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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
House Committees Consider Sweeping Budget Reconciliation Package
This week, the House Energy and Commerce Committee and Ways and Means Committee advanced their respective portions of Republicans’ budget reconciliation bill. This sweeping legislative package includes several tax provisions, as well as significant changes to the Medicaid program, a small inflation-based update to Medicare physician payment, and several provisions impacting medical education. The bill now moves to the full chamber for consideration and will need to be agreed to by the Senate to become law.
The proposed legislation does not address the 2.83% Medicare physician payment cut that went into effect at the start of 2025. Instead, it would implement a payment update incorporating the Medicare Economic Index (MEI) for future years, beginning in 2026. A payment adjustment would be implemented that accounts for 75% of the MEI in 2026 and 10% of the MEI in 2027 and subsequent years. During the markup, Representative Jimmy Panetta (D-CA) offered an amendment to update Medicare payments annually at a rate equal to the MEI starting in 2025. While this amendment failed, there was discussion during the debate that the language included in the Energy and Commerce Committee markup is a good starting point.
While the ACS appreciates that Congress recognized Medicare physician payment must be adjusted for inflation, this adjustment is not sufficient to make up for the 2025 cut, and more work is needed. The ACS will continue to advocate strongly for stable and sufficient payment for physicians.
The reconciliation package also makes several changes to the Medicaid program, including altering the federal financing structure, limiting eligibility, shifting costs to states, and increasing the administrative complexity of the program, among others. If advanced, changes of this magnitude, combined with Medicare physician payment rates that have not kept pace with inflation, would result in significant coverage loss for beneficiaries and risk exacerbating hospital and practice closures. Rural areas, in particular, would be affected, putting lifesaving and routine care out of reach for millions of patients.
The ACS recently joined a letter with 41 other medical organizations expressing these concerns and calling on Congress to protect patient access to health coverage.
Finally, the proposed legislation would cap federal student loan borrowing at $50,000 for undergraduate programs, $100,000 for graduate student programs, and $150,000 for professional programs. Though intended to incentivize lowering the cost of college tuition, this provision could make medical education unattainable for many individuals. The average medical school student graduates with approximately $235,000 in medical school debt alone or $265,000 of combined medical and premedical education debt. Medical schools, especially public institutions, will not be able to make drastic reductions to their tuition structures by July 1, 2026, when the loan caps would go into effect.
Additionally, this legislation would provide for 4 years of interest-free loan deferral which, though a step in the right direction, does not account for the fact that many medical residencies are longer than 4 years, potentially driving medical graduates into programs based on residency length rather than community need.
Lastly, the bill would exclude medical and dental residencies from the “qualifying public services work” for the consideration of Public Service Loan Forgiveness eligibility. The ACS recently joined a letter urging Congress to reconsider these proposals.
The ACS will continue to monitor these efforts closely as Congress considers this legislation.
ACS Continues Pressing for Research Funding
Congressional appropriations committees have officially kicked off the starting phase of fiscal year (FY) 2026 funding, and the ACS has been actively engaging in this process by submitting appropriations requests and sending letters to key appropriators.
Most recently, the ACS signed a letter supporting $1.7 billion for cutting-edge research at the Advanced Research Projects Agency for Health (ARPA-H) through FY 2028.
Additionally, the Senate Appropriations Committee held a hearing on Biomedical Research: Keeping America’s Edge in Innovationon April 30. The hearing focused on the importance of federally funded research in a variety of spaces and highlighted cancer research as particularly valuable.
The ACS submitted a letter for the Congressional record expressing support for key surgical research priorities.
Lawmakers Introduce Bill to Improve First Responder Access to Stop the Bleed Kits
Senators John Cornyn (R-TX), Sheldon Whitehouse (D-RI), Thom Tillis (R-NC), and Chris Coons (D-DE) introduced legislation earlier this month for expanding access to Stop the Bleed kits for states, tribal territories, and local governments.
The Improving Police Critical Aid for Responding to Emergencies (CARE) Act would allow law enforcement to purchase kits and other bleeding control supplies using funds from the Edward J. Byrne Memorial Justice Assistance Grant Program (Byrne JAG), ensuring that first responders have the tools necessary to save lives when minutes matter. The Byrne JAG program, administered by the Department of Justice (DOJ), provides funding to support a wide range of law enforcement and criminal justice activities, including training and supplies.
The bill would require kits purchased with these funds to include a Committee on Tactical Combat Casualty Care-recommended tourniquet and instructional materials developed by stakeholders, including the ACS. Further, the bill directs the DOJ to collaborate with stakeholder organizations on establishing standards for trauma kits and provide best practices for law enforcement agencies on how to use the kits.
ACS Opposes Legislation to Expand Chiropractic Scope of Practice
The ACS joined a letter in opposition to theChiropractic Medicare Coverage Modernization Act of 2025, which would extend Medicare coverage for services furnished by chiropractors beyond the manual manipulation of the spine.
This legislation would authorize chiropractors to use the title “physician” under the Medicare Part B program and potentially bill Medicare for services they have not specifically been trained to provide.
Currently, chiropractors’ scope of practice is appropriately restricted under Medicare to treatment by means of manual manipulation, which is aligned with chiropractic training and the treatments that chiropractors most often provide involving common musculoskeletal complaints such as back pain.
