This resolution expresses the House of Representatives' disapproval of the planned WISeR Model, asserting that its expansion of prior authorization requirements will undermine beneficiary access to necessary healthcare.
Mark Pocan
Representative
WI-2
This resolution expresses the sense of the House of Representatives opposing the implementation of the proposed Wasteful and Inappropriate Service Reduction (WISeR) Model. The House believes this model would severely undermine beneficiary access to necessary healthcare by significantly expanding prior authorization requirements in traditional Medicare. It urges the Centers for Medicare and Medicaid Services to terminate the plan due to concerns over patient access and the poor track record of private entities managing these reviews.
Congress Moves to Block 'WISeR' Medicare Model That Would Have Increased Prior Authorizations by 30%
This resolution is basically Congress stepping in and saying, "Hold up, not so fast" to a major change planned for traditional Medicare. Specifically, it expresses the sense of the House of Representatives that the proposed Wasteful and Inappropriate Service Reduction (WISeR) Model should be terminated immediately. This is a big deal because the WISeR Model, slated to kick off in January 2026, would have significantly increased the administrative hoops patients and doctors have to jump through to get care.
The Prior Authorization Problem
What was the WISeR Model trying to do? It was going to increase the number of medical services in traditional Medicare that require pre-approval (known as prior authorization) by a whopping 30 percent. If you’ve ever dealt with insurance, you know prior authorization is when your doctor has to ask the insurance company for permission before you can get a test, procedure, or drug. The resolution points out that this process already causes serious delays and access issues for patients, and it contributes heavily to physician burnout—a reported 89 percent of doctors say it’s wearing them out.
Why the Alarm Bells Are Ringing
The most concerning part of the WISeR plan was who they wanted to put in charge of these new checks: private companies. These aren't just any companies; they are the same ones that handle prior authorization for private insurance and Medicare Advantage plans. The resolution highlights their track record, noting that 81.7 percent of the denials these companies issue are overturned when patients appeal. Think about that: four out of five times, they were wrong, forcing patients to fight for necessary care. For a senior needing a quick procedure, that delay can be critical.
The AI Wild Card
To manage the 30% increase in paperwork, the WISeR Model planned to rely on new tech—specifically artificial intelligence (AI) and machine learning—to speed up reviews. While that sounds futuristic, the resolution notes that these AI tools have reportedly been making errors 90 percent of the time when making coverage decisions. Using error-prone algorithms to decide whether a Medicare beneficiary gets critical care is a huge red flag. This resolution is essentially blocking the government from outsourcing critical medical decisions to private firms using unproven, error-filled AI.
What This Means for Traditional Medicare
Since this is a resolution and not a law, it’s Congress telling the Centers for Medicare and Medicaid Services (CMS) what they think should happen. However, the message is clear: traditional Medicare beneficiaries and their doctors should not be subjected to the increased administrative burden and documented failures of the prior authorization system used in Medicare Advantage. By pushing to stop the WISeR Model, this resolution seeks to protect patient access and prevent unnecessary delays in care for millions of Americans, ensuring that your doctor, not a private company's flawed algorithm, makes the call on your medical needs.