In Vancouver, Senators Murray & Wyden Affirm Commitment to Protecting Medicare from AI Prior Authorization
ICYMI: At HELP Hearing, Murray Grills Trump Nominees on AI Denying Seniors’ Health Care
ICYMI: On Senate Floor, Murray Urges Colleagues to End Trump Administration’s AI Program that is Delaying and Denying Seniors’ Health Care
***VIDEO OF FULL ROUNDTABLE DISCUSSION HERE***
Vancouver, WA — Today, U.S. Senators Patty Murray (D-WA), Vice Chair of the Senate Appropriations Committee and former chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Ron Wyden (D-OR), ranking member of the Senate Committee on Finance, held a roundtable discussion with providers to discuss how the Wasteful and Inappropriate Service Reduction (WISeR) model, a new pilot program implemented by the Trump administration that’s using artificial intelligence (AI) to conduct prior authorization in Traditional Medicare, has been overruling doctors and denying or delaying critical health care for seniors. The WISeR pilot model began on January 1, 2026, and is set to last for six years in six selected states, including Washington state.
Joining Senators Murray and Wyden for the discussion at the Area Agency on Aging & Disabilities of Southwest Washington today were: Dr. Keren Rosenblum, MD, MBA, President, The Vancouver Clinic; Dr. Leon McCook, family medicine physician, PeaceHealth; and Dr. Ettore Palazzo, MD, FACP, CEO, EvergreenHealth.
“Despite a lot of empty promises from Republicans to not cut Medicare—Trump’s new WISeR model is essentially a cut to Medicare. What else do you call it when seniors are getting cut off from the health care they need, for no good reason? Under this dystopian system—Washington state seniors are seeking doctor-recommended care to treat debilitating pain, only to be told by Trump’s AI system that Medicare won’t pay for it, or that they must wait weeks on end to get their treatment,” said Senator Murray. “The truth is—the WISeR model has been a complete mess. This cannot continue—and it absolutely cannot expand. That’s why I’m here to continue talking with folks on the ground—patients, doctors and more—and gathering evidence and stories we can use to make the case back in Congress. We are going to keep pushing hard to stop private companies from raiding Medicare, and cheating seniors with AI. Republicans may be sitting on their hands but a Democratic majority will be aggressive in pushing back and working to end this experiment, and save Medicare.”
“Dr. Frankenstein isn’t the only one conducting dangerous experiments this Halloween season. The mad scientists given free rein in the Trump administration are quite willing to risk seniors’ access to lifesaving health care with their latest scheme grafting AI on to authorization decisions for traditional Medicare,” said Senator Wyden. “As the ranking member of the Senate Finance Committee overseeing Medicare, I’m proud to stand with Senator Murray in the battle against Trump empowering unaccountable AI companies to delay and deny certain types of care in traditional Medicare.”
“Physicians support innovation and efforts to reduce waste and improve value in health care. But those goals should not come at the expense of timely access to medically necessary care,” said Dr. Keren Rosenblum, MD, MBA, President, The Vancouver Clinic. “WISeR moves Traditional Medicare toward the same prior authorization system physicians already know creates administrative burdens, delays appropriate care, and creates uncertainty for patients. At a time when physicians are already facing significant administrative burdens and workforce challenges, we should be looking for ways to make health care simpler—not adding new layers of complexity. Innovation should strengthen the patient-physician relationship, not create new obstacles between patients and the care their physicians believe they need.”
“After almost a full year of WISeR, it is clear how its implementation has negatively impacted our patients and staff, but we are still unsure if the program is achieving its intended purpose. As a community-owned public hospital district, EvergreenHealth supports efforts to reduce fraud, waste and the inappropriate utilization of Medicare benefits. However, we must pursue those goals in a way that does not delay care nor create unnecessary hardship for the patients we serve,” saidDr. Ettore Palazzo, MD, FACP, CEO, EvergreenHealth. “In the months following WISeR’s January implementation, we saw patients live with prolonged pain due to delayed authorizations for their treatment. Confusion and inconsistent processes have created additional workloads for our providers, making it difficult for them to support their patients effectively. Let’s continue to improve quality, value and program integrity in Medicare, but let’s focus on patient-centered implementation, timely decision-making and reducing unnecessary burdens on our care teams.”
Under the WISeR model, patients on Traditional Medicare across six states—Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington—are subject to prior authorization requirements for several types of procedures or treatments, meaning that a claim needs to run through an opaque A.I.-driven system that may deny it with limited explanation. This forces starting the whole approval process over again and setting the patient back weeks in the process. Several of the procedures subject to prior authorization under the WISeR model are treatments for patients experiencing debilitating pain, who are now having to wait to receive necessary care. Before this model, patients would have been able to receive care within the same week, or even day, in most cases. Prior authorization requirements are used routinely by Medicare Advantage plans and private insurers, but rarely in Traditional Medicare—which is often one of the reasons seniors choose it for their coverage. While the Centers for Medicare & Medicaid Services (CMS) has described the model as voluntary, it is effectively mandatory for providers and their patients with Traditional Medicare in the selected states.
Each participating state is operating the pilot through a different for-profit company that contracts with CMS to use AI technology to process prior authorizations and conduct reviews for the specific services subject to WISeR. These participants are compensated based on a share of “averted expenditures.” In other words, they are financially incentivized to deny prior authorization requests, as they profit from denied services.
Senators Murray and Wyden have been pushing back on this harmful pilot program from the start, and for the past year and a half, Murray has been meeting with providers and patients across the state to hear about the implementation and harms of this program. In September of last year, Senators Murray, Wyden and other Senate Democrats sent a letter to CMS Administrator Dr. Mehmet Oz and Center for Medicare and Medicaid Innovation (CMMI) Director Abe Sutton, urging CMS to halt implementation of the model until a full analysis is conducted of the program’s impact on patient access—which, they argued, should include input from beneficiaries and their families, consumer and patient advocates, health care providers and suppliers. In December last year, Senators Murray and Wyden introduced the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, legislation that would prohibit CMS from implementing the WISeR model that began on January 1, 2026.
This July, Murray and Wyden forced a vote on a Congressional Review Act (CRA) resolution to overturn the WISeR program—Republicans chose to side with the Trump administration and blocked the CRA. In September, Senator Murray grilled Chris Klomp, the nominee to be Deputy Secretary of Health and Human Services (HHS), on the WISeR model and how the private companies conducting the prior authorization assessments are profiting from the denials.
Senator Murray is also an original cosponsor of the bipartisan Improving Seniors’ Timely Access to Care Act of 2025 to streamline and crack down on prior authorization practices in Medicare Advantage plans.
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