Congressional Review Act Makes WISeR Repeal Possible

There is a new congressional effort to terminate the WISeR program CMS (Center for Medicare and Medicaid Services) has imposed on Traditional Medicare beneficiaries in six states including Washington.

Senator Ron Wyden (OR) requested that the Government Accountability Office (GAO) determine if this private, for-profit, AI pilot program required congressional approval. The GAO issued an opinion that it did require congressional approval. The GAO stated that WISeR qualifies as an agency rule under the Congressional Review Act. CMS was legally required to seek the approval of Congress for the program.

The GAO decided that WISeR changes the rights of both health care providers and Medicare beneficiaries. While CMS argued that the program is “voluntary,” GAO found that in reality health care providers are forced to use the new AI system or face “strict prepayment reviews.”

Because of the GAO ruling, Congress can pass a joint resolution under the Congressional Review Act to repeal the WISeR model. There is a 60 day window to take action.

Sen. Wyden immediately introduced SJR 192 to terminate WISeR and Senators Murray and Cantwell as well as 18 of their colleagues are original co-sponsors of the resolution. Rep. Landsman and DelBene introduced a companion resolution in the House, HJR 187.

SJR 192 is better positioned because of the smaller number of co-sponsors needed to bring WISeR to the floor for a vote. The resolution was assigned to the Senate Judiciary Committee and on June 9th, the Judiciary Committee discharged SJR to the Senate floor calendar. Under the provisions of the Congressional Review Act, SJR 192 relating to the WISeR program must be brought to the Senate floor for a vote. Unfortunately, the majority leader, Sen. John Thune, determines the date the vote will take place.

If it passes the Senate with a simple majority (a big if ), it then goes to the House, and if the House passes the Resolution, WISeR is terminated. The good news on the House side is that very recently, a House subcommittee, working on the 2027 Health and Human Services budget allocation, voted unanimously to defund WISeR in the coming fiscal year. That amendment is a long way from actually being in the next fiscal year budget but it is an indication that WISeR is unfavorably viewed by both Democrats and Republicans.

With all of this interesting news, it is still a bit of a long-shot that this Congress will terminate WISeR. If SJR 192 passes the Senate, we will need to act collectively to get as many Washington House members as possible to support the Resolution.

Stay tuned and we will be in touch about SJR 192. At this point, sending a message to Senators Murray and Cantwell thanking them for being original co-sponsors of SJR 192 relating to the WISeR program would be a very good thing to do.