will be notified, supported, or protected if prior authorization requests are denied.

The Trump administration plans for the WISeR model to run as a pilot program for six years beginning January 1, 2026 in six selected states. The model is described as voluntary, but it is effectively mandatory for health care providers and their patients with Traditional Medicare in the six selected states: Washington, New Jersey, Ohio, Oklahoma, Texas, and Arizona.

In addition to Senators Warren, Murray, Wyden, and Gillibrand, the Seniors Deserve SMARTER Care Act is cosponsored by Senators Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Maria Cantwell (D-Wash.), Tammy Duckworth (D-Ill.), Ruben Gallego (D-Ariz.), Andy Kim (D-N.J.), Ben Ray Luján (D-N.M.), Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Lisa Blunt Rochester (D-Del.), Bernie Sanders (I-Vt.), Tina Smith (D-Minn.), and Peter Welch (D-Vt.).

In November, U.S. Representative Suzan DelBene (D-Wash.) introduced companion legislation alongside Reps. Kim Schrier (D-Wash.), Rick Larsen (D-Wash.), Greg Landsman (D-Ohio), Ami Bera (D-Calif.), and Mark Pocan (D-Wis.) in the House of Representatives.

The Seniors Deserve SMARTER Care Act is endorsed by: Washington State Hospital Association (WSHA), Washington State Medical Association (WSMA), Puget Sound Advocates for Retirement Action (PSARA), Physicians for a National Health Program, the Center for Health and Democracy, Social Security Works, Just Care USA, Washington Community Action Network, Healthcare is a Human Right Coalition, Health Care for All - Washington, Social Security Works Washington, National Nurses United, Public Citizen, Society for Cardiovascular Angiography and Interventions, American Osteopathic Association, American Podiatric Medical Association, Mental Health Liaison Group, and the American Academy of Physical Medicine and Rehabilitation.