AI-Powered Denials: Trump’s Attack on Medicare

Here is what you need to know.

The Trump Administration has announced a new Medicare pilot program that pays companies to deny coverage.

Called the Wasteful and Inappropriate Services Reduction (WISeR) model, the program hands reviews to private contractors, who will be supported by AI systems that flag claims for rejection. Their profits will rise with every denial.

On paper, WISeR is about cutting waste. In reality, it imports the worst features of private insurance into Medicare: red tape, AI-driven denials, and incentives to say “no” instead of helping patients.

How WISeR Works

• Prior authorization will now be required for certain outpatient procedures in traditional Medicare. The pilot begins in 2026 in six states.

• Private contractors will manage approvals, aided by AI algorithms.

• Payment is tied to denials, the more they say “no,” the more they make.

Why It Matters

Unlike Medicare Advantage or private insurance, original Medicare has always been valued for its simplicity. Seniors know what’s covered. Providers know how to bill. There’s trust in the system. Trump just erased that advantage.

If your business model relies on denials, that's what you’ll get. If this pilot “succeeds,” it could hardwire those incentives into Medicare for generations.

We’ve already seen what happens when denial is the goal. The “human review” becomes little more than a rubber stamp. Remember Trump’s Department of Government Efficiency (DOGE)? Its AI-driven systems slashed vital programs simply because the structure rewarded cuts over care.

What We Know About Prior Authorization

The evidence on prior authorization is mixed at best.

• Often wrong: A federal inspector general found that 13% of denied requests in Medicare Advantage actually met Medicare’s coverage rules.

• Delays care: 93% of physicians say prior authorization slows treatment (AMA).

• Patients give up: More than 80% of doctors report patients abandon treatment altogether because of these hurdles.

Now add AI into the mix. Algorithms are fast at flagging claims, but they don’t understand patient context. They amplify denials without improving accuracy.

What You Can Do

Spread the word: Trump’s new healthcare program rewards private contractors for denying treatment and uses AI to do it faster.

Here are some quick talking points and facts you can share:

• This isn’t about efficiency; it’s about denying care. Contractors get paid for saying “no,” not for getting it right.

• AI doesn’t provide better care. It just scales up denials.

• Trump is injecting the worst parts of private insurance into Medicare: red tape, AI-driven denials, and profit before patients.

• This isn’t just about Medicare. It’s about whether we let “efficiency” in public programs be defined as how much care can be denied.

If we don’t push back now, this experiment could hardwire the wrong incentives into the system for decades to come.