Oversight Record · 7 of 9 · Democrat · Washington WA-08 · Energy & Commerce
Rep. Kim Schrier, MD (D-WA)
Pediatrician · U.S. House · Energy & Commerce · "Wearing Patients Down" · January 22, 2026
What She Asked
At the January 22, 2026 Energy & Commerce Health Subcommittee hearing, Rep. Schrier, a pediatrician, took UnitedHealth Group CEO Stephen Hemsley through a Medicare Advantage case. A UnitedHealthcare patient had a stroke. The plan called the hospital stay "medically unnecessary," over the treating doctor's judgment, and took more than a year to pay.
She pointed out that when UnitedHealth patients do appeal, about 80% of the denials are partly or fully reversed. Her conclusion: the pattern looks like a strategy, not a mistake.
The Exchange · Watch It
Watch on the committee's official video, 2:40:13Her questioning runs from about 2:40:13 to 2:45:39.
On the Record · January 22, 2026
"Your companies are charging more, paying less, and then delaying or even denying care."
— Rep. Schrier
"It looks like you bet on wearing patients down, on them not appealing."
— Rep. Schrier, to Stephen Hemsley
"My constituents are sick of it, we're sick of it, doctors are sick of it, and people deserve better… We need Medicare Advantage reform now."
— Rep. Schrier
Quotes as published by Rep. Schrier's office, January 23, 2026.
Why It Lands Here
"Wearing patients down" is the pattern AbilityForge documents: deny, wait, and count on most people not appealing. Fewer than 1% of denied claims are appealed. When Medicare Advantage denials are appealed, most are overturned. The prior-auth numbers →
Michael Kissling fought UnitedHealthcare's Medicare Advantage plan for his prosthetic leg, won on appeal, and then switched to traditional Medicare to get away from the fights. His case →
Her Bill · Keeping Prior Auth Out of Traditional Medicare
Rep. Schrier is an original cosponsor of the Seniors Deserve SMARTER Care Act (H.R. 5940), introduced November 7, 2025, by Rep. Suzan DelBene (D-WA). It would bar Medicare from running the WISeR model, or anything substantially like it.
WISeR is a CMS pilot that, starting in January 2026, uses outside tech vendors and AI tools to add prior authorization to traditional Medicare for selected services in six states, including Washington. CMS says it targets fraud and waste. Critics say it brings Medicare Advantage-style denials into the program people choose to avoid them.
Why This Is Here — and What It Is Not
This is not an endorsement of Rep. Schrier's politics. It's here because a physician in Congress named the business logic behind Medicare Advantage denials to the CEO of the largest Medicare Advantage insurer, and because she has put her name on a bill to keep that logic out of traditional Medicare.
Congressional Voices is a record, not a roster. A good question or a good bill counts here whichever side of the aisle it comes from. AbilityForge has not contacted Rep. Schrier, and she has not reviewed this page.
Tell Them AbilityForge Sent You
If a Medicare Advantage plan denied you or someone you love and the denial was overturned on appeal, that's the pattern she named. Tell her office, and ask her to keep pushing for Medicare Advantage reform.
Sources
- House Energy & Commerce Health Subcommittee — hearing with health insurance company CEOs, January 22, 2026 (official video)
- Rep. Schrier — "ICYMI: Congresswoman Schrier Grills Healthcare CEOs Abusing Prior Authorization," January 23, 2026
- H.R. 5940, Seniors Deserve SMARTER Care Act of 2025 — bill text (Congress.gov)
- Fierce Healthcare — House Democrats push to roll back CMS's AI-powered prior auth model
- Portrait: official congressional photo.
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