[Congressional Record Volume 172, Number 116 (Thursday, July 16, 2026)]
[Senate]
[Pages S4131-S4132]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicare

  Ms. CANTWELL. Mr. President, today, we are faced with a critical 
choice here in the U.S. Senate and across the country about the future 
of traditional Medicare.
  We had an opportunity to protect Medicare, the thing that seniors 
care about most, and they wanted to hear from us that we were going to 
do that. I am not sure that is what transpired.
  People don't want to have corporations or insurance companies tell 
them about traditional Medicare. They want that relationship to be 
about the doctor-patient relationship.
  If you are on Medicare, you go to your doctor; you ask them what he 
thinks should be done; he basically tells you; and then you receive 
your Medicare treatment.
  Well, Medicare is a promise. And that promise is made when we pay 
into that, as taxpayers, and we expect to get the care that we need.
  But in this case, there are those in the Trump administration who are 
trying to change that obligation. Instead of having your doctor tell 
you what you need, they are trying to push an AI-driven software 
program that will tell you in advance--in advance--you don't even get 
that treatment.
  So, instead of relying on your doctor's advice, instead they are 
telling you, you do not get to hear what the doctor ordered.
  This is very troubling because this might be the way private 
insurance works; and many Americans know what it is like to be on the 
phone with an insurance company telling you they are going to deny your 
benefits. But they certainly don't, for traditional Medicare, want an 
AI app telling you in advance you don't even get the Medicare that you 
have paid into.
  More than 700,000 Washingtonians and 28 million Americans have chosen 
the Medicare program because they want their healthcare decisions made 
by their doctor. If they don't, you can choose Medicare Advantage. 
Medicare Advantage is different.
  But on January 1 of this year, the Centers for Medicare and Medicaid 
Services launched an application--driven by AI--euphemistically called 
the Wasteful and Inappropriate Services Reduction Model, known as 
WISeR.
  WISeR is an AI-driven prior authorization program being piloted in 
six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and in my home 
State of Washington.
  This model inserts a black box computer algorithm into the decisions 
that should be being made by a physician and the patient. It puts a 
layer of bureaucracy between seniors and the care their doctors have 
recommended.
  In April, with the help of the Washington State Hospital Association, 
my office released a report examining the impacts of this application 
on seniors in my State. What we found was deeply troubling.
  Washington patients are waiting up to four times longer to complete 
procedures covered by this model. Procedures that took approximately 2 
weeks to get taken care of are now taking months.
  In Washington alone, more than 18,600 people receive services now 
subject to this WISeR, and people in the Nation, it is about 1.1 
million. That is 1.1 million people who could face delays or denials 
for care.
  Michael Edgerly is a 78-year-old from Cle Elum in Washington, who 
spent 22 years serving his community as a mail carrier. He left his job 
with scoliosis and degenerative joint disease. His neurosurgeon 
recommended a nonopioid--a nonopioid--treatment, an epidural steroid 
injection, to manage this serious and severe chronic pain.
  But what did the AI app WISeR tell him? Nope. System delayed.
  He went on for weeks and weeks living in constant pain, which a 
doctor--if he was talking to a doctor--would have just said: I approve 
this treatment.
  But, no, he was forced into an AI app approval process that took 
longer and longer and longer to get this coverage.

[[Page S4132]]

  Another constituent Keith Magnuson of Seattle who used to be an 
extremely active man who could regularly walk 6 miles a day, now, 
because of a lumbar spinal stenosis, he can barely walk 100 yards 
without severe pain. His doctor recommended a minimally invasive 
procedure called MILD which is commonly used by physicians covered by 
Medicare. But, again, the WISeR model put in his treatment and said it 
was denied.
  As a result, this once-active man had to significantly scale back 
even his daily life all because of an AI model telling him he was 
denied.
  Michael and Keith are not isolated cases. At the University of 
Washington Medical Center alone, our report found that more than 100 
patients were waiting for similar approvals.
  What makes this even more concerning is that many of the procedures 
included in the WISeR model are nonopioid pain treatments. That means 
we are trying to get off of the opioids, not prescribe them. There are 
alternatives. But this AI model for Medicare, even though your doctor 
might have said otherwise, ``go ahead and do it,'' is now denying you 
or taking weeks and weeks and weeks and weeks to get you the approval.
  These treatments provide patients with critical alternatives to 
addictive medicines, and we need to continue to get them to our 
constituents.
  In a time when our country continues to face an opioid crisis with 
more than 50,000 overdose deaths annually, we should be making it 
easier for patients to access these nonopioid treatments, and we should 
not enable a system where contractors have financial incentives to 
delay or deny care. That is not efficiency.
  These concerns are not just coming from me; they are coming from 
seniors, physicians, and healthcare organizations. Organizations like 
AARP and the American Medical Association have warned that the impact 
of this program on aging Americans is real.
  I am hearing every day from my patients, from patients in my State--
including the two I mentioned--who have been negatively impacted by 
this WISeR model.
  I brought this up at an important Senate Finance Committee with the 
Secretary of HHS and have said: This has to stop.
  I do believe AI has enormous potential to improve in healthcare and 
healthcare research. I do think it is going to help us find some new 
things. But technology should not be used today, on programs that are 
guaranteed for our citizens, to now be interrupted and delayed by an AI 
model instead of allowing them to talk to their doctor.
  Again, private insurance can do whatever it wants. Medicare Advantage 
can do whatever it wants. But traditional Medicare should not be 
subject to an AI model denying people things that the doctor wants to 
order.
  There is nothing, in my mind, innovative about using a computer to 
tell seniors they can't get the care their doctors prescribe. 
Unfortunately, this model that is now in six States is being tested, 
but the administration has made it clear it expects to expand this 
nationwide.
  If you don't represent a State where it is being deployed, I 
encourage you to get up to speed on this. The Senate, in this last 
vote, just had a chance to stop it, but we didn't. So I am asking my 
colleagues to please get educated on how devastating this can be for 
individual lives and ask yourselves if you believe in traditional 
Medicare and the doctor-patient relationship. If you do, I guarantee 
you we will force this administration to stop using this AI tool to 
deny care for our seniors.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Budd). The majority leader.

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