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Senate

Providing for Congressional Disapproval Under Chapter 8 of Title 5, United States Code, of the Rule Submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human...

2026-07-16 Issue 116 Showing 1–7 of 7

Official Congressional Record ↗

Ron Wyden

Democrat

“I want to get rid of this rule. It makes life harder for seniors who need care. Doctors should decide what care people get. Not AI companies. Trump promised not to touch Medicare. But he did. Now seniors have to wait for care. That's wrong. I want things to be better for seniors. This rule is a mistake. We need to end it. I want Republicans to help me stop this rule.”

Official Congressional Record

Mr. President, colleagues, at the beginning of this year, the Trump administration empowered unaccountable AI companies to delay and deny certain types of care in traditional Medicare. Now, Donald Trump promised--promised--that he would not touch Medicare, and, today, it is clear that that Trump promise has been broken. Seniors paid into Medicare out of every paycheck during their working years, and they did so with an expectation they would have an ironclad guarantee of affordable healthcare. Today, seniors in six States across America are discovering that care their doctor has recommended for them has been slowed or halted by a shadowy AI-driven third party. The consequences are not abstract. Seniors with severe back pain have to wait weeks for relief, upending their lives and leaving them suffering because of the bureaucracy of healthcare. The types of care that are subject to these restrictions are not frivolous: knee arthroscopies, nerve stimulations, steroid injections, cervical fusion. These types of procedures are the care that seniors rely on to stay mobile and pain-free in the aging process. Now, decisions between doctors and patients are overridden by for- profit AI contractors. The Trump administration's only defense of this model has been to point to the rapid rise of skin substitute procedures to justify their flawed experiment. The Trump administration's work doesn't pass the smell test. First, the Centers for Medicare and Medicaid Services already have now lowered payment rates for this procedure; in doing so, closed the loophole driving the dramatic increase. (Mrs. CAPITO assumed the Chair.) Second, the skin substitute procedures only account for a tiny fraction of care under the model. In the case of Oregon's neighbor to the north, Washington State, skin substitutes account for less than 1 percent of services--less than 1 percent of the services, Madam Chair-- subject to the prior authorization under this model. So the excuses hold no water. Prior authorization has run rampant in the American healthcare system. For-profit insurance companies are increasingly using this business tactic to block and deter care in order to increase their profits. I want to put a fine point on this. In 2024, insurance companies that sell Medicare Advantage plans denied more than 4 million prior authorization requests--just think about that: 4 million prior authorization requests. Of those denials, only 1 in 10 were appealed by a senior or their doctor. But when the denial was appealed, it was overturned 8 times out of 10. What this tells me is that prior authorization is being used to deny legitimate care, often acting as a bureaucratic hurdle meant to discourage seniors and their doctors from pursuing a course of treatment that might impact insurance company's bottom line. It is bad enough that this is the state of affairs in Medicare Advantage, but now the Trump administration is trying to import insurance company tactics into traditional Medicare. And that would mean that seniors who selected it precisely because they don't want to deal with the headaches and complexity of an insurance company would suffer. This is not a partisan issue. Many of my Republican colleagues have expressed concern about prior authorizations and the state of Medicare Advantage. I hope that they will stand with those of us today who want to tell the Trump administration to abandon an ill-advised experiment that seniors don't want. They didn't ask for it. It doesn't make sense. There is a lot of work to be done to improve both traditional Medicare and Medicare Advantage for seniors that count on the Medicare guarantee. And I have been working on that Medicare guarantee since the days when I was a codirector of the Oregon Gray Panthers. Let's work on that together, and we can start by ending this AI-driven prior authorization experiment. It is a mistake. We can't run the risk of it being sent to other parts of the healthcare system. I urge a ``yes'' vote. I yield the floor.

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Mike Crapo

Republican

“Wyden is wrong. We need this AI program. It can help us fight fraud. It will find bad claims. It will save us money. It will make things better for patients. My friends should not stop this program.”

