A.I.-Driven Program Blocking WA Seniors From Pain Relief Will Continue After Republicans Vote to Maintain It

A.I.-Driven Program Blocking WA Seniors From Pain Relief Will Continue After Republicans Vote to Maintain It

In floor speech after vote, Cantwell urges colleagues to "please get educated" after failure of resolution that could have halted WISeR, an A.I. pilot program blocking and delaying procedures for Medicare patients; WA seniors report going through multiple rounds of A.I.-driven denials while they suffer in pain waiting for treatment

WASHINGTON, D.C. - Today, legislation that could have halted an A.I. pilot program that has both delayed and denied doctor-prescribed treatments for Medicare patients in Washington failed after Republicans voted to continue to block seniors' access to health care.

At the start of the year, the U.S. Department of Health and Human Services launched the Wasteful and Inappropriate Services Reduction (WISeR) model across six states. In those states -- Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington - Medicare patients are subject to prior authorization requirements for 13 types of procedures or treatments. This means that a claim needs to run through an opaque A.I.-driven system that may deny it with no explanation - starting the whole process over again and setting the patient back weeks in the process. Moreover, although it is described as a pilot program, the Trump Administration plans to subject patients in these states to the WISeR model for six years.

In May, U.S. Senator Maria Cantwell (D-WA), ranking member of the Senate Committee on Commerce, Science, and Transportation, and senior member of the Senate Finance Committee, introduced a Congressional Review Act (CRA) joint resolution to overturn WISeR and halt the pilot program.

Today, a vote to advance that joint resolution failed along party lines, 46-50. Sen. Cantwell delivered a speech on the Senate floor shortly after the vote concluded.

"This model inserts a black box computer algorithm into the decisions that should be being made by a physician and the patient," Sen. Cantwell said. "It puts a layer of bureaucracy between seniors and the care their doctors have recommended."

She continued: "I'm asking my colleagues to please get educated on how devastating this can be for individual lives and ask yourselves if you believe in traditional Medicare and the doctor-patient relationship. If you do, I guarantee you we will force this administration to stop using this A.I. tool to deny care for our seniors."

Video of Sen. Cantwell's floor speech today is HERE; a transcript of Sen. Cantwell's remarks is HERE.

A snapshot report released in April by Sen. Cantwell's office included data from the Washington State Hospital Association (WSHA) showing that patients forced to deal with WISeR are waiting two to four times longer to get the care recommended by their doctors - from a previous average of around two weeks to the current average of four to eight weeks.

In their survey of three hospital systems with 16 hospital locations spanning across the State of Washington, WSHA heard directly from its members how WISeR has impacted care for Medicare patients since Jan. 1:

• Authorization times for many medically necessary procedures have gotten longer (from about 2 weeks to 4-8 weeks)
• Delays mean patients are experiencing prolonged pain and reduced mobility, and some are turning to alternative treatment methods (For example: One of the most common procedures that now requires prior authorization under WISeR is an epidural steroid injection for back pain. Facing long approval delays and dealing with pain/limited mobility, some patients - who previously had no problem getting the procedure approved under Medicare - are now turning to opioids to help manage the pain)
• Claims are being sequenced based on authorization timing rather than clinical need
• Denials are often inconsistent with clinical criteria and lack clear reasoning

Before the vote, the Washington State Medical Association (WSMA) released a statement in favor of the resolution:

"The Washington State Medical Association strongly supports SJR 198 to overturn the CMS WISeR model. WISeR imposes a new layer of AI-driven prior authorization in traditional Medicare, creating unnecessary administrative burdens and delays that interfere with timely patient care. Medicare patients deserve access to medically necessary care without unnecessary barriers, and physicians should be able to focus on caring for their patients rather than navigating an unnecessary review process. We urge Congress to pass SJR 198 and protect access to care for Medicare beneficiaries."

Sen. Cantwell grilled Health and Human Services Secretary Robert F. Kennedy, Jr., about the WISeR rollout during a Finance Committee hearing in April. Video of their exchange is HERE; a transcript is HERE. Sen. Cantwell followed up the hearing with a letter to RFK Jr. demanding changes to the program. That letter can be read in full HERE.

In May, a decision from the Government Accountability Office (GAO) confirmed that the WISeR model meets the definition of a rule subject to the CRA's requirements, and that it was supposed to be submitted to Congress and GAO before it could take effect, making it eligible for this joint resolution of disapproval.