This week, Senator Maria Cantwell released a report outlining how the WISeR artificial intelligence model is eroding long-standing Medicare coverage practices by introducing AI-driven prior authorization requirements. Representatives DelBene, Schrier, Larsen, Jayapal, Smith, Strickland and Randall have raised similar concerns and shared stories from constituents denied care. Washington State is in the unfortunate position of being one of six states forced into a pilot of this program. 

The findings are clear and concerning. Patients are waiting two to four times longer for procedures, with approvals that once took days now stretching into weeks. In some cases, decisions that were historically guided by physicians are now being delayed or overturned by third-party systems using artificial intelligence. 

For providers, the impact is just as significant. Hospitals report growing administrative burdens, inconsistent denials, and a system that too often prioritizes process and profit over patient needs. At its core, this model risks shifting care decisions away from clinicians and toward opaque algorithms, undermining timely access to medically necessary services. 

WSHA strongly opposes the use of artificial intelligence to deny care. AI has an important role in advancing research and improving care delivery, but it should never be a barrier between patients and the care they need.  

We applaud Rep. DelBene and Sen. Cantwell, as well as others in our Congressional delegation, for their leadership in raising these concerns during recent hearings at the federal level. During a recent Senate Finance Committee and House Ways and Means hearing, they highlighted WISeR’s real-world impacts, including delays and denials leaving patients waiting for care they used to receive without barriers. The call for transparency and accountability reflects what hospitals across Washington are experiencing every day. CMS has stated their commitment to fixing the problems; we eagerly await meaningful action. 

This week, WSHA members had the opportunity to meet with our Congressional delegation in Washington, D.C. and thank them for their commitment to understanding this issue. Their engagement and advocacy are critical to ensuring Medicare continues to work for patients, not against them. 

Sincerely, 

Cassie Sauer
WSHA President & CEO
[email protected]