The administration imported the most loathed feature of private insurance — AI-driven prior authorization — into Traditional Medicare, then handed it to for-profit contractors paid more the more they deny. Seniors in six states are now waiting weeks for procedures their doctors prescribed. This is not a policy stumble. It is a window into a presidency unraveling.
When Mehmet Oz stood at a podium last June and declared that prior authorization “erodes public trust in the health care system,” the Centers for Medicare and Medicaid Services administrator was telling the truth. Nearly three-quarters of Americans surveyed by KFF this year called the practice a “major” problem. Doctors call it a hostage system. A UnitedHealthcare CEO was murdered in December 2024 over the public’s fury about denials, and his alleged killer was — grotesquely — cheered online. Oz himself acknowledged the rage when he said “violence in the streets” was a reason the Trump administration had pressed private insurers to voluntarily curb their use of it.
Days later, the same administration announced it was bringing prior authorization, supercharged by artificial intelligence, into Traditional Medicare for the first time.
The pilot is called the Wasteful and Inappropriate Service Reduction Model — WISeR — and it launched on January 1, 2026, covering thirteen categories of medical services across Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. It is scheduled to run through 2031. Private contractors using AI tools now stand between Medicare beneficiaries and the procedures their physicians have prescribed. The contractors are paid a percentage of every dollar of care they avert. The more denials, the bigger the check.
That arrangement is not a bug. It is the entire architecture.
1. What WISeR Actually Does
Traditional Medicare — the public program covering roughly 33 million Americans — has historically rejected prior authorization as bureaucratic obstruction. That is precisely why seniors prefer it to Medicare Advantage, where AI-driven denials have become an industry scandal. A 2024 Senate Permanent Subcommittee on Investigations report found that the largest Medicare Advantage insurers had used algorithms to dramatically raise denial rates for post-acute care, sometimes by orders of magnitude.
WISeR imports that exact mechanism into the public program. CMS contracts with private companies, which deploy machine-learning systems to flag claims for review. Those companies, as the Center for Economic and Policy Research documented, “receive a percentage of the savings associated with averted… care as a result of their reviews.” Translation: every denial enriches the denier.
CMS frames this as a hunt for “low-value care,” citing a Medicare Payment Advisory Commission estimate that taxpayers financed $5.8 billion in such services in 2022. The number is real. The framing is convenient. There is a yawning analytical chasm between the abstract category of “low-value care” and the concrete reality of a 74-year-old in Yakima who cannot get the epidural steroid injection her physician prescribed.
“WISeR is a dangerous program that is denying care to Medicare patients so companies can profit. If scaled up, it would be a back door to privatizing Medicare.”
— Rep. Suzan DelBene (D-Wash.) · House resolution announcement, May 20, 2026
2. The Damage, Already Documented
Pilot programs are supposed to surface problems. WISeR has done so spectacularly — just not in the direction its architects predicted. A report released in April by Sen. Maria Cantwell of Washington, drawing on data from sixteen hospitals in her state, found that Medicare patients are now waiting two to four times longer for procedures that previously moved through the system in days.
At the University of Washington Medical System, the report said, urgent prior-authorization requests that once turned around in a single day are now taking fifteen to twenty days. Standard authorizations have followed the same trajectory. Nearly one hundred patients were stuck waiting for epidural steroid injections at UW alone, according to Healthcare Dive’s reporting on the findings.
The Washington State Hospital Association warned of a public-health consequence the administration apparently never considered: when seniors cannot access non-opioid pain treatments like steroid injections, some turn to opioids to manage the wait. A program ostensibly about reducing waste is, in practice, pushing people toward addiction.
The Delay Multiplier
Procedures that previously took two weeks to approve are now taking four to eight weeks under WISeR, according to surveys of Washington hospitals by the state hospital association. Fierce Healthcare →
18,600 Affected
More than 18,600 Washington State residents received traditional-Medicare services in 2024 that are now subject to AI review under WISeR. WSHA Report →
The Denial Incentive
Contractors are paid a percentage of “averted expenditures” — an arrangement Democrats argue creates a structural incentive to deny rather than approve care. Becker’s Hospital Review →
A Backdoor Bypass
HHS never submitted WISeR to Congress for review. On May 12, 2026, the Government Accountability Office determined the pilot is a rule and is subject to the Congressional Review Act. STAT News →
3. Whose Side Is the Government On?
The central tell of this administration’s priorities is the timing. Oz announced WISeR just days after the White House staged a voluntary pact with private insurers to scale back their own prior-authorization regimes. The administration acknowledged in one breath that prior authorization is corrosive enough to provoke “violence in the streets,” and in the next breath imported it into the public program seniors had chosen specifically because it lacked such gatekeeping.