The letter expresses concern that permitting chiropractors to bill Medicare for additional services will lead to an unnecessary redistribution of scarce Medicare resources away from physician practices and jeopardize the health and safety of Medicare patients.
Lawmakers Reintroduce Bill to Provide Coverage for Children with Congenital Anomalies
The Ensuring Lasting Smiles Act (ELSA), introduced by Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA) and Representatives Neal Dunn, MD (R-FL), and Kim Schrier, MD (D-WA), would require health insurance plans to cover medically necessary services related to a birth defect, including any serious dental and oral-related procedures that are necessary for the individual’s health or function.
While most group and individual health plans include coverage for congenital anomalies, plans routinely deny claims by categorizing certain treatments as cosmetic or not medically necessary. The ACS strongly supports ELSA, which would close this gap by requiring all group and individual health plans to cover outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect that primarily impacts the appearance or function of the eyes, ears, teeth, mouth, or jaw.
Healthcare Organizations Support Funding for Pediatric Emergency Program
The ACS, along with 58 other healthcare organizations, sent a letter to congressional appropriators calling for robust funding for the Emergency Medical Services for Children (EMSC) program in fiscal year 2026.
EMSC is the only federal program focused on enhancing emergency care for children and adolescents. It provides funding to ensure that hospitals and ambulances are properly equipped to treat pediatric emergencies, provide pediatric training to paramedics and first responders, and improve the systems that allow for efficient, effective pediatric emergency medical care.
The ACS successfully lobbied Congress to pass the EMSC Program Reauthorization Actin December 2024, which reauthorizes the program for 5 years.
National Patient Identification Standard Is Needed
The ACS joined letters to the House and Senate urging lawmakers to allow the Department of Health and Human Services (HHS) to explore and adopt a unique patient health identifier standard.
Currently, there is no national strategy for accurately matching patients with their healthcare data. Inaccurate patient matching leads to adverse events, compromised safety and privacy, inappropriate and unnecessary care, and unnecessary burden on both patients and physicians. Unfortunately, outdated language included in appropriations legislation since fiscal year 1999 prohibits HHS from spending any federal dollars to promulgate or adopt a national unique patient health identifier standard.
The letters call on Congress to remove this language from the fiscal year 2026 appropriations bills so that a national strategy may be developed.
Regulatory Updates
CMS Releases 2025 QPP Exception Applications
On May 7, the Centers for Medicare & Medicaid Services (CMS) announced that applications for Quality Payment Program (QPP) Exceptions are now available through December 31, 2025. There are two applications: the Merit-Based Incentive Payment System (MIPS) Promoting Interoperability Performance Category Hardship Exception application and the MIPS Extreme and Uncontrollable Circumstances (EUC) Exception Application.
Surgeons may submit a MIPS Promoting Interoperability Performance Category Hardship Exception application for the following reasons:
Decertified Electronic Health Record (EHR) technology
Insufficient internet connectivity
Extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress, or vendor issues
Lack control over the availability of certified EHR technology
Surgeons may submit a MIPS EUC Exception Application for one or more MIPS performance categories (quality, cost, improvement activities, and promoting interoperability) due to circumstances that would:
Cause them to be unable to collect information necessary to submit for a MIPS performance category
Cause them to be unable to submit information that would be used to score a MIPS performance category for an extended period of time
Impact their normal processes, affecting your performance on cost measures and other administrative claims measures
If approved, surgeons will not be required to report data for the performance category or categories included in their application. However, surgeons should note that CMS will score any qualifying data submitted on their behalf, and those performance categories will contribute to their final score. Surgeons will be notified of their approval via email on a rolling basis.
For more information or to view the applications, surgeons can visit the Exception Applications page on the QPP website. Surgeons with further questions should contact QualityDC@facs.org.
Eight Improvement Activities for Performance Year 2025 Are Suspended
CMS has announced the suspension of eight Improvement Activities for the 2025 MIPS performance year. The agency also noted that it intends to propose the removal of these activities from the MIPS program in future rulemaking. The suspended activities include:
MIPS Eligible Clinician Leadership in Clinical Trials or CBPR
Create and Implement an Anti-Racism Plan
Implement Food Insecurity and Nutrition Risk Identification and Treatment Protocols
Create and Implement a Plan to Improve Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients
Practice Improvements that Engage Community Resources to Address Drivers of Health
Use of Toolsets or Other Resources to Close Health and Health Care Inequities Across Communities
COVID-19 Clinical Data Reporting with or without Clinical Trial
Vaccine Achievement for Practice Staff: COVID-19, Influenza, and Hepatitis B
CMS urged clinicians to select other improvement activities to complete, but if a clinician has already completed or is in the process of completing one of the suspended activities, the clinician may still attest to it and receive credit.
To earn full credit in the Improvement Activities performance category, most clinicians must attest to completing two improvement activities. Clinicians with the small practice, rural, non-patient facing, or health professional shortage area special status must attest to completing one. Each improvement activity must be completed over a minimum 90-day performance period.
While introduction and passage of legislation are the most visible parts of a bill progressing to a law, Congressional committees play an essential role in learning the impact of the legislation. Listen to ACS staff in Washington, DC, continue the Advocacy 101 video series and provide an overview of House and Senate Committees with jurisdiction over healthcare issues.
