Senate Republicans on Thursday defeated a Democratic attempt to terminate a Trump-era pilot program that deploys artificial intelligence to make prior authorization decisions for Medicare beneficiaries. The resolution, introduced under the Congressional Review Act, failed 46 to 50 along party lines, falling short of the simple majority needed to pass.
The Centers for Medicare and Medicaid Services launched the experiment, known as the WISeR (Wasteful and Inappropriate Service Reduction) Model, on January 1. It is set to run for six years across six states, targeting specific services such as skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for osteoarthritis. CMS has framed the pilot as a necessary test to curb wasteful spending and prevent unnecessary procedures.
Traditionally, prior authorization is rarely used in original Medicare, though it is common in Medicare Advantage plans run by private insurers. Critics argue the pilot represents a dangerous expansion of insurer-style tactics into the fee-for-service system. “It is bad enough that this is the state of affairs in Medicare Advantage, but now the Trump administration is trying to import insurance company tactics into traditional Medicare,” said Sen. Ron Wyden (D-Ore.) in a floor speech.
Democrats seized on the vote to force Republicans to publicly defend a policy that polls poorly among seniors. “I don’t know any senior, Republican or Democrat, who asked President Trump to let AI decide if their doctor-recommended treatment was necessary,” said Sen. Patty Murray (D-Wash.).
The political dynamics echo broader tensions over healthcare access. Lawmakers in both parties have expressed concerns about prior authorization delays in Medicare Advantage, and legislation to streamline the process unanimously cleared the House Ways and Means Committee on Wednesday. A report from Sen. Maria Cantwell (D-Wash.) found that patients under the WISeR model waited two to four times longer for care—jumping from an average of two weeks to between four and eight weeks.
The vote also highlights the ongoing partisan divide over using AI in government programs. Republicans argue the pilot could save taxpayer dollars and reduce fraud, while Democrats warn it could undermine physician judgment and delay critical treatments. The CRA resolution would have required CMS to end the program immediately if passed.
This clash comes amid other partisan fights over healthcare policy. Earlier this month, House Democrats were nearly split as 103 voted to cut Israel aid in a symbolic test, underscoring fractures within the party. Meanwhile, Sen. Chris Van Hollen has urged Democrats to sell a vision, not just oppose Trump, as the party struggles to define its message.
As the pilot continues, advocates for seniors are pressing Congress to rein in AI-driven prior authorization. The Senate vote ensures the WISeR model will remain in place for now, but the issue is unlikely to fade from the political agenda.
