Local opinion: Medicare pilot program draws criticism over prior authorization

As a health care activist, I began fighting WISeR eight months ago. I'm now a victim of WISeR’s privatization of Traditional Medicare by imposing prior authorization. Traditional Medicare has never required prior authorization for common medical procedures. But as of Jan. 1, 2026, the WISeR pilot program began in Arizona, Texas, Washington, Ohio, New Jersey and Oklahoma. It requires that doctors treating Traditional Medicare patients obtain prior authorization for some common procedures. If WISeR is not shot down, it will be imposed nationwide.

For two years, with no prior authorization, Traditional Medicare covered steroid injections every 90 days for chronic pain. This allowed me to live a fairly normal life. Now, with extended delays on treatment, my chronic, sometimes very severe back and leg pain is directly impacting my quality of life. It restricts my social interactions, bathing, dressing, food preparation, rehab program, exercise, chores and errands. Now, I have to complete these by 2 p.m. due to increasing pain and exhaustion.

Under WISeR, my doctor requested prior authorization over a month ago. There's been no response. With no approval, I don't know when or if I will be able to resume steroid injections. This is a clear violation of my treatment plan.

In each state, WISeR contracts with a private company to use AI to decide whether to authorize or deny a procedure. Note that these companies profit from every denial. To appeal denials, doctors must submit another request, which may be denied again. WISeR is causing unnecessary denials and two- to three-month delays of treatments for patients like me.

My doctor at The Pain Institute of Southern Arizona (PISA) is excellent. He and numerous other medical professionals are taking steps to try to end this nightmare. WISeR has been in effect only four months, and lawsuits have already been filed regarding its effects on patients and practitioners.

While WISeR's alleged goal is cutting costs, in reality it's just passing the costs on to practitioners and patients. Some patients are already being told by their clinicians that they will have to pay out of pocket for the same injections that Traditional Medicare has historically fully covered every 90 days with no prior authorization.

The Center for Medicare and Medicaid Innovation was created in 2010 as part of the Affordable Care Act, allegedly to reduce Medicare, Medicaid and CHIP spending. But CMMI has unrelentingly ignored the most obvious way to reduce health care costs, which would be expanding either of the two most efficient, least expensive, highest quality health care programs in the U.S.: Traditional Medicare and Veterans Administration Healthcare.

Instead, CMMI has been acting on its hidden pro-corporate agenda: privatization of Traditional Medicare. Neither CMS nor CMMI have authority over the VA, so ongoing defunding of the VA has been accomplished by many decades of corporate control of Congress, the presidency and the Supreme Court.

CMMI knew that WISeR would generate a huge pushback from seniors, so it already has another AI-generated trick up its blood-stained sleeve.

It's called ACCESS, the newest program attempting to privatize Medicare. "Advancing Corporate Cash by Exploiting Sickest Seniors” accurately describes it. But, as usual, its official title is the opposite of what it does, so CMMI calls it "Advancing Chronic Care with Effective, Scalable Solutions.”

Like WISeR, the 10-year plan's hidden goal is privatization of Medicare. The following are now done by physicians and medically trained practitioners. Under ACCESS, an investor-owned, for-profit corporation will have AI do these:

• Clinician consultations

• Lifestyle and behavioral support, including nutrition, exercise and smoking cessation

• Therapy and counseling

• Patient education and care coordination

• Medication management

• Ordering and interpreting diagnostic tests and imaging

• Use of, or monitoring, devices worn by seniors

Medical practitioners will be financially penalized for patients not meeting health care goals. So clinicians will be motivated to avoid patients with chronic or progressively worsening illnesses, or who can't afford recommended medications, supplements, foods, etc.

We must defeat WISeR and ACCESS. Medicare must be expanded, not privatized. Our health care system is broken. It cannot be fixed so long as it continues to be a wealth extraction system. Single-payer/Medicare for All would provide every American a much higher quality, truly comprehensive health care free from corporate profit and control.