State is one of six states selected by the Trump administration to take part in untested new program adding new red tape to Traditional Medicare by allowing AI to approve or deny medical procedures for seniors; As Republicans double down on health care sabotage, Senators lead effort to protect Medicare benefits from an AI experiment
WASHINGTON, D.C. – Today, U.S. Senator Maria Cantwell (D-WA), ranking member of the Senate Committee on Commerce, Science, and Transportation and senior member of the Finance Committee, joined Senate 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 that is set to begin January 1, 2026 and last for 6 years.
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—including Washington state. About 1.6 million are enrolled in Medicare in Washington state, just over half are enrolled in Traditional Medicare, with the remainder enrolled in Medicare Advantage. 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 November, U.S. Representative Suzan DelBene (D, WA-01) introduced companion legislation alongside Reps. Kim Schrier (D, WA-08), Rick Larsen (D, WA-02), Greg Landsman (D, OH-01), Ami Bera (D, CA-06), and Mark Pocan (D, WI-02) in the House of Representatives.
The Seniors Deserve SMARTER Care Act 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.”
In addition to Senator Cantwell, the Seniors Deserve SMARTER Care Act is cosponsored by Senators Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Maria Cantwell (D-WA), Tammy Duckworth (D-IL), Ruben Gallego (D-AZ), Kirsten Gillibrand (D-NY), Andy Kim (D-NJ), Ben Ray Luján (D-NM), Ed Markey (D-MA), Jeff Merkley (D-OR), Patty Murray (D-WA), Lisa Blunt Rochester (D-DE), Bernie Sanders (I-VT), Tina Smith (D-MN), Elizabeth Warren (D-MA), Peter Welch (D-VT), and Ron Wyden (D-OR).
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.
“Medicare was built on a promise that seniors can access timely, quality care guided by their doctors, not profit-driven algorithms. The WISeR model introduces AI-powered prior authorization and outsources critical decisions to private contractors, creating barriers that undermine trust and delay treatment. The Seniors Deserve SMARTER Care Act is essential to preserve the integrity of Traditional Medicare, protect patients from harmful delays and keep clinical decisions where they belong: in the hands of providers. Washington’s seniors deserve care that prioritizes health outcomes, not cost-cutting,” said Cassie Sauer, CEO of the Washington State Hospital Association.
Text of the legislation is available HERE.