MERIT Act

  Ms. SLOTKIN. Mr. President, I rise today to discuss the MERIT Act,
the Minimum Experience Requirements for Intelligence Transition Act--a
lot of words, but the bill is simple. It requires anyone serving as the
Director of National Intelligence--even in a temporary capacity--to
have extensive national security experience.
  It is common sense. You don't hand the keys to America's intelligence
community to someone who has no experience, regardless of party or
political loyalty.
  The Director of National Intelligence is a powerful job, and I know
because I was there at the creation. I was one of the first people at
the Office of the Director of National Intelligence, when it was stood
up. I was seconded there as a CIA officer. I helped stand it up after
Congress created it so that we never again miss a terrorist attack,
like we did on 9/11.
  The Office uses powerful tools to gather secrets from our foreign
adversaries, like China and Russia, from terrorist networks, and from
threats to our homeland. But it is that power in the wrong hands that I
want to talk about today.
  America's national intelligence community can be used to gather
information not just from our foreign adversaries but, if turned
against us, against the American people, it can be used to monitor
Americans, to target political opponents, to dig through records, to
punish critics, to help any President relitigate an election.
  Right now, that is where we are.

                                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.

  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.