Senators Propose Legislation to Block AI Prior Authorization Pilot in Traditional Medicare

U.S. Senator Kirsten Gillibrand and fellow Democratic senators have introduced the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act to halt the implementation of the Trump administration's Wasteful and Inappropriate Service Reduction (WISeR) model, which would introduce prior authorization and AI-driven care approvals in Traditional Medicare. Scheduled to launch on January 1, 2026, across six states, the WISeR model would mark the first time prior authorization requirements are applied in Traditional Medicare, enabling private insurers and AI tools to potentially delay or deny care recommended by physicians. The program raises concerns among lawmakers due to the involvement of third-party AI companies compensated based on the volume of care denied, as well as the lack of clear guidance for providers and patients on appeal processes or notifications regarding denials. This innovative but contested model is viewed as potentially burdensome for healthcare providers, particularly those in smaller or resource-limited settings, and could create new obstacles for seniors seeking timely access to medical procedures or medications under Medicare. The bill explicitly instructs the Secretary of Health and Human Services not to implement WISeR or any similar prior authorization models within Traditional Medicare. Senator Gillibrand and colleagues have previously pushed for enhanced Medicare protections and seek to ensure clinical decisions remain with healthcare providers and patients, opposing what they describe as a 'profit-driven AI program.' The bill has received broad support from Democratic senators and includes a companion measure in the House. This legislative effort highlights ongoing debates over the role of AI and private insurers in Medicare and reflects broader concerns about maintaining seniors' access to care without increasing administrative complexity or delaying necessary treatment.