Dear Senator:
On behalf of the AFL-CIO, I urge you to vote in support of the Congressional Review Act resolution (S.J.Res. 198) to end the Wasteful and Inappropriate Service Reduction (WISeR) demonstration program in Medicare. This disastrous program has subjected thousands of Medicare beneficiaries to unnecessary harm, and action to halt the Trump administration’s poorly-designed pilot for limiting access to care is overdue.
Contrary to its title, this pilot is neither wise nor properly designed to effectively identify and screen out inappropriate care. The emerging evidence from the ground in the six states where this program is being tested reveals a pattern where access to necessary medical care is being denied for thousands of people. Reports from hospitals about delayed steroidal treatments for pain management, from patients denied knee joint procedures, and from a survey in Washington state all point in the same direction – WISeR is delaying access to needed services by 2–6 weeks and is subjecting patients to prolonged pain and worsening underlying conditions.
The Trump administration has rushed the WISeR program into use, injecting a novel form of prior authorization driven by poorly-vetted artificial intelligence (AI) into the traditional Medicare program. Instead of building upon existing Medicare programs that reduce unnecessary procedures, the program appears to be designed to promote the vendors selling AI services for claims processing. Inexplicably, the program incentivizes vendors participating in the pilot to deny claims by paying the contractors a percentage of the dollar value of denied claims. Also, it is unclear that the required human review of claims decisions has been adequate to slow the rate of improper decisions. Documentation is accumulating that it has not been enough to protect the thousands of patients who have been inappropriately denied. The administration’s recent decision to place one of the vendors on a corrective action plan would seem to acknowledge these problems.
We urge you to vote for S.J.Res. 198 to force the Trump administration to end this program. Intervening with the vendors in this program is not enough. The focus should be on protecting the health of seniors and people with disabilities who rely upon Medicare, and it is clear this program is deeply flawed and must be ended.
Thank you for your attention.
Sincerely,
Jody Calemine,
Director, Government Affairs