By Megan R. Wilson

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In today’s issue:

• Exclusive: Democrats move to repeal a pilot program that adds AI-driven prior authorization to Medicare in six states, aiming to force a GOP vote
• Democratic-led states sue the Trump administration over student loan caps, while lawmakers on Capitol Hill introduce a bipartisan fix for those seeking advanced nursing degrees
• A new KFF report finds that average deductibles for Affordable Care Act plans are reaching a record high as millions of Americans risk losing coverage

Hello everyone; this is Health Brief. There’s 168 days until Americans across the country go to the polls in November — and it’ll be here before you know it. Until then, much of what happens within the administration, or on Capitol Hill, will be viewed through the midterm lens.

On Tuesday, voters go to the polls in a half-dozen states — Alabama, Georgia, Idaho, Kentucky, Oregon and Pennsylvania — to vote in primary elections. 

Health care could be a major factor in some of these races — including in Georgia, where a billionaire health staffing company executive named Rick Jackson is vying for governor of the state. There’s also a crowded GOP field in the Georgia Senate race to face off against Democratic Sen. Jon Ossoff in November, including Rep. Buddy Carter.

Please send any tips, documents or health industry intel to megan.wilson@washpost.com, or message me on Signal at megan.434.

Sen. Ron Wyden (D-Oregon) is leading an effort to halt the Trump administration's AI experiment in Medicare. (Demetrius Freeman For The Washington Post)

	The Lead Brief

Sen. Ron Wyden (Oregon), the top Democrat on the Senate Finance Committee, is launching an effort to overturn a Trump administration pilot project that’s testing the use of AI-driven prior authorization in traditional Medicare.

The pilot, called the Wasteful and Inappropriate Service Reduction, or WISeR, uses contracts with artificial intelligence companies to process requests — which some providers and Democratic lawmakers argue is leading to unnecessary delays in care.

Wyden is planning to invoke the congressional Review Act, an arcane legislative tool that allows Congress to roll back recently finalized federal rules with a simple majority vote, according to details shared first with me.

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The Centers for Medicare and Medicaid Services (CMS), which is overseeing the pilot program, has defended the experiment as a way to save taxpayer dollars and prevent services that aren’t needed. It’s happening as the agency is working with health insurers to curtail and streamline their use of prior authorization in other areas.

Why it matters: The effort faces steep odds in a Republican-controlled Congress, but it gives Senate Democrats a vehicle to force GOP lawmakers into an election-year vote on the policy that revolves around prior authorization, a practice that’s unpopular with voters.

“Americans are sick and tired of abusive prior authorization tactics putting needed health care out of reach,” Wyden said about the effort to overturn the model. “The last thing seniors need is even more AI denying the care they need.”

The move comes about a week after the Government Accountability Office issued a report that determined the WISeR model qualified for review under the law, opening the door for lawmakers to challenge it.

Wyden is partnering with four other Democratic senators on the effort: Patty Murray (Washington), Maria Cantwell (Washington), Richard Blumenthal (Connecticut) and Kirsten Gillibrand (New York).

The effort has gained 20 initial co-sponsors in the Senate, and needs 10 more to bypass the committee process and force a vote on the Senate floor. There are 47 Democrats in the Senate, including the two independent senators who caucus with them, which bolsters the chances of reaching the threshold.

→ Democratic Reps. Greg Landsman (Ohio) and Suzan DelBene (Washington) are leading the House version. There is no fast-track mechanism to force a vote in the House, however, so it will languish unless Republican leadership makes the unlikely decision to bring it up.

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The six-year pilot is operating in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. In March, WP Intelligence Lead Health Care Analyst Rebecca Adams reported that the model was already causing headaches for providers.

Cantwell has argued the model has unnecessarily delayed treatment for patients, releasing a report last month with data from the Washington State Hospital Association showing that authorization wait times for certain procedures under the model had increased from weeks to up to two months.

In a statement Tuesday, a CMS spokesperson said the WISeR model “includes safeguards intended to protect beneficiaries and provider access,” including protecting appeal rights and excluding emergency and inpatient-only services from triggering prior authorizations under the model.

The agency “anticipates releasing preliminary data on participant performance later this year,” the spokesperson added. “Participants have self-reported preliminary positive results including real-world examples of harmful and wasteful care being averted demonstrating the program’s role in protecting patient safety.”

What to watch: Although some Republican lawmakers — including Rep. Robert B. Aderholt (Alabama) — have expressed skepticism of the model, it’s not clear whether any will sign on to the Democratic-led effort to halt it. They may not want to risk appearing to rebuke the administration ahead of the November elections.

Last year, a House Appropriations panel that oversees CMS funding approved an amendment by voice vote to block funding to implement the WISeR model. The provision did not make it into the final government spending package.

Aderholt, who leads the appropriations subcommittee, said he appreciated the amendment, Politico reported at the time. His office didn’t respond to an inquiry about whether he still supports halting the WISeR model.

	Litigation Report

A group of 25 Democratic-led states and the District of Columbia is challenging new Trump administration regulations limiting student loans and narrowing the definition of professional degrees that qualify, arguing that they worsen health care shortages, reports The Post’s Danielle Douglas-Gabriel.

The states filed the lawsuit in a federal court in Maryland nearly three weeks after the Education Department finalized rules that lower the amount of money graduate students can borrow from the federal government.

