Last month, Congressional Democrats led by Senator Ron Wyden (D-Ore.), Representative Suzan DelBene (D-Wash.), and Representative Greg Landsman (D-Ohio) introduced a Congressional Review Act resolution to repeal CMS’s Wasteful and Inappropriate Service Reduction (WISeR) model. The effort follows a determination by the Government Accountability Office that WISeR qualifies as a rule under the Congressional Review Act and therefore should have been submitted to Congress before the Trump Administration’s implementation.
In a new interview with HEALTH CARE un-covered, Landsman said confusion and frustration among patients are already fueling opposition to the program.
“No one really knows what’s going on, and it’s going to prevent a lot of seniors from getting the health care they need. Simply because the administration wants to save some money and they want to send a bunch of that saved money into the bank accounts of Big Tech, who are going to use the AI systems.”
WISeR went into effect at the start of the year in six states and imposes AI-powered prior authorization for 17 medical services that previously did not require it in traditional Medicare. Critics argue the model imports many of the same prior authorization practices that have generated widespread complaints about Medicare Advantage, placing new administrative barriers between patients and the care recommended by their physicians.
As previously reported in HEALTH CARE un-covered, CMS awarded contracts to six vendors: Cohere Health, Genzeon, Humata Health, Innovaccer, Virtix Health, and Zyter. Several are backed by insurer-linked venture capital funds or have deep ties to the health insurance industry. Others have little publicly available information about their leadership, governance or operations. Several WISeR vendors already operate in Medicare Advantage, where prior authorization is routinely used to delay or deny care.
Watch Episode 3 of the HEALTH CARE un-covered Show, "Prior Authorization: Care, Delayed," featuring Rep. Suzan DelBene (D-Wash.), who discusses CMS's WISeR model and its impact on patients and providers in traditional Medicare.
In other reporting on HEALTH CARE un-covered documented weeks- and even months-long delays, technology failures, and inappropriate denials affecting seniors and providers participating in the pilot. Physicians in multiple states have described the system as burdensome, dysfunctional, and disruptive to patient care. Meanwhile, investigations have raised questions about whether the program’s projected savings are overstated and whether patients are being subjected to unnecessary hurdles in pursuit of those savings.
Still, Landsman believes the backlash itself is reason for optimism.
“I think the reason for hope is, had they come to Congress, it would not have passed. And ultimately this is the kind of stuff that Americans hate, and it’s nonpartisan.”
He also sees the fight over WISeR as an early test of how Americans will respond to the growing use of artificial intelligence in health care decisions.
“I mean, I think the fact that this is the first attempt to use AI, and you’re seeing this kind of backlash, is a good sign that the American people aren’t stupid, we’re very smart. And we’re going to fight back.”
Watch the full interview with Congressman Greg Landsman above.
