Surgeons Advocate for Insurance Reforms
Medical professionals are taking a more active role in shaping insurance policy. Surgery residents from Penn Medicine recently advocated at the ACS Leadership Summit for expanded insurance coverage for preventative care like breast cancer screenings, as well as for changes to Medicare reimbursement policies.
The push for insurance reform by surgeons extends beyond preventative care to address systemic issues within Medicare reimbursement. For years, physicians have been the only segment of the healthcare system not receiving an annual, inflation-based payment update, leading to a growing disparity between the cost of care and reimbursement rates. This financial pressure is a driving factor behind increased consolidation in healthcare, as smaller, independent practices are absorbed by larger hospital systems. A key point of contention is the Medicare Physician Fee Schedule's budget neutrality requirement, which mandates that any payment increases for new or existing services must be offset by cuts elsewhere. The threshold for triggering these cuts has not been updated since 1992. The American College of Surgeons (ACS) and other physician groups are advocating for legislation to tie Medicare reimbursement to the Medicare Economic Index (MEI) to account for inflation. In early 2026, the Centers for Medicare & Medicaid Services (CMS) implemented a 2.5% cut to work Relative Value Units (RVUs), further devaluing surgeon services. In response, the ACS has been instrumental in the introduction of the bipartisan Efficiency Adjustment Delay Act in Congress, which seeks to halt these cuts. This legislative effort is supported by a coalition of over 35 national medical organizations. The advocacy for expanded preventative screening coverage faces legal challenges. The Affordable Care Act (ACA) mandates that private insurance plans cover preventive services rated "A" or "B" by the U.S. Preventive Services Task Force (USPSTF) without patient cost-sharing. However, the court case *Braidwood Management Inc. v. Becerra* challenges this requirement, which could eliminate no-cost coverage for numerous screenings if the ruling stands. Another significant administrative burden targeted by reformers is the prior authorization process. A 2023 American Medical Association survey revealed that 93% of physicians reported prior authorization processes delayed patient care, with 78% believing these delays led patients to abandon necessary treatment. Studies have shown that prior authorization can increase the time to surgery and may not reduce overall healthcare costs. The ACS is also focused on broader issues impacting surgical care, including medical liability reform, graduate medical education financing, and ensuring that surgery is performed by qualified surgeons. Their advocacy efforts include lobbying Congress, grassroots initiatives like SurgeonsVoice, and political engagement through the ACSPA-SurgeonsPAC. Legislators are also beginning to examine the role of artificial intelligence in the prior authorization process. The emerging consensus is that while AI can be used for initial reviews, it should not be the sole basis for denying, delaying, or modifying patient care, with a human review being mandatory for any adverse decisions. The annual ACS Leadership & Advocacy Summit, scheduled for February 28–March 3, 2026, in Washington, DC, is a key event for these advocacy efforts. It provides a platform for surgeons to engage directly with lawmakers and their staff to discuss these critical healthcare policy issues.
