Reps. Jan Schakowsky, D-Ill., and Mark Pocan, D-Wis., introduced a resolution opposing a Trump administration initiative that they said would “force recipients of traditional Medicare to receive prior authorization, including through the use of artificial intelligence, before being able to receive some forms of medical care,” according to a Sept. 11 news release.
The model, called Wasteful and Inappropriate Service Reduction, or WISeR, instructs CMS to partner with AI companies to expedite prior authorization for some traditional Medicare services. The targeted services include deep brain stimulation for Parkinson’s disease, epidural steroid injections for pain management, cervical fusion, skin and tissue substitutes and arthroscopy for knee osteoarthritis.
“Every year, millions of seniors on Medicare Advantage are unfairly denied the care they need because of burdensome prior authorization rules. Now, the Trump administration plans to implement these same requirements on certain traditional Medicare services — threatening access to care for millions more. This is unacceptable,” Ms. Schakowsky said.
Prior authorization reforms and reductions have been on the rise this summer, but most adults do not believe insurers will follow through on their promises.
“It is not an exaggeration to say that the requirement of prior authorization for traditional Medicare services will kill seniors,” Mr. Pocan said. “Not only that, but the use of AI in determining whether or not treatment is necessary is extremely reckless. Unlike Medicare Advantage plans that already use AI in prior authorization decisions, traditional Medicare is supposed to cover you, no questions asked.”