Official Congressional Record

Madam President, in response to the discussion that my colleague from Oregon has just engaged in, far too often, our Nation's healthcare system incentivizes low-value, high-cost services. For years, bipartisan policy makers throughout Capitol Hill and across administrations have endeavored to disrupt this flawed paradigm, especially in the Medicare Program. Unfortunately, despite progress to incorporate new value-based payment arrangements, Medicare's underlying reimbursement structure continues to rely heavily on the volume of services provided, rather than the quality of care. In addition to failing patients and providers, Medicare's perverse financial incentives contribute to massive waste and abuse. Well- meaning clinicians often face opaque coverage guidelines that can result in denied reimbursements, while malicious actors exploit bureaucratic vulnerabilities to defraud the program. Through the wasteful and inappropriate service reduction model--work WISeR--CMS is testing whether enhanced technology can help address these systemic failures. For a limited set of nonemergency services with a documented history of abuse and overuse, providers in select States must submit claims for review. Claims that meet existing Medicare coverage requirements are quickly approved, offering providers payment predictability. When issues arise, board-certified clinicians--not technological machines, board-certified clinicians--intervene to make the final decision. The potential benefit of this ``detect and prevent strategy'' is substantial. For example, Medicare spending on skin substitutes, one of the chosen WISeR model services, increased and--hear this--increased from $256 million in 2019 to $10 billion in 2024. It doesn't even take a technological machine to tell you that something is wrong there. Proactive, technology-based scrutiny could have detected this outlier spending growth and protected both patients and taxpayers. Regrettably, misinformation about this model has sparked fears of delays in essential patient care and additional burdens on providers. Later today, the Senate will proceed to a resolution to stop this important work of the WISeR model. Every Member of this body agrees that patients should have access to high-quality care, providers deserve predictable payment for services, and avoidable waste, fraud, and abuse in Medicare should be stopped. Ending this pilot program prematurely will deprive CMS of a useful tool to accomplish each of those goals. And I urge my colleagues to consider the facts and oppose this resolution. I yield the floor.

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Ron Wyden

Democrat

“You say this program helps. I say it does not help. It makes patients come back many times. That is not good. We need changes. We can stop fraud in other ways. You should vote for our side. I want a vote from both sides.”

Official Congressional Record

Madam President, we don't take a back seat to anybody in terms of fighting inefficiency, fighting fraud. We have been working on those issues, as the chair of the Finance Committee knows, together wherever possible. Unfortunately, what we have seen in this experiment is that we are not dealing with inefficiency and fraud. We are forcing patients to come back again and again and again. That just defies common sense. And on the issues like skin substitutes, that has been addressed through a payment process, payment policy reform, to get at the incentives and wasteful utilization. So on the points that the minority is making, the reality is patients are not going to get care, and we are not going to make sensible changes as we have in other areas to deal with fraud and inefficiency. That is why we ought to be voting for what we are trying to do today on the Democratic side. I yield back and hope we will have a bipartisan vote.

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Patty Murray

Democrat

“You caused a bad program. It hurts old people. I want that program to end. I want you to vote for my bill. Old people need care from doctors. Machines should not decide care. Some old people have pain. That is very sad. The program makes them wait for help. My bill will fix that. I want more people to support my bill. We should all support this bill.”

