Democrats Move to Stop Medicare AI Denials in 6 States

Lawmakers are stepping up to protect seniors from a Medicare experiment that may be putting profits over patient care.

Twenty Senate Democrats introduced a resolution Wednesday to overturn a Medicare pilot program using artificial intelligence to approve or deny healthcare for seniors. The program, called WISeR, has already led to reports of delayed care in at least one of the six states where it's being tested.

The effort got a major boost last week when the Government Accountability Office ruled that the program should have required congressional approval before launching in January. Now Congress has the power to stop it.

"Americans are sick and tired of abusive prior authorization tactics putting needed health care out of reach," said Senator Ron Wyden, who's leading the charge. "The last thing seniors need is even more AI denying the care they need."

The program currently operates in Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington. Seniors in these states must get approval from contractors using AI before receiving certain medical supplies and procedures.

Here's what's raising red flags: these contractors get paid based partly on how many procedures they deny. Outside experts warn this creates a dangerous incentive to say no to patient care.

Senator Maria Cantwell reported in April that Washington seniors are already facing delays because of the program. She called the AI a "denial device" during a congressional hearing.

The Bright Side

The pushback shows democracy working exactly as it should. The resolution doesn't just have support from lawmakers in the six affected states. Senators from across the country are joining the fight because they recognize this could eventually impact their constituents too.

Medicare administrator Mehmet Oz responded to concerns by promising the agency will audit participants to ensure decisions follow existing Medicare rules. Contractors with high error rates will be terminated, he wrote in a recent letter.

The program does have some safeguards built in. Emergency services, inpatient care, and procedures that would be dangerous to delay are excluded from AI review. The targeted services are mainly those associated with fraud.

If the resolution gets 30 Senate signatures, it heads to the floor for a simple majority vote. These Congressional Review Act votes rarely happen, but when they do, they can work. The first Trump administration used this process to overturn 16 rules from the Obama era.

House members Suzan DelBene and Greg Landsman introduced a matching resolution in their chamber. If both the House and Senate pass it, WISeR stops immediately.

Whether the movement will gain Republican support remains unclear, but the growing coalition shows lawmakers are listening to seniors who deserve timely access to the healthcare they've earned.