Dr. Vinay Rathi, an Ohio State University physician and policy researcher who has been quoted across the press coverage, has accused the administration of sending “mixed messages.” That is generous. It is not mixed messaging; it is a coherent message in two directions. To corporate insurers: we will lighten your burden. To the seniors who are the explicit constituency of Medicare: we will pile that burden onto you.
The contractors selected to run WISeR are not nonprofits or research consortia. They are commercial firms whose business model is denial. They will be enriched by the same mechanism that, in the Medicare Advantage marketplace, produced a Senate report so damning it should have ended the experiment before it began. Instead, the administration scaled the worst features of corporate insurance into the program that 33 million Americans rely on precisely because it isn’t corporate insurance.
This is what siding with insurers, contractors, and consultants — and against the elderly — looks like as administrative practice. It is a transfer of pain from balance sheets to the elderly.
“AI is being used as a denial device for the CMS. For Washington’s seniors, WISeR is overriding doctors to delay care and deny treatment. My constituents should not have to suffer through bureaucratic delays disguised as modernization.”
— Sen. Maria Cantwell (D-Wash.) · Senate Finance Committee hearing, April 2026
4. The Congressional Resistance, In Sequence
The opposition to WISeR has not been a single dramatic moment. It has been a steady, escalating accumulation of legislative and procedural pressure — and it now spans both chambers, both parties’ coalitions, and the agencies meant to police federal rulemaking. The progression matters.
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This is what oversight looks like when an agency tries to do an end-run around Congress: a regulator declared it lacked authority, Congress is reasserting that authority, and a coalition stretching from Bernie Sanders to Mark Warner has aligned behind the resolution. The breadth is unusual. The fact that it is even necessary is the indictment.
5. A Pattern That Names Its Own Priorities
WISeR is not a one-off. It fits a pattern this administration has established repeatedly: the consistent prioritization of corporate convenience, ideological projects, and rhetorical victories over the material welfare of ordinary Americans. Rep. Ami Bera of California, himself a physician, captured the contradiction in a single sentence when the resolution was introduced: “These decisions should be made by doctors, not by algorithms designed to cut costs.”
That formulation is not partisan. It is the basic principle on which Medicare was built in 1965: that an older American’s access to care should not depend on an actuarial bet. To overturn that principle by administrative fiat — without statutory authorization, without congressional submission as the GAO has now ruled was required — is to govern not as a steward of public programs but as their adversary.
And it is to govern, increasingly, against the people the administration claims to represent. Seniors are not an abstract constituency. They are voters. They are, in many of the WISeR states — Ohio, Texas, Arizona — the very voters who returned this administration to office. Whatever this is, it is not populism. It is the opposite: the systematic transfer of an entitlement’s value away from beneficiaries and toward contractors. It is the use of the federal government as a revenue stream for the very industry whose practices the administration has elsewhere claimed to condemn.
When Policy Failure Becomes a Question of Fitness to Govern
The 25th Amendment to the Constitution, ratified in 1967, governs presidential succession and incapacity. Section 4 provides the rarely-invoked mechanism by which the Vice President and a majority of the Cabinet — or such other body as Congress may by law provide — may declare in writing that the President “is unable to discharge the powers and duties of his office.” Power transfers immediately to the Vice President as Acting President. The disputed president may contest the declaration; a two-thirds vote of both chambers of Congress is then required to sustain the removal.
Who Is Already Making This Argument
On April 14, 2026, Rep. Jamie Raskin (D-Md.), ranking member of the House Judiciary Committee, introduced legislation to establish a Commission on Presidential Capacity to Discharge the Powers and Duties of Office — the very body the 25th Amendment contemplates Congress creating. The bill drew 50 Democratic co-sponsors. More than 70 House Democrats called outright for the president’s removal earlier that month. Rep. Raja Krishnamoorthi (D-Ill.) issued a formal call for Vice President Vance and the Cabinet to act, citing “a dangerous pattern of reckless escalation, erratic decision-making, and general conduct.”
