New Bill Aims to Protect Medicare from AI-Driven Care Denials

WASHINGTON—Sen. Kirsten Gillibrand, a Democrat on the Senate Aging Committee, introduced new legislation to halt a pilot program that would allow private insurance companies and artificial intelligence (AI) tools to delay and deny care to seniors enrolled in traditional Medicare across six states. 

The Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act would prohibit the Centers for Medicare & Medicaid Services (CMS) from implementing the Wasteful and Inappropriate Service Reduction (WISeR) model, which is set to begin Jan. 1, 2026, and run for six years. 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.”

Gillibrand is leading the effort alongside Sen. Patty Murray (D-WA), vice chair of the Senate Appropriations Committee, and Sen. Ron Wyden (D-OR), ranking member of the Senate Finance Committee.

“The Trump administration’s WISeR model will introduce prior authorization requirements into traditional Medicare for the first time ever—allowing private companies to use AI to decide whether to approve or deny certain medical procedures for patients on Traditional Medicare,” Gillibrand’s office said in a released statement. “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.”

The statement continues that 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.

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 Jan. 1, 2026 in six selected states.

The WISeR model received criticism shortly after CMS made the debut announcement. In August, 17 Democrat lawmakers wrote a letter to Oz to raise concerns that the proposed prior authorization practices would prevent access to care and become a hindrance for those who need the care most.

“Artificial intelligence should not delay or deny seniors’ health care,” said Gillibrand. “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. 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 is gearing up to use AI to delay and deny Medicare benefits for seniors—this is outrageous and should be a national scandal,” said 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. 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.”

In addition to Sens. Gillibrand, Murray, and Wyden, the Seniors Deserve SMARTER Care Act is cosponsored by Senators 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).

Representative Suzan DelBene (D-WA-01) introduced companion legislation in the U.S. House of Representatives.