Trump Administration Pilots AI Medical-Spending Program in 6 States as Doctors Warn of Denials
Updated
Updated · Ars Technica · Jul 18
Trump Administration Pilots AI Medical-Spending Program in 6 States as Doctors Warn of Denials
3 articles · Updated · Ars Technica · Jul 18
Summary
A six-state pilot by the Trump administration is testing AI to curb unnecessary medical spending through the prior-authorization system.
Prior authorization is meant to check overuse, but AI is being explored because the current process often delays care, leaves patients waiting for insurer approval and can lead some to abandon treatment.
A 2025 American Medical Association survey found 61% of physicians fear AI will worsen denials of medically necessary care, adding to resistance against automated reviews.
The AMA is pressing insurers to disclose detailed clinical reasons for denials and provide more transparency on the algorithms, as policymakers weigh whether AI can speed approvals without increasing wrongful rejections.
Can AI fix healthcare's costly delays, or will it just become a faster way to deny necessary medical care?
When an AI denies care and a patient is harmed, who is legally responsible for the algorithm's decision?
The WISeR Model Rollout: How AI-Powered Prior Authorization Is Reshaping Traditional Medicare in Six States
Overview
The Wasteful and Inappropriate Service Reduction (WISeR) Model, launched by the Centers for Medicare and Medicaid Innovations in January 2026, is now active in six states and has quickly become a source of major controversy. Its main goal is to cut wasteful Medicare spending by adding new prior authorization requirements to traditional Medicare, a move that has upset many beneficiaries who chose this coverage to avoid such hurdles. Critics argue that WISeR brings unwanted administrative burdens and delays, while supporters believe it will help prevent fraud and unnecessary costs. The debate highlights the tension between cost-saving efforts and maintaining easy access to needed care.