ASCA’s fly-ins connect ASC advocates with policymakers who make decisions that directly impact the surgery center community and its patients. ASCA schedules congressional meetings for each fly-in participant and provides a training briefing before the meetings. During the briefing, ASCA staff explain current ASC legislation and how to conduct a successful congressional meeting.

Medicare Beneficiary Co-Pay Fairness Act

In 2025, Reps. Mike Kelly (R-PA), Robert Menendez (D-NJ), Troy Balderson (R-OH) and John Larson (D-CT) introduced the Medicare Beneficiary Co-Pay Fairness Act in the House of Representatives, and Sens. Bill Cassidy, MD (R-LA), and Richard Blumenthal (D-CT) introduced the bill in the Senate. The act aims to address the current inequity in Medicare’s copay structure between ASC and hospital payments. It seeks to increase Medicare beneficiaries’ access to ASCs by eliminating the copay penalty for certain Part B services when they are provided in an ASC. Medicare beneficiaries treated in either an ASC or hospital outpatient department are typically responsible for 20% of their cost of care. However, in HOPDs this 20% copay is capped at the inpatient hospital deductible amount ($1,736 in 2026), while there is no copay cap in ASCs. This results in higher out-of-pocket costs for beneficiaries seeking treatment in ASCs for approximately 183 procedures.

This policy incentivizes beneficiaries to choose the higher-cost HOPD setting, despite the savings generated for Medicare when beneficiaries choose an ASC. Applying the existing copay cap to ASCs would reduce Medicare costs, provide greater access to care and eliminate situations where out-of-pocket costs for beneficiaries treated in ASCs are higher than for beneficiaries treated in HOPDs.

Outpatient Surgery Access Act of 2026

Earlier this year, Reps. Beth Van Duyne (R-TX) and John Larson (D-CT) introduced the Outpatient Surgery Access Act of 2026 in the House of Representatives. If passed, the bill would help stabilize ASC reimbursement by permanently instituting the same inflationary factor used to update hospital payment rates. The legislation also would remove a budget neutrality adjustment that increasingly depresses ASC rates.

The Centers for Medicare & Medicaid Services aligned the surgery center payment system with the hospital outpatient payment system in 2009. However, CMS has historically updated ASC rates using the Consumer Price Index for All Urban Consumers. The consumer price index measures changes in prices for common household consumer goods, but it is not an accurate reflection of the costs of operating a healthcare facility. By contrast, hospital payments are updated using the hospital market basket price index, which incorporates prices for healthcare-related inputs such as healthcare wages, medical equipment and malpractice insurance. The difference in inflationary update factors creates a disparity in reimbursement between ASCs and hospitals, threatening access to the critical care that surgery centers provide. In 2019, after years of ASCA’s advocacy, CMS agreed to update surgery center payments using the hospital market basket for a trial period, which is set to expire at the end of 2026.

ASCA continues to work with its ASC champions on a Senate introduction of the Outpatient Surgery Access Act of 2026.

Advocacy efforts

ASCA will continue advocating for ASCs at the federal level. As challenges facing the ASC community evolve, educating members of Congress about their impact on patient care and the longevity of surgery centers remains a top priority.

To learn more about ASC legislation, visit ASCA’s Legislative Priorities webpage.

Write Maia Kunkel, ASCA’s Government Affairs manager, at mkunkel@ascassociation.org with questions.