AI prior authorization faces bipartisan backlash in congress

WASHINGTON, UNITED STATES — Congress has found rare common ground on artificial intelligence in healthcare — and the message is opposition. On June 10, the House Appropriations Committee voted unanimously to block funding for the Wasteful and Inappropriate Service Reduction (WISeR) model, a Centers for Medicare & Medicaid Services pilot using AI to approve or deny care in traditional Medicare, Healthcare Dive reports.

WISeR pilot puts AI over doctors

Launched in January 2026 across six states, WISeR applies AI-enabled prior authorization to specific Medicare services — including skin and tissue substitute procedures and epidural steroid injections.

CMS announced the model in summer 2025, framing it as a tool to reduce wasteful spending. Critics argue it replaces clinical judgment with algorithmic decisions at a moment when Medicare patients are most vulnerable.

“Medicare was built on a simple promise… prior authorization by artificial intelligence is putting the judgment of doctors and the needs of patients behind,” said Rep. Lois Frankel (D-Florida), one of the amendment’s sponsors.

The WISeR model effectively positions AI as the gatekeeper between Medicare beneficiaries and their physicians’ recommended care — a function critics argue belongs to clinicians, not algorithms.

Bipartisan vote moves to defund WISeR

What makes the June 10 vote notable is not just the outcome — it is the coalition behind it. Rep. Robert Aderholt (R-Alabama), the Republican subcommittee chair overseeing HHS funding, co-sponsored the amendment alongside Frankel and Rep. Andy Harris (R-Maryland), calling the vote “bipartisan” across the full committee.

The amendment, attached to HHS fiscal year 2027 appropriations legislation, would bar CMS from spending funds on WISeR or any similar AI prior authorization model in traditional Medicare. It still requires passage by the full House and Senate.

Congressional opposition to WISeR built steadily before the June vote: House Democrats introduced repeal bill H.R. 5940 earlier this year, and in May 2026 both chambers’ Democrats filed resolutions to roll back the pilot — but neither advanced until the appropriations vehicle gave the effort bipartisan force.

The legislative backlash signals growing unease with deploying AI in coverage-decision roles without stronger accountability frameworks in place. The unanimous committee vote suggests that concern is no longer confined to one party.

For healthcare outsourcing providers operating in prior authorization support, revenue cycle management, and claims processing, the WISeR debate is a leading indicator.

As Congress scrutinizes AI-driven coverage decisions, demand for human-reviewed prior authorization workflows — often supported by offshore claims processing and clinical administrative teams — is likely to grow alongside regulatory pressure.

AI prior authorization is a policy bet. Congress is now placing its own.