Washington 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 Patty Murray (D-WA), Vice Chair of the Senate Appropriations Committee and a senior member and former chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, Senator Ron Wyden (D-OR), Ranking Member of the Senate Finance Committee, and Senator Kirsten Gillibrand (D-NY), Ranking Member of the Senate Aging Committee, led 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 that is set to begin January 1, 2026 and last for six 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 Trump administration is gearing up to use AI to delay and deny Medicare benefits for seniors—this is outrageous and should be a national scandal,” said Senator Murray. “Seniors already face painful delays when it comes to getting health care, and Republicans have plunged our nation’s health care system further into crisis by passing the largest-ever cuts to Medicaid and the Affordable Care Act—leaving many hospitals hanging on by a thread. The very last thing this administration should be doing is strangling already overworked providers in new red tape and letting AI decide who gets health care and who doesn’t.”
“We already know that prior authorization creates major burdens and delays for patients and providers, and expanding it to Traditional Medicare will just force seniors to wait longer and navigate mountains of paperwork to get the care their doctor says they need,” Senator Murray continued. “Make no mistake: this is a backdoor effort to privatize Medicare and cut benefits. My message to seniors in Washington state: I will fight with everything I’ve got to stop this morally bankrupt AI takeover of Medicare and make sure you can get the health care you need.”
“The Trump Administration is pushing automated care denials on seniors in Traditional Medicare, which is the last thing Americans want for their health care,” Senator Wyden said. “Instead of improving Traditional Medicare to give seniors the health care they’ve earned, Donald Trump and his cronies are empowering insurance companies and AI special interests. It’s time to stop this experiment on seniors.”
“Artificial intelligence should not delay or deny seniors’ health care. The Trump administration’s new program would force seniors to jump through unnecessary hoops just to get the care they need and impose new, unnecessary burdens on health care providers,” said Senator Gillibrand. “As the top Democrat on the Senate Aging Committee, protecting and expanding access to Medicare is one of my top priorities, and I will keep fighting to ensure that health care decisions are made by patients and their doctors, not untested, profit-driven AI programs.”
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 September, Senator Murray and other Senate Democrats sent a letter to CMS Administrator Dr. Mehmet Oz and 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. The senators’ letter asks CMS for more information on the rationale for the selected six states, the plan for collaborating with the third-party vendors on AI, the reason for a lack of notice-and-comment rulemaking, and more. There have been very few details even to this day about the WISeR model rollout. 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.
Senator Murray has championed Medicare and fought to protect the program throughout her entire career—including as the top Democrat on the Senate Health Committee from 2017-2022—alongside other efforts to bring down the cost of health care and make care more accessible to families. She championed efforts to allow Medicare to negotiate lower prescription drug prices for seniors for years, and worked hard with her Democratic colleagues to make lower drug costs for seniors a reality as part of the Inflation Reduction Act, which every Republican voted against. Senator Murray is committed to getting answers about the WISeR model, holding the Trump administration accountable through any implementation, and protecting Americans’ Medicare benefits from Trump’s AI experiment.
In addition to Senators Murray, Wyden, and Gillibrand, the Seniors Deserve SMARTER Care Act is cosponsored bySenators Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Maria Cantwell (D-WA), Tammy Duckworth (D-IL), Ruben Gallego (D-AZ), Andy Kim (D-NJ), Ben Ray Luján (D-NM), Ed Markey (D-MA), Jeff Merkley (D-OR), Lisa Blunt Rochester (D-DE), Bernie Sanders (I-VT), Tina Smith (D-MN), Elizabeth Warren (D-MA), and Peter Welch (D-VT).
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.
“The Washington State Medical Association applauds Senator Murray for introducing the Seniors Deserve SMARTER Care Act — a necessary step toward protecting patients from burdensome prior authorization policies. The proposed legislation recognizes what physicians and patients have long warned about: the Centers for Medicare and Medicaid Services’ WISeR pilot would impose unnecessary delays, expand administrative waste, and ultimately jeopardize patient access to care. We stand firmly with Senator Murray in calling for a complete prohibition on implementation of the WISeR Model and urge lawmakers to enact the SMARTER Care Act swiftly to ensure timely, patient-centered care remains the priority,” said Bridget Bush, MD, FASA, President, Washington State Medical Association (WSMA).
“PSARA and all Medicare beneficiaries in Washington State appreciate Senator Murray for stepping up to defend Original Medicare from attacks like the WISeR program, that will incentivize delays and denials of needed medical care,” said Mike Andrew, Executive Director of the Puget Sound Advocates for Retirement Action (PSARA).
Text of the legislation is available HERE.
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