ASCA 2025: Leading lawmaker reflects on surgery center priorities

Editor's Note

At the 2025 Ambulatory Surgery Center Association (ASCA) conference, discussion of legislative priorities extended beyond educational sessions. Thanks to a visit from the ranking lawmaker of the congressional subcommittee responsible for most healthcare policymaking, attendees also got first-hand insight into the latest negotiations on Capitol Hill.

US Representative Diana DeGette (D-Colo.), who heads the House of Representatives Health Subcommittee of the Energy and Commerce Committee, detailed how mounting fiscal pressure and partisan gridlock could jeopardize key healthcare programs, focusing particularly on physician payments and Medicaid funding. “A whole group of us—Democrats and Republicans—have been trying to get a physician payment fix done,” she said, noting the fix was stripped from the budget bill right after the election along with a broader, bipartisan healthcare package that also contained provisions on diabetes, maternal health, and dozens of other issues. “We’ve been trying to get it passed ever since.”

Whatever the prospects for a physician payment fix in the latest budget reconciliation package, “the math doesn’t work,” DeGette said. Proposals to offset a $4 trillion tax cut package passed in 2017 would require “cutting about $2 trillion from the budget,” she continued, noting that her committee alone was asked to find $880 billion in savings—roughly equivalent to the total projected 10-year Medicaid spend.

Speaking on the prospect of potentially deep cuts to Medicaid, DeGette emphasized the program’s broad public support, calling it one reason why Republicans are struggling to achieve consensus on where to cut. “Public support for Medicaid is through the roof—almost 80%,” she said, adding that the support is bipartisan. “This is not abstract. This is going to impact millions of Americans.”

DeGette then addressed what she painted as a key inequity in ambulatory surgery center (ASC) reimbursement: Medicare coinsurance caps for patients in hospital outpatient departments (HOPD). With no similar cap for ASCs, patients “go to a higher cost care setting, which not only costs the taxpayers more money, but potentially it’s robbing those patients of the most appropriate setting for the procedures they need.”

Prospects for fixes could be slim, with DeGette noting very little legislation has been passed during President Trump’s first 100 days despite a flurry of executive actions. “I have never seen such chaos as we are seeing now,” DeGette said, explaining that she just began her 14th term. Nonetheless, she emphasized continued commitment to bipartisan work on healthcare, drawing applause after expressing support for a newly introduced bill that promises to close the coinsurance gap.

A key legislative priority for ASCA, the Medicare Beneficiary and Copay Fairness Act of 2025 is so-named because “copay cap just rolls of the tongue easier” said ASCA chief advocacy officer Kara Newbury, JD, in a conference session the previous day. Whatever the name the legislation may take if enacted, it would cap patient cost-sharing in ASCs at the same limit applied to HOPDs—currently $1,632.  

Another priority for ASCA is the Outpatient Surgery Quality and Access Act. Aside from the removal of the coinsurance fix (now covered in the aforementioned, separate bill), this yet-to-be-enacted legislation is largely the same as the version introduced in 2023, Newbury said. Key priorities include:

• Keeping ASCs aligned with the hospital market basket update rather than the Consumer Price Index for All Urban Consumers (CPI-U)
• Increasing transparency and reducing barriers to expansion of the ASC covered procedure list, including requiring CMS to explain its rationale for rejecting or accepting procedures.
• More thoroughly evaluating quality reporting requirements adopted from HOPDs before imposing them on ASCs
• Changing the secondary weight scalar that ASCA says penalizes ASCs for performing the same Medicare services as higher-cost HOPDs; due to cost, eliminating the scaler may be unpalatable to lawmakers, so the legislation calls for combining HOPD and ASC volumes into a single outpatient weight scalar, Newbury said.

Meanwhile, bipartisan interest has grown in site-neutral legislation, but Newbury warned none of the proposals currently on the table would benefit ASCs.

Another key theme of Newbury’s session was the urgent need to protect ASC facility fees from growing political scrutiny and misunderstanding. Now being explored in multiple states, facility fee restrictions represent an existential threat to ASCs, she said. “I’m sure you all know what goes into a facility fee, but not everyone does—including lawmakers,” she said early in the expansive, hour-plus-long presentation, pointing attendees to an educational ASCA one-pager on the topic.