United States Senate
Washington, DC 20510
Dear Senator:
On behalf of our 3 million members and the 50 million students they serve, we urge you to VOTE YES on S. J. Res. 198, the Congressional Review Act resolution to end Medicare’s disastrous Wasteful and Inappropriate Service Reduction (WISeR) program. Votes on this issue may be included in NEA’s report card for the 119th Congress.
Instead of building on proven ways to discourage unnecessary procedures, the Trump administration created the pilot WISeR program that injects prior authorization driven by poorly-vetted artificial intelligence (AI) into traditional Medicare. The program currently contracts with private companies to use AI to review claims for certain procedures in six states: Washington, Ohio, New Jersey, Oklahoma, Texas, and Arizona. Pay is based on claim denials—the vendor receives a percentage of the dollar value of the claims it denies. If Congress allows this program to continue, it will expand to more states.
A survey of Washington hospitals, as well as experience in other states, shows a pattern: obtaining prior authorization under the WISeR program delays access to care for two to six weeks. Patients with excruciating knee pain, for example, are being denied everything from steroidal treatments to surgical procedures. It is unclear whether the required human review of claims decisions has been adequate to slow the rate of improper decisions. The Trump administration even recently placed a vendor on a corrective action plan, a seeming acknowledgment of the problem.
Due to claim denials encouraged by the WISeR program, thousands of Medicare beneficiaries have experienced unnecessary suffering and a worsening of their underlying condition—a pattern that will continue as long as the program endures.
The focus should be on preserving the health of the seniors and people with disabilities who rely on Medicare—not putting profits over patient care and incentivizing vendors to prolong suffering. Please VOTE YES on S.J. Res. 198 to force the Trump administration to end the WISeR program.
Sincerely,
Kimberly Johnson Trinca
Director of Government Relations
National Education Association
