Improving Seniors' Timely Access to Care Act of 2022

Floor Speech

Mr. Speaker, I thank Representative DelBene for being with me today.

We are really proud of this bill because it has taken a lot of time to get there, and it has taken so many people on both sides of the aisle looking at it and saying this is something that just makes sense.

The purpose of the Improving Seniors' Timely Access to Care Act is very simple: it is to protect our seniors. They deserve fast, high- quality care when they see their doctor, not bureaucratic paperwork and delays. Unfortunately, our current prior authorization system often produces just that.

My office has heard countless stories of Pennsylvanians being affected by having their care delayed due to prior authorizations. One ophthalmology practice reported that they had problems getting both of a patients' eyes authorized for a basic operation because the system rejected the second eye as a duplicate.

At the University of Pittsburgh's Department of Neurosurgery, doctors can perform an advanced surgery with a Gamma Knife to control brain tumors. In many cases, these operations give patients life and more time. The problem is that it takes prior authorization, and care is delayed for way, way too long costing patients' valuable time.

As a result, patients lose confidence in the medical system, and they also begin to lose hope. That is why we are here today, to move the prior authorization process into the 21st century and give doctors and health insurance plans the tools they need to make these decisions more quickly.

The current system allows insurance plans to take weeks to review prior authorization requests, leaving patients waiting. The process is often manual, requiring fax machines, phone calls, and paper submissions, meaning doctors cannot easily appeal these decisions.

The Improving Seniors' Timely Access to Care Act requires prior authorization decisions to be done faster, helping seniors get care more quickly. Most routinely approved prior authorization items and services will receive a real-time electronic response.

For nonroutinely approved items, doctors and patients will have clear expectations of how long they are going to need to wait for a response, allowing them to better coordinate their care.

Additionally, health insurance plans must begin to disclose data on how many prior authorizations they approve or deny, along with an analysis of how they made that decision.

Truthfully, I have seen many similar situations in the business I have been in my whole life. I am an automobile dealer, and when we are working on an owner's car under warranty, too often it is a negotiation with a manufacturer on what repairs we are able to do.

The manufacturer does their own time studies on how long they think it should take and what they think should be repaired. But oftentimes those time studies are on a brand new car or truck just off the assembly line. As we all know, living in western Pennsylvania, we have a lot of steep hills, and we go through really rough winters where there are a lot of things put on the road--salt and whatever else--that can corrode different parts once they are in operation.

It is the same story with insurance companies when we are doing covered auto body work. We have to give the insurance company the estimates before we ever touch a car or truck, and then continuously negotiate with them as we get into the tear-down of the vehicle and find other damage. We have to go back and get authorization to do that, and that holds up the process.

As much as people say, now, wait, wait, wait, don't compare cars and trucks and that warranty work to patients. You know what? It is the same thing. It is the same thing. You are denied access to care that you need today, not tomorrow, not some time in the future. There is no reason why you should have to wait for it, not in today's world, and not with the way we are able to improve all of this.

I know when I talked to Dr. Bera or Dr. Bucshon and especially with Ms. DelBene, we think: Why in the world are we working on old ways of getting answers as opposed to being able to get them today and get them more quickly?

I just think what we are doing makes sense. I would rely more on a technician who has expert experience than somebody who does time studies on something that isn't actually the duplicate of what we are looking to do.

This whole thing is about protecting our seniors, the people who have done the most for this generation and previous generations, who have really put their shoulders to the wheel and have never ever complained and always done what they think is best.

Why in the world would we make it harder for them to get the healthcare they deserve? Why? That makes absolutely no sense to any of us. This is not a red concern or a blue concern. It is all about red, white, and blue. It is about Americans. It is not Republicans or Democrats or Libertarians or anything else. It is about this body's obligation to come together on issues that are really critical.

There never should be this type of work that we have had to go through to get this done. And then all of a sudden last night, by the way, the CBO decided after 11 months to weigh in on how we would score this legislation. They waited until the 11th hour, and right after the 11th hour they pulled back what they had said they thought the cost was going to be.

I don't know how anybody runs a business like that.

I know if I give somebody an estimate or tell somebody something is going to be done at a certain time--and I know we make commitments to all of the people we represent, give them the right answer in the right time. Why make them wait for something that is so basic?

I know we always have this concern about fraud, waste, and abuse. My complaint really comes down to service. We can complain about a lot of things, but we cannot complain about what we owe our seniors.

We wrote and rewrote this bill over the course of the last several years to ensure it was as strong as possible, using everything that is available to us today to implement, to get answers quicker, not longer, not put people off, not tell them to wait in the waiting room, not tell them to stay on hold, but to get them an answer and get them the care that they need today.

Feedback is important. Honesty is more important. I know Ms. DelBene and Dr. Bera and Dr. Bucshon and so many of our colleagues agree the same way, and all the staff members that you mentioned.

This is not something that just happened very quickly and on the back of an envelope. This is something that a great deal of concern went into, a great deal of care went into, and a great deal of looking into went into.

So I am going to thank my colleagues, and I am going to ask everybody today, when this comes up for a vote, please vote for seniors. Please vote for all of those who have done so much for all of us. And take this opportunity to thank them in a way that really makes sense and, that is, by saying, you have played the game well; you have played the game long. You have done so much for all of us. Why don't we do something for all of you?

