In January 2026, CMS launched the Wasteful and Inappropriate Service Reduction (WISeR) model, introducing prior authorization into traditional Medicare for certain services in selected states. However, this controversial program could face a repeal following an effort led by Congressional Democrats this month.
The WISeR model seeks to reduce unnecessary, duplicative and low-value care in traditional Medicare via prior authorization and the use of AI. It’s currently being tested in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, and in partnership with tech vendors Cohere Health, Genzeon Corporation, Humata Health, Innovaccer, Virtix Health and Zyter.
The model is controversial for two main reasons, according to Neil Patil, senior fellow and the policy director at the Medicare Policy Initiative at Georgetown’s Center on Health Insurance Reform. While prior authorization can help reduce wasteful care, it can also lead to denials and delays of necessary care. Prior auth can also increase out-of-pocket expenses for beneficiaries. In addition, the fact that the WISeR model leverages AI is worrying as the technology can lead to more denials and worsen health disparities.
“There have been a lot of concerns around the use of artificial intelligence and algorithms to apply prior authorization because of some reports that they may be inappropriately denying care, just based on some of the underlying algorithms that are used,” Patil said in an interview.
As a result, several Congressional Democrats are fighting the implementation of the WISeR model. On May 20, Democrats — including Sen. Ron Wyden (D-Oregon), Rep. Suzan Delbene (D-Washington) and Rep. Greg Landsman (D-Ohio) — introduced a resolution to repeal the WISER model through the Congressional Review Act (CRA). The CRA empowers Congress to review and overturn federal agency rules.
The resolution came after the Government Accountability Office found on May 12 that WISeR imposes new prior authorization requirements on some Traditional Medicare providers, meaning it qualifies as a rule that may be subject to congressional review under the CRA. The CRA requires federal agencies to submit rules to Congress before they take effect, and if they fail to do so, Congress may take steps to repeal the rule.
“[Congressional Democrats] introduced this joint resolution of disapproval, and now they have a 60-day window where they can actually bring this to the floor for a vote, and if this is passed, that can actually go directly to the president’s desk [to sign],” Patil said. “Ultimately, the president can veto this and decide to keep the model in effect, but this does put a lot of members of Congress in a difficult position to actually have to decide whether they want to stand by this controversial model right now.”
The 60-day window began after the GAO’s determination on May 12.
Is the WISeR model likely to be repealed?
While repealing the WISeR model has the support of Congressional Democrats, it’s hard to say for sure if it will gain the support of Congressional Republicans and ultimately President Donald Trump, who will need to sign off on it, according to Patil.
“Given that this is the Trump administration’s own model that they introduced, I would imagine it’s pretty unlikely that the president would go ahead and sign on and terminate this model,” he said. “I would imagine that even if this resolution does pass both chambers of Congress, it’s likely it would be vetoed by the President. Now, granted, if it passes both chambers with a lot of support, I think it would be pretty difficult for the president to see that and go ahead and veto it.”
Another healthcare expert believes it’s unlikely that this model will have staying power. Michael Abrams, managing partner of consulting firm Numerof & Associates, noted that while prior authorization is novel in traditional Medicare, it is widely used in Medicare Advantage and has been criticized for delaying care and adding administrative burdens to the program.
The WISeR model also uses incentives with outside contractors, who may receive 10-20% of savings from reduced spending. This is problematic as “when you incentivize denial of service, you get more denials of service,” Abrams said. He added that in MA, 75-82% of denials are overturned on appeal.
“The country has yet to finish dealing with the murder of a major insurance company executive in which denial of service reportedly played a role. Building the same flaws that make Medicare Advantage problematic into traditional Medicare would seem a monumental mistake. The WISeR program is out of step with the national experience in healthcare insurance. That is why this pilot program is unlikely to proceed as outlined,” Abrams said, referring to the 2024 killing of UnitedHealthcare CEO Brian Thompson.
Abrams isn’t alone in his objections to the WISeR model. AARP, a nonprofit supporting Americans aged 50 and older, noted that while the organization is “deeply concerned” about fraud and abuse in Medicare, it has reservations about the use of prior authorization.
“We believe, though, that fighting fraud must be accomplished in ways that target the bad actors and do not get in the way of enrollees receiving needed care,” a spokesperson told MedCity News. “The health care of older Americans must always come first, and nobody should be denied legitimate treatments they need. AARP has repeatedly elevated concerns about prior authorization barriers and the use of emerging technology to make medical determinations, and will continue to support the ability of older Americans to make health care decisions with their family and doctors.”
Ultimately, it’s hard to say for sure if the WISeR model will be repealed. But anecdotal reports found that there have been technical challenges and low approval rates compared to Medicare Advantage, according to the Medicare Policy Initiative at Georgetown’s Center on Health Insurance Reform.
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