Congress blocks Medicare from using AI to deny care

What it does

This bill prohibits the Department of Health and Human Services from implementing the WISeR model—a Medicare pilot program that uses prior authorization (including AI) to identify and reduce wasteful or inappropriate services—and bars the Centers for Medicare & Medicaid Innovation from testing any similar prior-authorization models under traditional Medicare going forward. The bill protects Medicare beneficiaries from having their doctors' treatment decisions delayed or denied by automated systems.

Why we flagged it

The bill's operative mechanism is a straightforward prohibition on a specific payment model and a class of future models. It is a direct restriction on government authority to implement prior authorization in Medicare, framed as consumer protection against AI-driven service denials.

What the text implies

• Blocks not only the named WISeR model but any 'substantially similar' model, creating a broad statutory bar on prior-authorization testing in traditional Medicare—future administrations cannot easily revive such pilots without new legislation.
• Forecloses potential cost-containment strategies: if WISeR or similar models could identify genuinely wasteful services, this bill prevents that data from being collected, potentially raising Medicare spending over time.
• Does not affect Medicare Advantage plans (Part C), which already use prior authorization extensively; the restriction applies only to traditional (fee-for-service) Medicare, creating a two-tier system.
• The amendment to Section 1115A(b)(2) is permanent statutory language; it will bind all future Secretaries and Congresses unless explicitly repealed, making this a durable constraint on CMS innovation authority.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries gain protection against AI-driven service denials and delays; doctors retain clinical autonomy without algorithmic interference. The bill removes a mechanism that could restrict access to care, though it also forecloses potential cost savings from identifying genuinely wasteful services.

Named in the bill

Department of Health and Human Services, Centers for Medicare & Medicaid Innovation (CMS/CMI), Medicare (traditional fee-for-service), Medicare Advantage (Part C), Social Security Act Section 1115A

Where it stands

4 cosponsors: 4 Democrats.

• Dec 2, 2025 — Introduced · Congress.gov: “Introduced in House”
• Dec 2, 2025 — Referred to House Committee on Energy and Commerce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

3 lobbying clients named this bill on 3 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $1,125,000 in lobbying spend. A filing names 59 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 61% of bills with at least one filing.

Greg Landsman, the sponsor, reported $1,006,728 in PAC receipts in the 2026 cycle.

• American Federation of State County and Municipal Employees — $630,000 on 1 filing
• American Federation of Teachers — $410,000 on 1 filing
• Alliance for Retired Americans — $85,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.