A group of 42 Democratic members of Congress, spearheaded by Reps. Alexandria Ocasio-Cortez (D-NY) and Lloyd Doggett (D-TX), has issued a forceful call to the Centers for Medicare & Medicaid Services (CMS) to abandon a new pilot program.
They argue that it threatens the integrity of Traditional Medicare.
The Wasteful and Inappropriate Services Reduction (WISeR) model, set to launch on January 1, 2026, has raised alarms over its reliance on for-profit companies and artificial intelligence (AI) in prior authorization processes.
The WISeR model would mandate prior authorization for certain health services in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—requiring providers to seek approval from private, for-profit entities.
According to the lawmakers’ letter, dated July 31, 2025, and addressed to CMS Administrator Dr. Mehmet Oz and Deputy Administrator Abe Sutton, these companies would be incentivized to deny care, as their payments are tied to the “savings” generated from rejected services.
The coalition warns that this structure risks eroding the high patient satisfaction rates associated with Traditional Medicare.
“Allowing private entities to dictate care decisions, even in a pilot, sets a dangerous precedent for the future of Medicare,” the letter states.
The lawmakers argue that the program could lead to delays and denials of critical health care, undermining the program’s commitment to accessible, quality coverage.
AI in Prior Authorization Sparks Alarm
A key point of contention is the WISeR model’s proposed use of AI to determine medical necessity.
The lawmakers cite research and legal challenges indicating that AI-driven prior authorization systems often increase care denials, potentially harming patient outcomes.
They contrast this with Traditional Medicare’s streamlined approval process, which has historically avoided such barriers.
The letter also draws parallels to issues in Medicare Advantage, the privatized alternative to Traditional Medicare, where prior authorization denials are frequently overturned on appeal.
The lawmakers argue that introducing similar practices to Traditional Medicare could diminish its reliability and patient trust.
Instead of implementing the WISeR model, the coalition urges CMS to address documented issues of waste, fraud, and abuse within Medicare Advantage.
They emphasize that Traditional Medicare remains a cornerstone of equitable health care and should not be subject to experiments that prioritize cost-cutting over patient well-being.
A Unified Stand for Medicare’s Future
The letter, signed by 42 representatives, underscores a broader concern about creeping privatization in Medicare.
By halting the WISeR model, the lawmakers aim to preserve the program’s patient-centered approach and prevent the introduction of practices that could compromise care for millions of beneficiaries.
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