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.