The Constitutional Argument, Honestly Stated
The 25th Amendment is not a remedy for policy disagreements, and it should not be cheapened into one. Bad health policy — even cruel health policy — is not the same thing as incapacity. The case Raskin and his co-sponsors make is broader: that a sustained pattern of decisions taken without apparent grasp of their consequences, combined with public conduct that has alarmed senior military officials, foreign allies, and constitutional scholars, raises a legitimate question about whether the duties of the office are being discharged at all. WISeR belongs in that pattern not because a single Medicare pilot proves incapacity, but because it illustrates the deeper symptom: an administration making consequential decisions about millions of vulnerable Americans on a structural logic — pay contractors to deny seniors’ care — that no functioning steward of the public trust would have approved, and that the GAO has now formally ruled was implemented in violation of the procedures Congress requires.
The Practical Barriers
We should be honest. The 25th Amendment’s Section 4 has never been invoked in American history. The current Vice President was selected on this ticket; the Cabinet was appointed by this president. There is no mechanism by which the politics align for an internal declaration of incapacity. Raskin’s commission bill faces a Republican-controlled House and Senate, and the president himself would have to sign any law creating the body. The realistic political path is, for now, closed.
Why the Barriers Don’t Negate the Case
The framers placed Section 4 in the Constitution precisely because they anticipated a circumstance in which the ordinary mechanisms of accountability would prove insufficient. That the political path is closed today does not mean the constitutional question is illegitimate; it means the constitutional question has become urgent. WISeR is a case study in what happens when an administration governs as if accountability does not apply to it. The remedy may not lie in Section 4 this year or next. But the conversation Raskin is forcing — about what we do as a republic when the executive branch acts in ways its own agencies have ruled unlawful and its own constituents have begged it to stop — is the conversation the 25th Amendment was written to make possible.
6. What Must Happen
The immediate path is the resolution Senators Wyden, Cantwell, Blumenthal, Gillibrand, and Murray have placed on the Senate calendar. The Congressional Review Act gives Congress sixty days from the GAO determination to force a floor vote. Every senator — including the Republican senators from Texas, Ohio, Oklahoma, and Arizona, whose constituents are right now being denied care — will be on the record. Voters in those states should remember the vote.
The medium-term path is statutory. Traditional Medicare was built without prior authorization for a reason. If CMS will not respect that design, Congress should codify it. Sen. Ron Wyden, the ranking member of Senate Finance, has been clear: “The last thing seniors need is even more AI denying the care they need.”
The longest path is the one Raskin is opening. It is not a path to removal this year. It is a path to making the country honestly confront what its presidency has become.
Editorial Conclusion
Medicare was the most popular thing the federal government ever did. It was popular precisely because it placed the question of care between a patient and a doctor, not between a patient and an algorithm whose owner gets richer when the algorithm says no. The WISeR program inverts that design, by administrative action, without statutory authority, against the people it is meant to serve. Congress now has sixty days. The Constitution provides the tools. The question is whether the country still has the will to use them. Democracy is not only the ability to vote. It is the ability to govern oneself between elections — and that ability is what is at stake when an administration sells the elderly to the insurance industry and dares us to do nothing about it.
Sources & References
- KFF Health News — AI Will Soon Have a Say in Approving or Denying Medicare Treatments
- NBC News — Private health insurers use AI to approve or deny care. Soon Medicare will, too.
- Center for Economic and Policy Research — Denying Coverage with AI: CMS’s New Medicare Model
- USC Schaeffer Center — Medicare Is Experimenting With Having AI Review Claims
- STAT News — Congressional Democrats try to force a vote to end Medicare AI prior authorization pilot
- Senate Finance Committee — Wyden, Senate Democrats Take Action to Roll Back Trump AI Care Denial Experiment on Seniors
- Fierce Healthcare — House and Senate Democrats move to overturn CMS’ WISeR AI prior auth pilot
- Healthcare Dive — Senate Democrats move to roll back Medicare AI prior authorization pilot
- Healthcare Dive — Medicare AI prior authorization pilot delaying care in Washington
- Fierce Healthcare — AI-powered prior authorizations for Medicare have greatly delayed care, hospitals say
- Washington State Hospital Association — Report highlights clear risks of AI in Medicare
- RISE Health — Another report finds WISeR pilot causing longer delays, higher costs, and care denials
- Stateline — Medicare’s new AI experiment sparks alarm among doctors, lawmakers
- Newsweek — Medicare Is Using AI for Prior Authorization; Democrats Want It to Stop
- Becker’s Hospital Review — Democrats ramp up efforts to repeal Medicare prior authorization pilot
- Komo News — WA politicians warn federal AI program could reject medical treatments for seniors
- The Hill — Rep. Jamie Raskin introduces bill to assess president’s fitness under 25th Amendment
- Krishnamoorthi.House.gov — Krishnamoorthi Calls for President Trump’s Removal Under 25th Amendment
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