DelBene to RFK Jr.: You Are Hurting Patients for No Reason

Today, Congresswoman Suzan DelBene (WA-01) demanded answers from HHS Secretary Robert F. Kennedy, Jr., about a new program he implemented that is unnecessarily delaying and denying care to seniors in Washington.

DelBene has been a leading voice in raising the alarm about how this program could harm patients since it was announced. She has introduced legislation and championed several efforts to cancel it.

Here is a link to the video, and below is the transcript:

DelBene: Secretary, I'm glad you're appearing before us today. Under your leadership, CMS recently added new layers of red tape that Medicare patients need to navigate to get the care that they're entitled to. Mr. Secretary, I hope you understand the harm that delaying and denying necessary care can have. Do you remember saying this: "Americans shouldn't have to negotiate with their insurer to get the care they need. Pitting patients and their doctors against massive companies was not good for anyone." Do you remember?

Kennedy: I don't remember, but I would, I would align with that,

DelBene: I'll submit for the record, actually, a press release from CMS with your quote in that is from June 23 of 2025. In this case, I agree. Pitting patients and their doctors against massive companies isn't good for anyone. And yet, less than a week after you said that CMS announced the WISeR model. The program allows private companies to use AI to review traditional Medicare claims and pays them based on the amount of care they deny. This program went into place in six states across the country, including my home state of Washington.

President Trump said multiple times on the campaign trail that he would not cut Medicare, but this program does exactly that. For example, Joanne is a senior from Washington on Medicare. She has a herniated disc that is pinching her sciatic nerve, causing immense pain down the right side of her body. Her doctor prescribed an injection that would help relieve her pain. If it had been prescribed last year, she would have received the treatment, no problem. But because of the WISeR model that has been implemented, she has been in intense pain for over six weeks while she waits for approval. She has been using crutches or a wheelchair for over a month now, which is making her arthritis worse, adding to her chronic pain. Since using crutches, she's fallen multiple times, including earlier this week. Instead of simply approving the procedure, Joanne's conditions are getting worse, and Secretary Kennedy, the W in the WISeR model stands for 'wasteful.' Do you think that Joanne's treatment, which would allow her to walk and live with less pain that her doctor has prescribed. Do you think that's wasteful?

Kennedy: Do you want me to actually answer that question?

DelBene: Yeah!

Kennedy: I think that that's a terrible outcome. It's one that was not intended by the system. Obviously, the problem is there's tremendous ways… In Medicaid, there's only 5% of the cases are given prior authorization. In private industry, 30%.

DelBene: This is traditional Medicare now where it's now. This is only been put under prior authorization under your leadership. Now, President Trump promised multiple times that he "will not lay a finger on Medicare." Given President Trump's promise, did you or the President approve this model, which is now delaying and denying care for people in states like the state of Washington?

Kennedy: Can I answer the question?

DelBene: Yeah, people are being denied care across our state right now.

Kennedy: Very quickly, and this is an example - Five years ago, we were paying $250,000 a year for - $250 million for skin substitutes. This year, $23 billion. Why? Because there was no prior authorization in the Medicare program.

DelBene: And now someone like Joanne is not getting her care. It's more expensive for us because Joanne is not getting her care. We have story after story. I can also submit for the record stories of all the people who are being delayed and denied care. It is more expensive for us. It is more expensive for them when they are not getting the care they need.

Last year, I sent CMS a letter detailing my concerns about the WISeR model. I still have not gotten a response. That was last August. Can you publicly commit to responding to that letter and addressing the concerns of this harmful model?

Kennedy: Yeah, absolutely, we will, and I apologize for not getting back to you sooner. We have an unprecedented number of communications from Congress.

DelBene: Well, we don't have you here very often. We have people in my state who are being denied care, who are being hurt based on this policy, and there's an indifference to the challenges that they are facing, all because of a model put in place for no reason and doing exactly what you said shouldn't happen, which is "pitting patients and their doctors against massive companies." These are private companies doing this prior authorization was not good for anyone. Thank you, I yield back, Mr. Chairman.

Kennedy: Discovering $23 billion worth of fraud is not for no reason.

DelBene: You are hurting patients in our state and other states across the country for no reason, and I appreciate you finally responding to the letter. Thank you. I yield back.