A new Medicare pilot program is quietly changing how some seniors get care in six states, according to Rich Fiesta, Executive Director of the Alliance for Retired Americans.
Fiesta told the America’s Work Force Union Podcast that the Wasteful and Inappropriate Service Reduction (WISeR) initiative introduces prior authorization into traditional Medicare by routing treatment approvals through for-profit artificial intelligence vendors, a shift he said is already producing delays and denials that Medicare was designed to avoid.
Rich Fiesta, Executive Director of the Alliance for Retired Americans, told the America’s Work Force Union Podcast that a Medicare pilot launched at the start of the year is shifting key medical decisions away from physicians and toward outside contractors using artificial intelligence. Fiesta said the initiative, operating under the name WISeR, is running in six states and is already producing the kinds of delays and denials that working people have long associated with privatized health plans.
Fiesta’s warning was not framed as a theoretical concern about technology. He described WISeR as an administrative move requiring no Congressional vote or formal rulemaking, and one that lacked the public awareness typically seen with major changes to a bedrock program. In his view, this combination makes it easier for the program to spread before seniors, unions and advocates fully understand what is happening.
Fiesta said the WISeR pilot was added at the end of the year as a new demonstration program. He noted that pilot programs can sometimes reduce paperwork or improve access. Still, he argued that this one does the opposite by adding a layer of prior authorization to traditional Medicare.
According to Fiesta, prior authorization has not historically been part of fee-for-service Medicare. He said it is a hallmark of Medicare Advantage and other privatized models, in which insurers review requests and decide whether a service will be covered.
Fiesta said WISeR routes certain care decisions through for-profit AI companies that evaluate whether a patient can receive a service. He described the shift as a fundamental change in how Medicare has operated since its creation in 1965, because it inserts a profit-driven decision-maker between a patient and a doctor.
He noted that the program’s name, Wasteful and Inappropriate Service Reduction, is designed to sound universally appealing. However, Fiesta argued that the branding masks the real-world impact: a system that can slow down care, complicate approvals and increase the likelihood that medically necessary services are denied.
Fiesta said the pilot is currently active in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington state.
He emphasized that the limited footprint should not be mistaken for a limited ambition. Fiesta said the pilot model is often used to introduce a policy in a small number of states, declare it a success and then expand it nationwide.
In his view, the risk is that WISeR becomes normalized before the public has a chance to weigh in. Fiesta said that this is especially concerning because the program can be implemented administratively, without the kind of congressional authorization most people assume would be required for a major Medicare change.
Fiesta said the pilot has only been running for a few months, but he attributed early reports of delayed care and longer wait times to the new prior authorization layer.
He pointed to reporting by The Seattle Times that, according to Fiesta, found evidence of delays affecting people with chronic conditions and pain-related needs. Fiesta said those patients are among the most vulnerable to administrative slowdowns because their care is often ongoing, time-sensitive and dependent on consistent access to services.
Fiesta framed the issue as both practical and ethical. He said a licensed physician who knows a patient’s history should be managing care decisions, not an automated system run by a contractor whose business model depends on reducing spending.
He also argued that even when an appeal is possible, the process itself can function as a barrier. Fiesta said the appeals path is complicated and unclear because traditional Medicare beneficiaries are not accustomed to navigating prior authorization disputes.
Fiesta said there is already legislative action to block the WISeR approach.
He attributed a bill to Sen. Patty Murray (D-Wa.) and Rep. Greg Landsman (D-Ohio). Fiesta said the measure would ban the AI-driven, prior authorization model in traditional Medicare.
Fiesta urged swift action, arguing that waiting could allow the pilot to expand from six states to the entire country. He said Congress should intervene decisively to preserve Medicare’s original structure, in which doctors make care decisions, and patients are not forced into unnecessary administrative battles.
Fiesta also discussed a separate issue involving Social Security data, describing it as a long-running legal fight over access to sensitive personal information held by the Social Security Administration.
He said the Alliance for Retired Americans, along with AFSCME and American Federation of Teachers, pursued litigation in federal court in Baltimore to block outside access to that data. Fiesta described a period when a temporary restraining order was in place, followed by a change after higher court action.
Fiesta said that after the restraining order was lifted, data was moved into unsecured servers. He also said the Justice Department later acknowledged in court that earlier representations were inaccurate.
Fiesta said a federal judge has now authorized discovery, allowing advocates to seek documents and sworn testimony to determine what happened to the data and how it was handled.
As tax season closed, Fiesta addressed confusion among beneficiaries about whether taxes on Social Security benefits had been eliminated.
Fiesta said the policy did not exempt Social Security benefits from taxes. He said a portion of beneficiaries, which he estimated at roughly 12 percent to 15 percent, will continue to pay taxes on their benefits.
He described the change as a temporary tax credit that can reduce taxable income for some filers, but he said it is not permanent and is limited to the duration of the underlying law, which runs for four years.
Fiesta said the result is predictable: many retirees will discover that the policy did not match what they believed they were promised.
Fiesta’s central message was that Medicare and Social Security remain targets for administrative changes that can move quickly and quietly.
On Medicare, he said the immediate concern is preventing WISeR from becoming a national template for inserting AI prior authorization into traditional coverage.
On Social Security, he said the priority is accountability for how sensitive data was accessed and stored.
Taken together, Fiesta framed the moment as a reminder that retirement security is not self-sustaining. He said it requires constant vigilance, public pressure and congressional action to keep core programs aligned with their original purpose: protecting working people after a lifetime on the job.
Every victory at the bargaining table starts with workers standing together. From the shop floor to the statehouse, hear how activists are fighting for better wages, safer conditions and a stronger future. Subscribe to the America’s Work Force Union Podcast to get the latest interviews with the leaders and organizers building worker power across America.