Gallego, Colleagues Take Action to Roll Back Trump AI Care Denial Experiment on Seniors

GAO confirmed WISeR pilot program is currently functioning illegally across 6 states, including Arizona, and requires oversight from Congress WASHINGTON – This week, Senator Ruben Gallego (D-AZ) introduced a Congressional Review Act (CRA) resolution to overturn a new pilot program that is using artificial intelligence (AI) to conduct prior authorization in Traditional Medicare to deny or delay certain procedures for seniors. “Health care providers know what treatments are in the best interest of their patients. No Arizona senior should have to worry that their doctor will get overruled by an AI bot,” said Senator Gallego . “I have opposed the WISeR model since the beginning and will continue doing all I can to push back on this dangerous program.” Under the Wasteful and Inappropriate Service Reduction (WISeR) model, which began on January 1, 2026, and is set to run for six years, Traditional Medicare patients across six states—Arizona, New Jersey, Oklahoma, Ohio, Texas, and Washington—are subject to prior authorization requirements for several types of procedures or treatments, meaning that a claim needs to run through an opaque AI-driven system that may deny it with limited explanation, starting the whole approval process over again and setting the patient back weeks in the process. Prior authorization requirements are used routinely by Medicare Advantage plans and private insurers, but rarely in Traditional Medicare, which is often one of the reasons seniors choose it for their coverage. While CMS has described the model as voluntary, it is effectively mandatory for providers and their patients with Traditional Medicare in the selected states. Each participating state is operating the pilot through a different for-profit company that contracts with CMS to use AI technology to process authorizations and conduct reviews for the specific services subject to WISeR. These participants are compensated based on a share of “averted expenditures.” In other words, they are financially incentivized to deny prior authorization requests, as they profit from denied services. Last week, the Government Accountability Office (GAO) released a determination that the WISeR model is subject to the Congressional Review Act, following a request from Senate Democrats. This determination starts a 60-day period during which Democrats can force a vote on the resolution of disapproval to repeal the WISeR model. In September, Senator Gallego called on the Trump administration to halt this experiment. In December, he introduced legislation that would prohibit CMS from implementing WISeR. READ MORE: RFK Jr.’s AI program delaying care to seniors, Arizona senators say (Arizona Republic) Full text of the legislation can be found HERE . A summary of the resolution can be found HERE . The resolution was led by Senator Ron Wyden (D-OR). In addition to Senator Gallego, it was co-introduced by Senators Patty Murray (D-WA), Maria Cantwell (D-WA), Richard Blumenthal (D-CT), Kirsten Gillibrand (D-NY), Cory Booker (D-NJ), Ed Markey (D-MA), Tammy Duckworth (D-IL), Tammy Baldwin (D-WI), Andy Kim (D-NJ), Mark Kelly (D-AZ), Bernie Sanders (I-VT), Elizabeth Warren (D-MA), Mark Warner (D-VA), Tina Smith (D-MN), Ben Ray Luján (D NM), Jeff Merkley (D OR), and Dick Durbin (D IL).