• The rules are a feature of Republicans’ signature domestic policy law enacted last summer. They implement borrowing caps based on whether students are pursuing a degree in what is designated as a professional or graduate program.
• The lawsuit alleges that the Education Department unlawfully changed the federal definition of a “professional degree” by adding new requirements and narrowing eligibility in ways not authorized by Congress.

The states fear the rule will force many students to rely on more expensive private loans, delay completing their education or abandon their pursuit of an advanced degree altogether. The lawsuit seeks to block the rule, which is set to go into effect July 1.

• Nursing groups and other professional associations pushed back on the rulemaking, arguing that it restricts access to people who want advanced degrees and shrinks the overall pool of professionals while demand grows. In a joint statement, the American Academy of Physician Associates and the PA Education Association said they “welcome” the legal challenge.
• The Education Department has said 95 percent of nursing students borrow below the annual limit and would not be affected by the new caps.

Education Undersecretary Nicholas Kent criticized opposition to what he said are “common-sense loan caps” that incentivize colleges and universities to lower tuition, Danielle reports.

“For years, Democrats parroted illegal loan forgiveness to ‘end the debt crisis’ and buy votes, and now the same people are fighting against the Trump administration’s legal efforts to drive down the cost of college,” Kent said in a statement to The Post. “Clearly, these Democratic governors and attorneys general are more concerned about institutions’ bottom line rather than American students and families’ ability to access affordable postsecondary education.”

Read the full story: “Health worker shortage will worsen with federal loan limit, 25 states say in suit.”

	Health on the Hill

Meanwhile, new bipartisan legislation on Capitol Hill takes aim at the Education Department’s rule.

Sens. Jeff Merkley (D-Oregon) and Roger Wicker (R-Mississippi) introduced a bill Tuesday that would restore higher federal student loan limits for nurses pursuing postbaccalaureate degrees — including nurse practitioners, nurse anesthetists and nurse midwives. The legislation, which has a bipartisan companion in the House, specifically includes advanced nursing degrees in the definition of “professional degrees.”

Merkley, who coleads the Senate Nursing Caucus with Wicker, called it a “simple and straightforward” fix.

“Republicans and Democrats alike have sounded the alarm over changes that make student loans for nurses more expensive, which threatens the future of the nursing workforce,” Merkley said.

• Under the Education Department’s current policy, nursing students in graduate programs face federal borrowing caps of $20,500 annually and $100,000 overall. The legislation would raise those limits to $50,000 annually and $200,000 total, putting nursing students on similar footing with other professional degree programs.

“It is imperative that Congress address the nursing shortage across the United States. This legislation would make nursing a more achievable profession by expanding the loan limits for nursing students,” Wicker said.

Merkley and Wicker said in an announcement that 250 organizations support the bill.

	Numbers Game

$3,786

That’s the amount of the average deductible for people with Affordable Care Act marketplace plans — a 37 percent increase and a record-high figure, according to a new KFF report.

Christopher Rowland in The Washington Post newsroom has a story about the data, which found that the spike in average deductibles stems from more Americans shifting to the cheapest “bronze plans” in response to premium hikes amid the expiration of enhanced Affordable Care Act subsidies.

→ The KFF report estimates that millions of Americans could lose coverage either because they never signed up amid rising premiums, or because they can no longer afford to keep paying for their plans. Active enrollment could fall from 22.3 million in 2025 to about 17.5 million in 2026, according to the report, citing an analysis by Wakely Consulting Group.

Republicans have argued that decreases in enrollment reflect a purge of fraudulent or nonexistent enrollees. However, the health care industry and some consumer advocates have warned that the drops could ripple throughout the system and increase costs for everyone.

• For insurers: The biggest concern is who’s leaving coverage. Younger or healthier consumers appear to be dropping out of the marketplaces at higher rates, according to the KFF report. Meanwhile, people with chronic medical conditions and greater medical needs are more likely to stay enrolled despite rising costs.

That dynamic could worsen the risk pool and push insurers to seek even higher premium increases in 2027 to offset rising medical costs.

• For providers: Patients who are staying enrolled are shifting from silver plans to cheaper bronze plans with higher deductibles, which could change how and when people seek health care. Uninsured or underinsured patients may delay routine doctors’ visits or treatment for medical issues due to higher out-of-pocket costs, which could ultimately land them in the emergency room.

The shifts could be particularly painful for safety-net providers that care for a large number of lower-income patients and rural hospitals in states seeing the steepest Affordable Care Act enrollment declines, including North Carolina (22 percent), Ohio (20 percent) and West Virginia (17 percent).

Arizona, Delaware and Indiana each experienced a 16 percent drop in marketplace plan enrollment, according to the KFF report.

The election angle: The figures feed into the affordability debate underlying the midterm elections, as Democrats aim to use the cost increases against GOP competitors in battleground races.

	What We’re Reading

“TrumpRx will add 600 generic drugs, president says,” writes The Post’s Dan Diamond.

“Why this Ebola outbreak will be so difficult to contain,” Lena H. Sun and Lauren Weber report for The Post.

“HHS reorganizes Office for Civil Rights to focus on conscience and religious freedom,” Politico’s Carmen Paun reports.

“Board votes to cap how much state, local governments spend on Ozempic,” Danielle J. Brown writes at Maryland Matters.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence.