ACS Advocacy Brief: June 2026

Federal Judge Blocks $100,000 Fee on H-1B Visas

On June 8, a federal judge blocked President Trump’s $100,000 fee for H-1B visas. The H-1B visa fee was implemented in September 2025 by Presidential proclamation and was opposed by the ACS and other national healthcare organizations which called for an exemption for healthcare workers.

The judge ruled that this fee violates the separation of powers and characterized it an unauthorized “tax,” which would require congressional approval. The ACS has advocated for Congress to pass legislation creating an exemption for healthcare workers and supports the H-1Bs for the Physicians and Healthcare Workforce Act (HR 7961). 

This ruling is a significant victory, especially for rural and underserved areas where H-1B surgeons are highly concentrated. The ACS will follow all developments and will provide updates as needed.

House Committee Advances Healthcare Funding Priorities 

On June 9, the House Appropriations Committee advanced fiscal year (FY) 2027 appropriations for the Department of Health and Human Services, with several wins and items of interest for ACS advocacy. Some highlights from the draft L-HHS report include:

• $100 million increase in funding for the National Institutes of Health
• Increase of $3 million for MISSION ZERO, bringing the total to $7 million in FY 2027
• Decrease of $237 million for the Hospital Preparedness Program (HPP) and elimination of HPP formula grants due to funding constraints

Additionally, for the second consecutive year, a bipartisan amendment was adopted by voice vote to prohibit Centers for Medicare & Medicaid Services (CMS) funds from being used to enact the WiSER model, which implements prior authorization in traditional Medicare. The amendment also directs CMS to provide Congress with information in the FY 2028 budget justification regarding the model’s impact and the rationale for state selection. This is notable, because a similar amendment passed in the House FY 2026 bill but did not make it through negotiations with the Senate. 

This bill will be sent to the House floor for a vote before being conferenced with the Senate. The Senate is set to consider its version of this bill later this summer.

ACS Comments on IPPS Proposed Rule, Encouraging Improved Quality Measurement

On June 9, the ACS submitted a comment letter in response to the fiscal year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, published by the Centers for Medicare & Medicaid Services (CMS) in April. The letter focuses on key elements of the rule, including proposals to update hospital quality reporting programs and the Transforming Episode Accountability Model (TEAM). The letter also responds to several requests for information (RFIs). 

The ACS’s overarching comments encouraged CMS to build a quality measurement framework that aligns with the ACS quality model—one that prioritizes the structures, processes, and outcomes necessary to build care teams around patients’ goals—in order to support more meaningful value-based care models.

The ACS provided extensive comments on TEAM, which was proposed in 2024 and took effect earlier this year, covering the following areas:

• Emphasized the importance of pairing episode-based arrangements with meaningful quality measurement
• Opposed the mandatory participation requirement and encouraged CMS to improve model design to promote participation
• Provided evidence-based refinements for the Major Bowel Procedures episode and recommended changes to the risk adjustment methodology
• Highlighted the importance of accurately distinguishing care quality from patient complexity to ensure patient access in rural and underserved areas

Additionally, the ACS responded to two TEAM RFIs that solicited feedback on the inclusion of ambulatory surgical centers (ASCs) and physician-owned hospitals (POHs). The ACS opposed the inclusion of ASCs in the model due to significant gaps in the ASC quality framework, as well as differences in pricing compared to hospitals, raising concerns about incentives that may shift patients from one setting to another based on financial considerations rather than patient preference or physician recommendation.

The College also provided feedback on design elements for incorporating ambulatory surgical care into an accountable care model. The ACS supported an option for POHs to opt in to the model. 

Finally, the ACS commented on the inclusion of new measures in the Hospital Readmissions Reduction Program and the Hospital Inpatient Quality Reporting Program.

For more information about the proposed rule and the College’s comments, contact regulatory@facs.org.

OMB Proposed Rule Threatens Independent Medical Research 

On May 29, the Federal Register published the “Regulation for Federal Financial Assistance” proposed rule from the Office of Management and Budget (OMB). This rule would fundamentally reshape the federal grantmaking process, and the ACS is drafting comments opposing aspects of its implementation that would harm surgical research and surgical patients.

One of the most consequential changes would give political appointees, rather than researchers, control over all discretionary grants. These appointees would not be required to defer to peer reviewers or routinely ratify their recommendations, and they must block funding for any award that does not demonstrably advance the President's policy priorities.

The rule also would expand federal agencies' authority to terminate or modify active grants mid-award. Currently, agencies must demonstrate noncompliance or fraud to terminate a grant; under the proposed rule, they would only need to show that a project is inconsistent with agency priorities.

