Wyden Calls on Republicans to End Trump’s AI-Driven Care Denial Experiment in Traditional Medicare

Wyden Calls on Republicans to End Trump's AI-Driven Care Denial Experiment in Traditional Medicare

Watch a video of Wyden delivering his remarks here.

As prepared for delivery.

Later today the Senate will vote to put a stop to a dangerous experiment jeopardizing seniors' access to lifesaving health care.

At the beginning of this year, the Trump administration empowered unaccountable AI companies to delay and deny certain types of care in Traditional Medicare.

Despite Donald Trump's promise that he would not touch Medicare, today it is clear that promise has been broken. Seniors paid into Medicare out of every paycheck during their working years, with the expectation that they would have an ironclad guarantee of affordable health care.

Today, seniors in six states across the nation 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 are forced to wait weeks for relief, upending their lives and leaving them suffering for no reason other than the addition of more bureaucracy in health care.

The types of care that are subject to these restrictions are not frivolous medical procedures. Knee arthroscopies. Nerve stimulation. Steroid injections. Cervical fusion. These types of procedures are the care that seniors rely on to stay mobile and pain free as their bodies age.

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 this experiment. But that doesn't pass the smell test.

First, the Centers for Medicare and Medicaid Services already lowered payment rates for this procedure, which closed the loophole driving the dramatic increase.

Second, these 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 accounted for less than 1 percent of services subject to prior authorization under this model. So the excuses just don't hold any water.

Prior authorization has run rampant in America's health care system. For profit insurance companies are increasingly using this business tactic to block and deter care in order to increase profits.

I'd like to put a fine point on this. In 2024, insurance companies that sell Medicare Advantage plans denied more than 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 ten.

What that tells me is prior authorization is being used to deny legitimate care, acting as a bureaucratic hurdle meant to discourage seniors and their doctors from pursuing courses of treatment that might impact an insurance company's bottom line.

It's 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, which many seniors select precisely because they don't want to deal with the headaches and complexity of an insurance company.

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 they will stand with Democrats today to tell the Trump administration to abandon this ill-advised experiment that seniors did not ask for. There's a lot of work to be done to improve both Traditional Medicare and Medicare Advantage for seniors that count on the Medicare guarantee. Let's work on that together, and start by ending this AI-driven prior authorization experiment.

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