Official Congressional Record

Madam President, I wanted to talk today about not just how Republicans are making healthcare more expensive but also how they are making it just plain worse for seniors. President Trump came into office saying he would not cut Medicare, but that was clearly a lie because right now his administration is trying to privatize Medicare; in part, by putting AI between Medicare beneficiaries and their healthcare. In January of this year, under Secretary Kennedy and Dr. Oz's leadership, CMS began this pilot program that uses AI to require prior authorization in traditional Medicare for the first time ever, and it is set to run for 6 years. They call it the Wasteful and Inappropriate Service Reduction Model. Well, they got the wasteful and inappropriate part right. The WISeR Model uses AI to deny vulnerable seniors the care they need and that their doctors recommend. Not only that, but the for-profit contractors that conduct this prior authorization are paid a percentage of the cost of care that they deny. They are literally incentivized to rip healthcare away from seniors because that is best for their bottom line. When your business model relies on denials, denials are what seniors are going to get, and that is perverse. WISeR was rolled out in the beginning of this year in my home State of Washington and five other States without safeguards and without any transparency and without the best interests of Medicare beneficiaries at the heart of this program. President Trump is saying: Forget the doctors who went to medical school and took an oath to do no harm. AI knows better when it comes to healthcare decisions for our seniors. The consequences of that poor judgment are real, and they are life- threatening. I hear from Medicare patients in Washington State all the time. They are suffering debilitating pain for weeks because they are not getting the care they need, thanks to this harmful model--patients like Joanne. She is a Medicare beneficiary from Quilcene, WA. She went to her doctor for severe pain. An MRI showed that a herniated disk was pressing on her sciatic nerve. Joanne's doctor prescribed an epidural injection to help ease that pain. This was standard, routine care--care that, before this year, she would have been able to get quickly after it had been recommended by her doctor. But because of this WISeR Model, she had to wait 6 weeks to get approval. That means, thanks to WISeR, Joanne had to deal with unnecessary, unrelated pain for 6 weeks. Because of this nonsense delay, her day-to-day life was disrupted and the burden fell on her then to fight for the care she needed. This is simply outrageous, but that is also WISeR working by design, and that is a direct impact of the Trump administration's actions. We have seen way too many stories like Joanne's from States that have been selected for this pilot program. No way should an algorithm decide if seniors should get the care they need. That is exactly why I join my colleagues here in introducing a resolution to overturn this model. And I want all of my colleagues to join me in voting for it so we can make sure seniors in my State and all over the country can, once again, receive their healthcare on time and without interruption. Let's just use our common sense. It is clear as day that some AI models should never be at the wheel making healthcare decisions left and right. And it is not just patients I have heard from. I have met with healthcare providers all over my State. Whether it is a rural hospital or a doctor in Seattle, no one--no one--has had anything good to tell me about prior authorization in traditional Medicare. Now, I ran for office because I believe regular people deserve a say in how their government is run, and that is especially true when it comes to the government deploying AI technology. I don't know any senior--Republican or Democrat--who asked President Trump to let AI decide if their doctor-recommended treatment was necessary. Of course, AI can help make things more efficient or do good things. That is not what the WISeR Model is doing. So let's get to the crux of it. As a country, we make a promise to American seniors: If they paid their taxes throughout their careers, they earned their Medicare coverage. Full stop. WISeR breaks that promise to seniors with these senseless AI-driven prior authorizations that deny and delay care. Let me be clear, many seniors choose traditional Medicare over other options because traditional Medicare rarely requires prior authorizations. People choose traditional Medicare because they want to make their healthcare decisions with their doctor, not with a private company that is out to make a profit. Simply put, the WISeR Model--which, again, delays and denies necessary care to Medicare patients--is reckless, and it is irresponsible. I want my Republican colleagues to join us in voting to get rid of WISeR once and for all because this should not be a partisan issue. We all have seniors in our States that deserve the highest level of care without having to deal with redtape and delay. Thanks to Trump, AI is getting in between our seniors and their healthcare in Arizona, in New Jersey, in Ohio, in Oklahoma, in Texas, and in my State of Washington. We have an opportunity to stop this harmful experimental pilot program before more seniors are harmed. No senior in America should have to appeal their pain and suffering to a machine. To my colleagues, if it were your spouse or parent who needed care, whom would you want to decide if they get their treatment, their doctor or a for-profit algorithm? Would you want them to suffer in pain for weeks for care that they are entitled to? I know what my answer is. Let's maintain the promise of Medicare. Let's pass this resolution. I yield the floor.

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Ron Wyden

Democrat

“I agree with you. Your speech was good. I don't like those people. They want to make money. That is very bad. Our states work together. We want to end this bad program.”

John Barrasso

Republican

“I want to say who is absent. Some Senators are not here. They did not vote. I want the record to show how they would have voted.”

Richard J. Durbin

Democrat

“I want to say who is absent. One Senator is not here. He did not vote. I want the record to show the result. The motion was rejected.”

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