As your constituent and someone who relies on Medicare or cares for someone who does, I am deeply concerned about the Centers for Medicare and Medicaid Services' (CMS) plan to expand prior authorization requirements in Traditional Medicare through the new Wasteful and Inappropriate Service Reduction (WISeR) model beginning January 1, 2026.
Prior authorization has been a disaster for patients and healthcare providers. When insurance companies require pre-approval before treatments, it creates dangerous delays that harm patients' health. Studies show that 90% of doctors report prior authorization causes treatment delays, and one-third report these delays have resulted in serious adverse events for their patients.
The facts speak for themselves:
- Under this new model, for-profit companies will be paid more money when they deny more care, creating a perverse incentive to block treatment.
- These companies plan to use artificial intelligence to make coverage decisions, despite evidence that AI increases harmful denials.
Traditional Medicare has always provided peace of mind to seniors and people with disabilities, allowing them to see any doctor and receive necessary care without bureaucratic barriers. This is why 81% of Americans support Traditional Medicare.
I urge you to do everything you can to push back against this proposal from CMS and demand an immediate halt to the WISeR model. This dangerous expansion of prior authorization will hurt patients, burden healthcare providers, and erode the quality of Traditional Medicare that millions of Americans depend on.
Our healthcare system should prioritize patient care, not corporate profits. Please stand with your constituents and oppose any expansion of prior authorization in Traditional Medicare. Thank you for considering this urgent matter.
