U.S. Representative Susan DelBene stepped before reporters at the University of Washington Medical Center on Monday to raise the alarm about a federal program she says has been denying Washington seniors the medical care they need and making it harder for providers to do their jobs. She was joined by patients, medical providers and health care leaders who have all dealt directly with the program and were set to share their experiences.
At the center of her concerns is the WISeR program, short for Wasteful and Inappropriate Service Reduction, which the Trump administration launched on the first of January this year. The experiment operates in six pilot states, including Washington, and contracts with private technology companies that use artificial intelligence to review, delay and deny care for patients enrolled in traditional Medicare, a program that has rarely required prior authorization in the past.
DelBene argued that the design of the program creates a troubling conflict of interest. The companies involved are paid a percentage of the cost of the care that they deny, which she said creates a clear and perverse incentive to turn patients away. She framed the entire effort as an unnecessary risk, declaring that Washington seniors should not be the guinea pigs for the administration's AI experiment.
The congresswoman also revealed a new development she had learned just before stepping up to the microphone. She said the Centers for Medicare and Medicaid Services, or CMS, informed her that they are now requiring Vertex, the company handling the claims in Washington, to submit a corrective action plan for failing to comply with the program's review timeline. Companies like Vertex are supposed to complete their reviews within seventy two hours.
According to DelBene, the timeline of what regulators knew is part of the problem. She said CMS told her in May that the benchmarks were being met, yet the agency had been aware as far back as February that Vertex was not meeting the three day review requirement. That revelation, she said, confirms what providers and patients across her region have already described, with care being delayed far longer than the promised seventy two hours.
While she said she was encouraged that Vertex is being held accountable, DelBene stressed that the case underscores her fundamental concerns about a program rolled out without proper vetting, transparency or safeguards. She described WISeR as nothing more than a Trojan horse to privatize Medicare, and noted that she has been demanding answers, spearheading several legislative efforts to cancel it, and questioning Health and Human Services Secretary Kennedy about the program.
To illustrate the human stakes, DelBene shared the story of Joanne, a Washington senior enrolled in Medicare who suffered from a herniated disc that was pinching her sciatic nerve. Her doctor prescribed an epidural steroid injection to help relieve her immense pain, a procedure that in previous years would have been far easier to obtain, before the new prior authorization requirements complicated access to the care she needed.