Senator Kirsten Gillibrand: As Republicans double down on health care sabotage, senators lead effort to protect Medicare benefits from AI experiment
December 17, 2025 - On Tuesday, U.S. Senator Kirsten Gillibrand, the top-ranking Democrat on the Senate Aging Committee, introduced legislation to halt a pilot program that would allow private insurance companies and artificial intelligence (AI) tools to delay and deny care to seniors enrolled in Traditional Medicare across six states.
Senator Gillibrand is leading the effort alongside Senator Patty Murray (D-WA), vice chair of the Senate Appropriations Committee, and Senator Ron Wyden (D-OR), ranking member of the Senate Finance Committee. The senators introduced the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, legislation that would prohibit the Centers for Medicare & Medicaid Services (CMS) from implementing the Wasteful and Inappropriate Service Reduction (WISeR) model, which is set to begin January 1, 2026, and run for six years.
The Trump administration’s WISeR model will introduce prior authorization requirements into Traditional Medicare for the first time ever — allowing private companies to use AI to decide whether to approve or deny certain medical procedures for patients on Traditional Medicare. The model will impose new burdensome requirements on health care providers, especially those working in small or low-resource settings, and create new roadblocks for patients — meaning that AI will get to decide what care patients receive, even after their doctors have recommended a particular procedure or medication. Most concerningly, the third-party AI companies involved in the program will be compensated based on a share of “averted expenditures” — rewarding companies based on the volume or cost of care they deny to seniors on Medicare. According to CMS, human clinicians will review any denials made by AI — but the Trump administration has failed to provide clear guidance to providers and the public about what this will look like, despite implementation being mere weeks away. The Trump administration has provided little detail on how patients will be notified, supported, or protected if prior authorization requests are denied. The Trump administration plans for the WISeR model to run as a pilot program for six years beginning January 1, 2026 in six selected states.
“Artificial intelligence should not delay or deny seniors’ health care. The Trump administration’s new program would force seniors to jump through unnecessary hoops just to get the care they need and impose new, unnecessary burdens on health care providers,” said Senator Gillibrand. “As the top Democrat on the Senate Aging Committee, protecting and expanding access to Medicare is one of my top priorities, and I will keep fighting to ensure that health care decisions are made by patients and their doctors, not untested, profit-driven AI programs.”
“The Trump administration is gearing up to use AI to delay and deny Medicare benefits for seniors—this is outrageous and should be a national scandal,” said Senator Murray. “Seniors already face painful delays when it comes to getting health care, and Republicans have plunged our nation’s health care system further into crisis by passing the largest-ever cuts to Medicaid and the Affordable Care Act—leaving many hospitals hanging on by a thread. The very last thing this administration should be doing is strangling already overworked providers in new red tape and letting AI decide who gets health care and who doesn’t. We already know that prior authorization creates major burdens and delays for patients and providers, and expanding it to Traditional Medicare will just force seniors to wait longer and navigate mountains of paperwork to get the care their doctor says they need. Make no mistake: this is a backdoor effort to privatize Medicare and cut benefits. My message to seniors in Washington state: I will fight with everything I’ve got to stop this morally bankrupt AI takeover of Medicare and make sure you can get the health care you need.”
“The Trump Administration is pushing automated care denials on seniors in Traditional Medicare, which is the last thing Americans want for their health care,” said Senator Wyden. “Instead of improving Traditional Medicare to give seniors the health care they’ve earned, Donald Trump and his cronies are empowering insurance companies and AI special interests. It’s time to stop this experiment on seniors.”
The Seniors Deserve SMARTER Care Act would prohibit CMS from implementing the WISeR model. Specifically, the bill reads: “The Secretary of Health and Human Services shall not implement the innovative payment and service delivery model described in the notice titled ‘Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model’ (90 Fed. Reg. 28749 (July 1, 2025)), or any substantially similar model.”
In September, Senator Gillibrand led other Senate Democrats in sending a letter to CMS Administrator Dr. Mehmet Oz and CMMI Director Abe Sutton urging CMS to halt implementation of the model until further analysis on patient access to care could be conducted. The senators’ letter asked CMS for more information on the rationale for the selected six states, the plan for collaborating with the third-party vendors on AI, the reason for a lack of notice-and-comment rulemaking, and more.
Senator Gillibrand has worked throughout her career to protect and strengthen Medicare. Earlier this year, she reintroduced the Improving Seniors’ Timely Access to Care Act, which would improve access to care for seniors enrolled in Medicare Advantage plans. She is also an original cosponsor of the Strengthening Medicare and Reducing Taxpayer (SMART) Prices Act, which would enhance the Medicare Drug Price negotiation established under the Inflation Reduction Act tolower the cost of some of the most expensive and commonly used prescription medications covered under Medicare Part D.
In addition to Senators Gillibrand, Murray, and Wyden, the Seniors Deserve SMARTER Care Act is cosponsored by Senators Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Maria Cantwell (D-WA), Tammy Duckworth (D-IL), Ruben Gallego (D-AZ), Andy Kim (D-NJ), Ben Ray Luján (D-NM), Ed Markey (D-MA), Jeff Merkley (D-OR), Lisa Blunt Rochester (D-DE), Bernie Sanders (I-VT), Tina Smith (D-MN), Elizabeth Warren (D-MA), and Peter Welch (D-VT).
Representative Suzan DelBene (D-WA-01) introduced companion legislation in the U.S. House of Representatives.
The full text of the legislation is available here.
Source: Senator Kirsten Gillibrand
