Retiree Advocate readers know that PSARA has been actively pushing back on the upcoming changes to Original Medicare the WISeR pilot program. As reported in previous RA issues, the WISeR model is slated to begin on January 1 in Washington State. As a result, prior authorization (prior approval by Medicare) will then be required for 17 procedures that previously were left up to you and your doctors to decide (although described by CMS as “voluntary,” absent prior authorization, your healthcare provider risks not being reimbursed by Medicare for your treatment).

Original Medicare, unlike private Medicare Advantage plans, has in the past rarely required prior authorization. But under WISeR, contractors utilizing artificial intelligence will review doctors’ requests for approval of these procedures. And these contractors will be rewarded with a share of the costs that they “save” for Medicare (i.e., savings from denying or discouraging treatments).

CMS introduced WISeR in July with little fanfare or consultation with the public or the medical community. So, few seniors realize this change is coming. This is why the PSARA outreach team has made many presentations during the last few months throughout the Puget Sound area to raise awareness and to push back against WISeR. Many of you have responded with calls and letters to your representatives. Your advocacy is working!

PSARA has met with staff of our Congressional leaders, including Rep. DelBene, Senator Patty Murray, and Senator Maria Cantwell. You’ll find an inspiring video about WISeR by Senator Patty Murray on our webpage. We’ve met with staff of the state Office of Insurance Commissioner, Patty Kuderer, and she has now issued a statement critical of WISeR. At press time, Representatives Smith, DelBene, Jayapal, Randall, and Strickland had signed onto the Pocan/Schakowsky House Resolution calling for WISeR to be stopped (see the September issue of the RA for more info on this Resolution).

PSARA continues our work to protect Medicare from becoming a privatized system that reaps profits by denying care to seniors and the disabled. Regardless of whether you are in Original Medicare or a Medicare Advantage plan, it benefits all of us to maintain a strong, solvent, publicly-funded Medicare system as a safety net for all seniors and the disabled.

Finally, dear Retiree Advocate readers, if you have a personal story you are willing to share about prior authorization and how it affected you or your family’s care, please send it to organizer@psara.org. We know that personal stories show us how real lives are affected, and these can in turn affect public opinion and elected officials.

Thank you for joining us in this fight.