By Bill Prentice
With the rising demand for outpatient procedures and the need for high-quality, cost-effective care, ASCA’s advocacy efforts are critical in shaping policies, influencing regulations and ensuring that ASCs continue to thrive and provide essential services to millions of patients each year. We advocate to ensure surgery centers have the policy support, legislative protection and financial resources they need to operate effectively. We work with federal, state and local officials to protect the interests of surgery centers and their patients. Our primary advocacy focus areas are Medicare reimbursement and payment policies, Medicaid and private insurance, regulatory issues and oversight.
One of our key advocacy initiatives is the expansion of ASC services through changes in healthcare policy. ASCA works with lawmakers to expand the procedures that can be safely and effectively performed in an ASC setting, freeing up hospitals to focus on non-elective procedures and emergency cases. This includes advocating for the addition of more specialty surgical procedures to the ASC Covered Procedures List (ASC-CPL) and expanding insurance coverage for outpatient surgeries.
As part of our advocacy efforts, we invite our members to lobby their members of congress through initiatives such as National Advocacy Day, facility tours and National Advocacy Month.
Fair Pay for Patients
ASCA advocates for policies that place patients’ needs first. Recently, we supported the introduction of the Medicare Beneficiary Co-Pay Fairness Act of 2025 (H.R. 3006/S.1776). Representatives Mike Kelly (R-PA), Robert Menendez Jr. (D-NJ), Troy Balderson (R-OH) and John Larson (D-CT) introduced the bill in the House in April, and Senators Richard Blumenthal (D-CT) and Bill Cassidy, MD (R-LA), introduced a Senate companion bill three weeks later in May. When passed, the legislation will reduce beneficiary costs by capping the maximum Medicare copayment for procedures performed in ASCs at the inpatient deductible.
In introducing the bill, Senator Cassidy said, “If your grandmother depended on Medicare for life-saving treatment, you would not want to hear that Medicare was cutting corners. This bill makes costs fairer for patients while keeping the quality of care high.”
In June, ASCA led a coalition of 48 leading healthcare organizations to send a letter to congressional committees urging support for this bill. The letter was addressed to the relevant congressional committees of jurisdiction – the House Committees on Energy and Commerce and Ways & Means, and the Senate Committees on Finance and Health, Education, Labor & Pensions (HELP). The coalition includes organizations such as the American Academy of Orthopaedic Surgeons, the American Society of Anesthesiologists and the Medical Device Manufacturers Association. The support of these organizations shows the widespread appreciation for surgery centers and the services they provide. The absence of a limit on beneficiary coinsurance creates greater patient expense without justification, limiting their access to the high-quality, low-cost care that ASCs provide.
Medicare beneficiaries who receive treatment in either an ASC or hospital outpatient department (HOPD) are typically responsible for 20 percent of their cost of care. In HOPDs, this 20 percent copay is capped at the hospital inpatient deductible amount, which is $1,676 for 2025. In ASCs, however, there is no copay cap. As a result, Medicare patients treated in an ASC face higher copays for approximately 183 procedures.
Moreover, when the copay cap is applied in an HOPD, the hospital is made whole, meaning that Medicare pays the hospital the difference between what 20 percent of the procedure would have yielded and the capped amount of $1,676. Since Medicare reimburses HOPDs significantly more than ASCs for virtually every procedure, current policy incentivizes beneficiaries to choose the higher-cost site of care, adding unnecessary costs to the Medicare program.
Surgery centers are the high-quality and cost-effective site of service for an ever-growing number of outpatient procedures. The current absence of a limit on Medicare beneficiary out-of-pocket costs in ASCs unintentionally drives patients to higher-cost care settings. The copay fairness act will allow beneficiaries to receive care in the ASC setting without paying more for the procedure.
Better Care for Seniors
A second piece of legislation that we backed recently is the Improving Seniors’ Timely Access to Care Act of 2025 (H.R.3514/S.1816), a bipartisan bill that will streamline the prior authorization process for Medicare Advantage (MA) beneficiaries. We joined a coalition of more than 235 organizations, 52 senators and 120 representatives to ensure the passage of this bill.
The prior authorization process places a significant administrative burden on healthcare workers, forcing them to spend hours submitting requests in the form of detailed paperwork or electronic forms, following up if the initial request is denied or needs additional information, and appealing denials. In addition, audits by the Office of Inspector General at the U.S. Department of Health and Human Services (HHS) have revealed that a significant percentage of initially denied requests are ultimately approved, and that MA plans have incorrectly denied access to services.
If passed, this legislation will establish an electronic prior authorization process for MA plans and, consequently, reduce paperwork burden on healthcare providers and give millions of seniors improved access to essential services. It also will increase transparency, clarify HHS’ authority to set time frames for e-prior authorization requests, expand beneficiary protections, and require HHS and other agencies to report to Congress on program integrity efforts. Best of all, this bill is projected to cost nothing to taxpayers.
Senators Roger Marshall, MD (R-KS), and Mark Warner (D-VA) reintroduced the legislation in May. Senator Marshall emphasized that “prior authorization is the number one administrative burden facing physicians today across all specialties.” Senator Warner said that “our seniors deserve high-quality care delivered in a timely fashion.”
Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), John Joyce, MD (R-PA), and Ami Bera, MD (D-CA), introduced a companion bill in the House also in May.
We believe that by reducing administrative burdens, this act will allow surgery centers to continue to provide high-quality, cost-effective surgical care and better advocate for their patients. In addition, it will ensure that the more than 32.8 million Americans enrolled in MA plans receive timely and appropriate care. This will result in a more efficient and accountable healthcare system.
More than 6,300 Medicare-certified ASCs currently operate in the U.S., performing a wide variety of outpatient procedures. Surgery centers represent a significant source of savings potential for both patients and payers because they can perform procedures with greater efficiency and at a lower cost than hospitals. According to an analysis from KNG Health Consulting, surgery centers are projected to reduce Medicare program costs by $73.4 billion from 2019 to 2028.
ASCA will continue to advocate for policies that place patients’ needs first while promoting innovation, transparency and efficiency throughout the healthcare continuum.
