In the News

When Health & Human Services Secretary Robert F. Kennedy, Jr. sat before me during a Ways & Means Committee hearing in April, I shared the story of Joanne, a Washington senior on Medicare who had been lingering in crippling pain for weeks while she waited for approval for a common pain treatment. Her delay was the direct result of the Trump administration’s new AI experiment that started earlier this year. This program, known as the Wasteful and Inappropriate Service Reduction (WISeR) program, pays private companies to use AI to review Medicare claims.

Joanne’s severe pain forced her to use crutches and a wheelchair to get around, leading to multiple falls that compounded her injuries. Secretary Kennedy called this a “terrible outcome,” yet defended the program, saying it was running as planned. Conveniently, Joanne’s treatment was approved quickly after the hearing. If her doctor had ordered the procedure last year, it would have been approved without friction. Instead, her nightmare is emblematic of this chaotic rollout.

When WISeR was first announced, I cautioned the administration that quickly rolling out a program that uses the same problematic delay tactics that private Medicare Advantage plans use would leave patients frustrated and in pain. Sure enough, I began hearing about issues with WISeR from health care providers and patients almost as soon as it launched in January in Washington and five other test states.

For months, the administration operated in the dark, releasing no meaningful data. Even Congress couldn’t see under the hood until the Electronic Frontier Foundation filed a Freedom of Information Act (FOIA) lawsuit against the administration and finally received almost 1,000 pages of internal documents. What I called a Trojan horse to privatize Medicare earlier this year is now more alarming than ever.

So far, this pilot program only applies to certain procedures, like the pain treatment that Joanne was waiting for. My concern from the start was that once the administration started doing this, it was only a matter of time before it was scaled up to more procedures and more states. The new documents confirm exactly that, outlining the administration’s next targets: cancer treatments, cardiology procedures, and even air ambulances. To state the obvious, none of these treatments can wait weeks for approval.

Washington seniors have borne the brunt of this experimental program’s malfunctions. From January to March, over half of the claims submitted in Washington were denied and far exceeded the 72-hour decision deadline. This triggered an internal CMS audit and corrective action plan. This shouldn’t come as a surprise because the program pays these private companies for every claim they deny, which incentivizes them to reject more care.

The audit and corrective action plan have never been released, which would further help inform lawmakers, health care providers, and patients about how WISeR is failing to function. This stonewalling must end. That’s why I am filing a new FOIA request for these specific documents in addition to the audits and corrective action plans of any other private company participating in WISeR.

Congress has a constitutional duty to conduct oversight of the administration, but the Republican-controlled House has shown little interest in carrying out this responsibility since Trump took office. Most recently, the majority of Ways & Means Republicans voted down a proposal I offered that would have released more WISeR documents. After pressure from Republican leadership in the room, five of them flipped their votes to reject the effort. Even if my fellow lawmakers don’t represent districts in these pilot states, their constituents will be impacted if the administration scales up the program as planned. When Democrats take control of the House in November, we need to rigorously investigate this program so more seniors like Joanne aren’t victims of this reckless AI experiment.

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