Finally, many provisions of the proposed rule are overly vague, limiting researchers' ability to comply. Agencies are instructed to prioritize "Gold Standard Science," but the rule does not define this principle. It also bans federal funding for projects broadly addressing diversity, equity, and inclusion, and institutions conducting such research, even with non-federal funds, could face grant termination as well.

The ACS is preparing comments on behalf of the surgical community and encourages surgeon-scientists and other interested stakeholders to make their voices heard by submitting comments to OMB before the July 13 comment deadline.

ACS Advocacy at Home Program Brings You to the Table

The ACS Advocacy at Home program offers surgeons a meaningful way to advocate for the profession by meeting directly with elected officials during congressional district work periods. 

This year, the program will focus primarily on stopping the 2026 Medicare Physician Fee Schedule “efficiency adjustment,” which has imposed a 2.5% cut on work relative value units for non-primary care physicians, including surgeons. 

Getting involved is easy. Just send a pre-drafted meeting request through SurgeonsVoice to your congressional district office, and congressional staff will coordinate the details with you. Join your colleagues and take action to ensure surgery has a strong voice on Capitol Hill and at home. 

Strengthen ACS Advocacy Through Grassroots Committee and Network

The ACS is strengthening advocacy efforts through the ACS Grassroots Committee and Grassroots Network.

The ACS Grassroots Committee was approved by the Board of Regents and is comprised of leaders from across the College who represent different specialties and constituencies, including the Advisory Councils, Board of Governors, Commission on Cancer, Committee on Trauma, Young Fellows Association, Resident and Associate Society, and ACS Health Outreach Program for Equity in Global Surgery (H.O.P.E.). 

The Committee members serve as a bridge between their constituencies and the ACS advocacy leaders. Members are tasked with elevating advocacy concerns, sharing policy developments, and encouraging participation in advocacy activities within their respective groups. By facilitating this two-way communication, the Committee helps ACS leadership better understand the issues affecting all surgeons and their patients while increasing awareness of opportunities to get involved.

Together, the Grassroots Committee and Grassroots Network create a stronger advocacy network for the College. While Committee members help communicate priorities and opportunities between ACS leadership and their constituencies, Grassroots Network members expand those efforts by engaging directly in advocacy campaigns and legislative outreach.

The ACS Grassroots Network is open to all ACS members interested in advocacy. As the College's "grasstops" advocacy community—which includes surgeons who have the “ear” of policymakers—the Network connects surgeons with opportunities to act on legislative issues affecting surgery and patient care.

Network members receive advocacy updates and action alerts, participate in targeted advocacy campaigns, and share insights on issues affecting surgeons in their states, specialties, and practice settings.

To join the ACS Grassroots Network, complete the following survey, and ACS staff will follow up with information about next steps. 

Advocate Spotlight: Dr. James Jeng Supports ACS Priorities

This month, the ACS is proud to recognize James C. Jeng, MD, FACS, for his dedication to advancing the surgical profession through advocacy.

Dr. Jeng is a board-certified, fellowship-trained surgeon specializing in trauma, burns, and critical care and is a professor in the Division of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery at the University of California, Irvine.

Through his longstanding engagement in surgical advocacy, Dr. Jeng built a strong relationship with Representative Lou Correa (D-CA), helping secure Rep. Correa’s co-sponsorship of HR 7520, the “Efficiency Adjustment Delay Act.” He also regularly participates in the ACS Leadership & Advocacy Summit, supports SurgeonsPAC, and serves on the ACS Legislative Committee.

The ACS thanks Dr. Jeng for his leadership and steadfast commitment to ensuring the voice of surgery is heard on Capitol Hill.

ACS Engages at AMA House of Delegates Meeting

The American Medical Association House of Delegates (AMA HOD) convened June 5–10 in Chicago, Illinois, for its annual meeting. Over the course of the meeting, hundreds of delegates considered numerous items of business covering topics spanning all aspects of healthcare, including Medicare physician payment, AI in health delivery, prior authorization, medical education, and more. 

The ACS Delegation proudly represented the College and provided testimony on several items relating to the importance of unity in physician advocacy for Medicare reimbursement and other issues important to surgeons and their patients. 

The HOD reaffirmed current AMA policy on opposing two policies enacted as a result of the Calendar Year 2026 CMS Medicare Physician Fee Schedule: the efficiency adjustment and reallocation of indirect practice expense costs. The House also reaffirmed policy on reforming the Merit-Based Incentive Payment System program. 

Additional details on the HOD meeting will be provided soon.