[Congressional Record Volume 172, Number 116 (Thursday, July 16, 2026)]
[Senate]
[Pages S4127-S4129]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
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 SERVICES
RELATING TO ``MEDICARE PROGRAM; IMPLEMENTATION OF PRIOR AUTHORIZATION
FOR SELECT SERVICES FOR THE WASTEFUL AND INAPPROPRIATE SERVICES
REDUCTION (WISeR) MODEL''--Motion to Proceed
Mr. WYDEN. Mr. President, I move to proceed to Calendar No. 447, S.J.
Res. 198.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
Motion to proceed to Calendar No. 447, S.J. Res. 198, a
joint resolution 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 Services relating to
``Medicare Program; Implementation of Prior Authorization for
Select Services for the Wasteful and Inappropriate Services
Reduction (WISeR) Model''.
Mr. WYDEN. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
The yeas and nays are ordered.
S.J. Res. 198
Mr. WYDEN. 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.
The PRESIDING OFFICER. The Senator from Idaho.
Mr. CRAPO. 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.
[[Page S4128]]
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.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. 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.
The PRESIDING OFFICER. The Senator from Washington.
Mrs. MURRAY. 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.
The PRESIDING OFFICER. The Senator from Oregon.
[[Page S4129]]
Mr. WYDEN. Fortunately, for--let me say to Senator Murray that I so
appreciate your presentation, and particularly talking about the
algorithms. And, also, the fact is that under what you have described
very clearly, the big winner under this flawed experiment is a bunch of
middlemen who are trying to profit off denials, and not the people who
really desperately need care.
So I very much appreciate it, and Oregon is proud to be a partner
with Washington State in leading the country to get rid of this very
flawed idea. And I thank you for your remarks.
Mrs. MURRAY. Thank you. Thank you.
Mr. WYDEN. I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Madam President, I would ask consent to start the 1:30
vote now.
The PRESIDING OFFICER. Without objection, it is so ordered.
Vote on Motion to Proceed
The PRESIDING OFFICER. The question is on agreeing to the motion.
The yeas and nays were previously ordered.
The clerk will call the roll.
The senior assistant executive clerk called the roll.
Mr. BARRASSO. The following Senators are necessarily absent: the
Senator from Tennessee (Mr. Hagerty), the Senator from Kentucky (Mr.
McConnell), and the Senator from Mississippi (Mr. Wicker).
Further, if present and voting: the Senator from Tennessee (Mr.
Hagerty) would have voted ``nay'' and the Senator from Mississippi (Mr.
Wicker) would have voted ``nay.''
Mr. DURBIN. I announce that the Senator from Connecticut (Mr. Murphy)
is necessarily absent.
The result was announced--yeas 46, nays 50, as follows:
[Rollcall Vote No. 199 Leg.]
YEAS--46
Alsobrooks
Baldwin
Bennet
Blumenthal
Blunt Rochester
Booker
Cantwell
Coons
Cortez Masto
Duckworth
Durbin
Fetterman
Gallego
Gillibrand
Hassan
Heinrich
Hickenlooper
Hirono
Kaine
Kelly
Kim
King
Klobuchar
Lujan
Markey
Merkley
Murray
Ossoff
Padilla
Peters
Reed
Rosen
Sanders
Schatz
Schiff
Schumer
Shaheen
Slotkin
Smith
Van Hollen
Warner
Warnock
Warren
Welch
Whitehouse
Wyden
NAYS--50
Armstrong
Banks
Barrasso
Blackburn
Boozman
Britt
Budd
Capito
Cassidy
Collins
Cornyn
Cotton
Cramer
Crapo
Cruz
Curtis
Daines
Ernst
Fischer
Graham
Grassley
Hawley
Hoeven
Husted
Hyde-Smith
Johnson
Justice
Kennedy
Lankford
Lee
Lummis
Marshall
McCormick
Moody
Moran
Moreno
Murkowski
Paul
Ricketts
Risch
Rounds
Schmitt
Scott (FL)
Scott (SC)
Sheehy
Sullivan
Thune
Tillis
Tuberville
Young
NOT VOTING--4
Hagerty
McConnell
Murphy
Wicker
The motion was rejected.
The PRESIDING OFFICER (Mr. Armstrong). The majority leader.
____________________