As Republicans double down on health care sabotage, Democrats lead effort to halt the Trump Admin’s looming Medicare AI prior authorization takeover
WASHINGTON, D.C. – U.S. Senator Peter Welch (D-Vt.), a member of the Senate Finance Committee, this week joined U.S. Senators Patty Murray (D-Wash.), Vice Chair of the Senate Appropriations Committee, Ron Wyden (D-Ore.), Ranking Member of the Senate Finance Committee, Kirsten Gillibrand (D-N.Y.), Ranking Member of the Senate Aging Committee, and 14 Democratic Senators in introducing the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, bicameral legislation to 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 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. Under this model, AI will get to decide what care patients receive, even after their doctors have recommended a particular procedure or medication.
“From Day One, the Trump Administration has been on a rampage to wreck Medicare and make health care unaffordable. Their newest plan to let AI take over important Medicare prior authorization decisions will be a disaster for providers and make it harder for seniors to get the care they need,” said Senator Welch. “We’re fighting to ensure health care decisions stay in the hands of seniors and their doctors.”
“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. 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,” said Senator Murray. “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. 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,” said Senator Wyden. “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 Trump Administration plans for the WISeR model to run as a pilot program for six years beginning January 1, 2026, in six selected states: Washington, New Jersey, Ohio, Oklahoma, Texas, and Arizona. 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.
In addition to Senators Welch, Murray, Wyden, and Gillibrand, the Seniors Deserve SMARTER Care Act is cosponsored by Sens. Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Maria Cantwell (D-Wash.), Tammy Duckworth (D-Ill.), Ruben Gallego (D-Ariz.), Andy Kim (D-N.J.), Ben Ray Luján (D-N.M.), Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), Lisa Blunt Rochester (D-Del.), Bernie Sanders (I-Vt.), Tina Smith (D-Minn.), and Elizabeth Warren (D-Mass.).
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 is endorsed by the American Academy of Physical Medicine and Rehabilitation; American Podiatric Medical Association; American Osteopathic Association; Center for Health and Democracy; Just Care USA; Health Care for All – Washington; Healthcare is a Human Right Coalition; Mental Health Liaison Group; National Nurses United; Physicians for a National Health Program; Public Citizen; Puget Sound Advocates for Retirement Action (PSARA); Social Security Works; Social Security Works Washington; Society for Cardiovascular Angiography and Interventions; Washington Community Action Network; Washington State Hospital Association (WSHA); and the Washington State Medical Association (WSMA).
This Congress, Senator Welch has led the introduction of several bills to make health care more accessible and affordable for Vermonters, including the 340B Pharmaceutical Access To Invest in Essential, Needed Treatments & Support (PATIENTS) Act, Eliminating Thickets to Improve Competition (ETHIC) Act, Maximizing Opioid Recovery Emergency (MORE) Savings Act, Share the Savings with Seniors Act, Comprehensive Alternative Response to Emergencies (CARE) Act, Strengthening Medicare and Reducing Taxpayer (SMART) Prices Act, Social Security Emergency Expansion Act, Fair Prescription Drug Prices for Americans Act, End Price Gouging for Medications Act, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, Protecting Pharmacies in Medicaid Act, Fair Funding for Rural Hospitals Act, Repealing the Trump Sick Tax Act, and the Rural Hospital Support Act.
Read and download the full text of the bill.
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