On June 9, the House Appropriations Committee adopted an amendment to the FY2027 Labor-HHS bill barring CMS from funding the Wasteful and Inappropriate Service Reduction (WISeR) model, its pilot bringing AI-enabled prior authorization to traditional Medicare.
The vote looks like vindication for the providers who fought the model. It changes nothing yet: WISeR is still operating in all six pilot states, a similar defunding effort died last year, and the more durable lesson for strategy leaders is in how CMS stood the model up—by notice, with no comment period and no published savings estimate—because the same mechanism enables whatever model comes next.
The model
CMS announced WISeR in June 2025 and launched it January 1, 2026, in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Modeled on Medicare Advantage's use of prior authorization and pitched as a "fraud, waste, and abuse" measure, it applies to more than a dozen mostly Part B services, including some epidural steroid injections, some percutaneous spine procedures, incontinence control devices, and skin and tissue substitutes. Providers in the six states must obtain prior authorization for these services or accept prepayment review. CMS contracts with six technology vendors, one per state, who are paid a percentage of the spending their reviews avert.
Advocacy groups argue that the model has added Medicare Advantage–style prior authorization burdens to traditional Medicare, causing delays and administrative headaches. Early accounts from the six-state pilot cite technical failures, slow approvals, and concerns about inappropriate denials.
The opposition
Given the high-profile scrutiny of Medicare Advantage plans for the use of functionally similar prior authorization practices, the introduction of prior authorization to traditional Medicare even on this limited scale raised significant industry opposition.
The American Hospital Association set the terms in an October 2025 letter, filed with the six state hospital associations, arguing that the payment structure for vendors incentivizes denials and that traditional Medicare beneficiaries would lack the appeal rights Medicare Advantage enrollees have. In a letter in March 2026, Democrats led by Rep. Suzan DelBene asked appropriators to defund the model, and May brought Congressional Review Act resolutions in both chambers. The June committee vote was the culmination—and the second straight year the committee has voted to defund WISeR.
So What?
The defunding vote is meaningful, but not the end of the story. The funding bill to which the defunding provision is attached must still clear the full House, the Senate, and conference; a similar FY2026 effort never became law, lapsing when the full-year bill collapsed into a stopgap. The Congressional Review Act resolutions, which attack the model's legal foundation, are the more serious threat—and they remain unresolved.
WISeR's "voluntary" label is what let CMS skip rulemaking. Mandatory CMMI models must go through notice-and-comment rulemaking; voluntary ones can launch by notice. CMS classified WISeR as voluntary—its participants are the vendors, who applied—even though providers in the six states cannot opt out and face prepayment review if they decline. That classification meant no comment period and no published savings estimate, unlike TEAM and CJR-X, mandatory models which went through the FY2025 and FY2027 IPPS rules with full regulatory impact analyses including projected savings. The same authority lets CMS stand up the next voluntary model just as fast.
This is evidence of Medicare's political durability, not its retrenchment. Medicare is a roughly $1 trillion dollar program serving close to 68 million beneficiaries. But a pilot program to reduce spending that touches fewer than 20 services in six states has nearly been sidelined due to bipartisan opposition. Although there is good reason to believe that the politics of prior authorization in particular has catalyzed opposition, WISeR’s marginalization is but one further reason to conclude that the political appetite for substantial Medicare cuts is meager to say the least, particularly in an election year. CMS may continue to pressure Medicare spending around the edges of provider economics, but Medicaid cuts remain a much greater threat.