So I thank my colleague--it has been great--and all our colleagues for getting on board on this. It has been a really good example of how, when we actually work together on good policy and don't worry about the politics of it, amazing, amazing what can get done for the American people.

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Mr. KELLY of Pennsylvania. Mr. Speaker, I want to take a moment also to thank the Regulatory Relief Coalition because they have been working hand in hand with us trying to contact as many members as they can. And today is an example of when we work together, what we can get done.

Mr. Speaker, I present one of the doctors in our Doctors Caucus from North Carolina, Dr. Murphy, to give his actually on-the-job, on-the- field experience of what it is like to try to work through this massive group of--I don't know what you call these people. They are hard to work with and they don't represent us. They do represent something else. I think we need to represent just our folks back home.

Mr. MURPHY of North Carolina. Mr. Speaker, I thank Representatives DelBene and Kelly for putting forth the timely Improving Seniors' Timely Access to Care Act.

Mr. Speaker, I would just like to explain to the public what pre- authorization means. I am a practicing physician, so if I order a test, I recommend a surgery, it then goes into a bucket at an insurance agency, and then we play the great waiting game. The patient is no longer in the office because we have no idea how long that waiting game is. It was put in and accepted for what I believe was a good cause. But as with many government programs, or institutions, or institutions of our bureaucracy in the private sector even, it is something that has gone bad and gone terribly wrong.

I may be waiting 2 or 3 or 4 weeks to speak with somebody who is not my peer. I am a surgeon. I may be speaking with a pediatrician or, even more, I might be speaking with a nurse practitioner who has no experience whatsoever in my field of study to get their approval of something that I know needs to happen. It is an absolutely antiquated system that does not work.

I am going to give you a couple of examples. Approximately 10 weeks ago, I saw a prostate cancer patient. There were two avenues to go on this: Either he needed to be operated on very quickly, or the cat was out of the bag, and he needed intensive chemotherapy quickly.

A week goes by, 2 weeks go by. What is that patient doing at home? He hasn't slept one wink because his entire future, his entire life, is then suspended in front of him.

It took 3 weeks, 3 weeks to get the study that every urologist in the country knew was necessary to get that answer. Yet, in the meantime, that patient has lost years, just in life as far as worry.

A second; one of my partners did a very complicated surgery on a patient. The patient was a bad diabetic; came in a week or two later with a wound infection. Fine, come in, get some intensive IV antibiotics. Try to get the patient out of the hospital because we know it is good to get patients out of the hospital when they don't need to be in the hospital.

He needed a certain oral antibiotic that was prescribed for him. It was denied. It was denied. It was denied. A week and a half later, he shows up in my office as an emergency. I have to send him over somewhat late in the afternoon, so that means he gets on the OR schedule at 10:00, 11:00, or 2 a.m., and has to have an abscess drained. And then he is in the hospital now another 2 weeks because he didn't get that antibiotic prescribed to him when he should have because it was denied, his authorization.

Mr. Speaker, I know the CBO score came in. I don't believe it. I have lived and breathed this for 30-plus years. I don't believe it. It doesn't pass the smell test. To come up at the last minute with this score, in my opinion, is erroneous and needs to be looked at again, because I look at the savings that we, as physicians, provide in knowing what is right for our patients in the moment versus some bureaucrat in an insurance company who is given the directive to deny, deny, deny, is not what we should be doing in medicine. Our medical system has become bankrupt and these pre-authorizations are part of it.

So I have a hard time going along with the CBO score of $16 billion because I don't believe it. This is what is right for patients. This is decades past the time when this should have been done.

I look at the doctors that I have worked with, and we are just plagued in clinic, because we know what we are going to recommend for our patients after years of study and work with patients is going to be possibly denied by someone who has no experience who has been told by insurance companies, deny, deny, and deny until they wear out the doctor and wear out the patient.

So, Mr. Speaker, this is a travesty, I believe, to not pass this bill. I also do not believe the CBO score, and I think it is a great injustice for our patients to be denied care because of this antiquated pre-authorization system.

I know Dr. Bera is leaving the floor right now.

So often, when I am home and I am here, we always pick winners and losers and, somehow, that becomes the main objective of who won, who lost. So we are worried today about the score. It doesn't matter on the score because everybody wins on this. There is no loser on this.

And if we can't look to the people who have supported us our whole lives and have created opportunities that exist in this country on their backs, what in the world are we doing here?

Well, I can't tell you how much I appreciate the opportunity to be with Ms. DelBene. This is incredible to get this done today.

I am urging every single Member to vote for this. Please throw out your scorecard and look at the picture in your wallet of who it is that parented you or grandparented you and say you know what, wouldn't it be nice to give them something back after they gave us their whole life? And let them have some peace of mind.

I don't think there is anything greater in your later years than peace of mind and being able to know that I am getting healthcare when I need it. I am not going to have to wait for somebody someplace else to determine whether I should get it.

So it has been a pleasure working with you. It has been a pleasure working with all of our colleagues. And for Dr. Marshall, who used to sit here with us but now is over in the senior area of this magnificent model--although, I think he is too young to be there. Now, I am sure my older Senators will say, hey, Kelly, please don't call us old. I won't. Let's just say the more seasoned Members.

But I am glad we can wrap this up on a really good note. I can't tell you how good I feel about this, that we can go home and tell those people that we represent--I don't care how they vote. All I want them to know is we care about what they have done for us, and we are going to be able to supply them some peace of mind.

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