By Elise Takahama
The Seattle Times, Dec. 15, 2025
U.S. Sen. Patty Murray plans to introduce legislation Monday in an effort to halt a federal pilot program that would add AI reviews to Medicare approvals in some states, including Washington.
The bill, co-sponsored by Oregon Sen. Ron Wyden, follows companion legislation filed in November by U.S. Rep. Suzan DelBene, D-Medina, and five other congressional Democrats, who slammed the program for its potential to exacerbate delays in care for some Medicare enrollees. Patient advocacy groups, physicians and hospital leaders have also raised concerns about bringing in artificial intelligence tools to review pending Medicare procedures, particularly because AI companies will have a financial incentive to deny care.
âThe Trump administration is gearing up to use AI to delay and deny Medicare benefits for seniors â this is outrageous and should be a national scandal,â Murray said in a statement to The Seattle Times. âMake no mistake: this is a backdoor effort to privatize Medicare and cut benefits.â
The Centers for Medicare and Medicaid Services announced the new model â known as the Wasteful and Inappropriate Service Reduction, or WISeR, program â in June. CMS Administrator Dr. Mehmet Oz said at the time the goal of the pilot is to protect patients from being given âunnecessary and often costly proceduresâ by testing a âstreamlined prior authorization processâ in original Medicare plans, the federal insurance program for people 65 and older, and many younger people with disabilities.
The program is expected to run for six years starting Jan. 1, 2026 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
If passed, Murray and Wydenâs bill would prohibit the federal government from implementing the model.
According to CMS, the model would work with third-party tech companies to decide the medical necessity of certain procedures deemed âvulnerable to fraud, waste and abuse,â including some nerve stimulators, steroid injections, spine surgeries and skin and tissue substitutes. The program would not review emergency services or inpatient stays, according to CMS.
Health care providers would still look over final denials, government officials have said.
When Robby Stern, a retired gas fitter, first heard about the federal pilot, the Seattle resident immediately felt it would be a âbig deal.â
âHoly moly, this is really bad news,â Stern, 81, said he remembers thinking. âWe have chosen traditional Medicare because we wanted the primary relationship to be between us and our provider of choice. Not have private corporations be inserted.â
Stern is a past president and active member of Puget Sound Advocates for Retirement Action, and quickly started helping organize presentations at senior living facilities and other community centers to educate other Medicare enrollees about the WISeR pilot.
âPeople were horrified,â Stern said.
According to the state, Washington has about 1.6 million Medicare enrollees. About half have traditional Medicare plans, while the other half are enrolled in Medicare Advantage, private plans financed by the U.S. government.
Several Washington physicians, both retired and practicing, have also spoken out against the program, and questioned why our state was chosen as one of the pilot sites.
CMS has not been clear about why these six pilot states were selected. According to the Federal Register, the states were chosen based on several criteria, including geographic diversity and types of claims.
CMS did not immediately respond to a request for comment.
Dr. Matt Hollon, president-elect of the Washington State Medical Association and an internal medicine and primary care physician in Spokane, called the federal program âincredibly unfortunateâ and said the Murray legislation is an âimportant step to take.â
âWe know prior authorization overall is a significant barrier for patients to adequate care,â Hollon said. âThis is not allowing physicians to practice medicine; itâs allowing insurance companies to obstruct medicine.â
Hollon and other providers are well-versed in how prior authorization practices can slow care for significant medical conditions and sometimes result in more expensive treatment, he said. Dana Iorio, a retired primary care provider who worked at Harborview Medical Center, said one of the reasons he left the field in 2019 was because of the excessive documentation required by insurance providers to prescribe certain tests or medications, primarily for his patients with Medicare Advantage plans.
âIt would take inordinate amounts of time,â Iorio said. âI once spent over an hour and half with a Medicare Advantage program on a particular patient, just trying to justify getting an ultrasound.â
According to a January report from the American Hospital Association, a survey found that 62% of Medicare Advantage patients had care delayed because of their insurance provider in the past two years. About 43% of patients reported their health worsened as a result.
A 2022 report from the U.S. Department of Health and Human Servicesâ Office of Inspector General found that about 13% of Medicare Advantage prior authorization denials actually met Medicare coverage rules, but were denied inappropriately.
Denials can not only lead to consequences for patients, but also mean an increased administrative burden and ethical concerns for health providers, said David McLanahan, a retired surgeon who worked for Pacific Medical Center.
âItâs going against physiciansâ ethics â they couldnât do for their patient what they knew the patient needed,â said McLanahan, who co-founded the Washington chapter of Physicians for a National Health Program, an advocacy organization that pushes for a universal single-payer health system.
Hospital leaders, too, are worried about the looming start date of the federal program, and still have a range of questions about how it might affect providersâ day-to-day workload.
âWe already have a huge burden with [prior authorization] â that is already something that our hospitals have to hire for specifically,â said Jacqueline Barton True, vice president of advocacy and rural health for the Washington State Hospital Association, which also opposes the WISeR pilot.
âAny expansion of that is really concerning,â she added.
While the pilot is starting fairly small, Barton True said, itâs unclear what the next steps for the program might be. For example, thereâs the possibility the model expands to review other types of procedures, she said.
âIt starts as a pilot, but where does it go?â she said.
Stern, of Puget Sound Advocates for Retirement Action, acknowledged the desire to reduce âwaste, fraud and abuseâ in Medicare plans, but said the government should instead be targeting reform in Medicare Advantage plans, where thereâs been more evidence of massive overpayments to health insurance companies.
âWe all share concern about waste in the system,â he said. âBut if youâre really concerned about waste, fraud and abuse, why arenât you focusing on where the greatest amount of it is?â