Expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction Model undermines beneficiary access to health care and should not be implemented.
- Bill Number
- H.Res. 704
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-11: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2025-12-17T09:06:17Z
AI-Generated Summary
Purpose of the Legislation
This House Resolution (H. Res. 704) expresses the sense of the U.S. House of Representatives regarding a proposed program by the Center for Medicare and Medicaid Innovation (CMMI), part of the Centers for Medicare and Medicaid Services (CMS). It disapproves of the Wasteful and Inappropriate Service Reduction (WISeR) Model, arguing that it would harm access to health care for Medicare beneficiaries and urging CMS not to implement it.
Key Provisions
The resolution includes background "Whereas" clauses highlighting concerns about the WISeR Model and concludes with three main directives:
- Disapproval of the Model: The House expresses strong disapproval of the WISeR Model, set to start on January 1, 2026.
- Undermining Access to Care: It states that expanding prior authorization processes (a requirement for pre-approval of certain medical services) from Medicare Advantage (a private insurance option under Medicare) into traditional Medicare would hinder timely and necessary medical care.
- Request to Terminate: The House strongly urges CMS to end the WISeR Model.
Background details in the resolution note:
- The model would increase prior authorization requirements in traditional Medicare by 30%.
- It would involve private companies (currently handling prior authorizations for private insurers and Medicare Advantage) and use advanced technologies like artificial intelligence (AI) and machine learning for processing.
- Prior authorizations are cited as barriers to care, contributing to physician burnout (89% of doctors affected, per the American Medical Association).
- Private companies involved have high error rates, with 81.7% of Medicare Advantage denials overturned on appeal (per Kaiser Family Foundation data), and AI tools from similar companies showing up to 90% error rates (per Fierce Healthcare).
Significant Changes to Existing Law
This is a non-binding resolution, so it introduces no legal changes to existing laws or regulations. It does not amend statutes like the Social Security Act (which governs Medicare) or alter CMS authority. Instead, it serves as a formal statement of congressional opinion to influence administrative actions.
Potential Impacts
- On Government Agencies: CMS and CMMI may face political pressure to reconsider or abandon the WISeR Model, potentially delaying or altering Medicare policy innovations aimed at reducing wasteful services.
- On Citizens: Medicare beneficiaries in traditional Medicare could avoid expanded barriers to care if the model is halted, preserving easier access to services without increased pre-approvals. Physicians might experience less administrative burden and burnout.
- On International Relations: No direct impacts, as this concerns domestic U.S. health policy.
- Broader effects could include reduced reliance on private sector involvement in public Medicare programs, potentially affecting efficiency efforts but prioritizing patient access over cost savings.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary group at risk of delayed or denied care due to expanded prior authorizations.
- Physicians and Health Care Providers: Face increased administrative workload and burnout from prior authorization processes.
- Centers for Medicare and Medicaid Services (CMS) and CMMI: Targeted for policy reversal, affecting their innovation mandate under the Affordable Care Act.
- Private Insurance Companies and Medicare Advantage Plans: Companies contracted for prior authorizations may lose opportunities to expand into traditional Medicare.
- Advocacy Groups: Organizations like the American Medical Association, which provided data cited in the resolution, stand to influence or benefit from blocking the model.
Notable Legal, Constitutional, or Political Implications
- Legal: As a "sense of the House" resolution, it has no enforceable power but can signal congressional intent, potentially complicating CMS rulemaking under the Administrative Procedure Act if challenged in court. It highlights concerns over outsourcing public health decisions to private entities with error-prone AI tools.
- Constitutional: No direct implications; it aligns with Congress's oversight role over executive agencies like CMS but does not infringe on separation of powers.
- Political: Introduced by progressive Democrats (e.g., Reps. Pocan, Ocasio-Cortez), it reflects partisan divides on Medicare privatization and AI in health care. Referred to key committees (Ways and Means, Energy and Commerce), it could spark debates on balancing cost control with access, influencing future appropriations or legislation like Medicare reforms.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (24)
Rep. Schakowsky, Janice D. [D-IL-9], Rep. Doggett, Lloyd [D-TX-37], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Tlaib, Rashida [D-MI-12], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Landsman, Greg [D-OH-1], Rep. Goodlander, Maggie [D-NH-2], Rep. McBride, Sarah [D-DE-At Large], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Frankel, Lois [D-FL-22], Rep. Khanna, Ro [D-CA-17], Rep. Omar, Ilhan [D-MN-5], Rep. McDonald Rivet, Kristen [D-MI-8], Rep. DelBene, Suzan K. [D-WA-1], Rep. Smith, Adam [D-WA-9], Rep. McIver, LaMonica [D-NJ-10], Rep. Strickland, Marilyn [D-WA-10], Rep. Jayapal, Pramila [D-WA-7], Rep. Dingell, Debbie [D-MI-6], Rep. Randall, Emily [D-WA-6], Rep. Schrier, Kim [D-WA-8], Rep. Cohen, Steve [D-TN-9], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Thanedar, Shri [D-MI-13]
Recent Actions
- 2025-09-11: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-09-11: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-09-11: Submitted in House
- 2025-09-11: Submitted in House
Bill Versions
- Expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction Model undermines beneficiary access to health care and should not be implemented. — issued 2025-09-11 — PDF (3 pages)