The last year has seen several waves of federal policy updates affecting healthcare as President Donald Trump and his administration took on the first year of his second term in office.
Here are eight of the most important policy shifts that took place this year and what they mean for ASC leaders and physicians:
1. ACA enhanced tax subsidies saga: The House will hold a vote to extend the ACA’s enhanced subsidies after four Republicans signed a Democratic-led discharge petition to force a vote Dec. 17.
- The petition, signed by the four Republicans and all 214 Democrats, surpassed the 218-signature threshold hours before lawmakers voted to pass a healthcare package that excluded an extension of the subsidies. The effort to force the vote comes after House Speaker Mike Johnson, R-La., said Dec. 16 that he would not call a vote to extend the subsidies.
- The discharge petition will force a vote on extending the subsidies for three years, though the vote likely will not happen until January as House rules require a waiting period before the bill can be called to the floor. Lawmakers have also departed Washington, D.C., for the remainder of the year.
- The bill will now go to the Senate, where it is not expected to pass. The anticipated price hikes are expected to impact more than 20 million Americans who buy healthcare plans through the ACA marketplace
2. CMS bumps ASC pay: CMS published its 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule Nov. 21. The update included:
- A 2.6% increase to ASC payments via the hospital market basket update. HOPDs will also receive a 2.6% payment increase, and the hospital market basket update will be used again for ASCs next year.
- Finalized plans to phase out the inpatient-only list over the next three years, removing 285 primarily musculoskeletal procedures from the list in 2026. CMS will add 547 codes to the ASC-covered procedure list, including 271 coming off the inpatient-only list.
- Plans to align payment rates for select outpatient services between HOPDs and off-campus facilities to avoid higher copays based on site of service.
- Changes to the ASC Quality Reporting Program: CMS did not adopt two reporting metrics, nor will it require ASCs to use the Hospital Quality Reporting system for ASC data, as was initially proposed. ASCs will not be required to report on COVID-19 vaccinations for healthcare providers, health equity measures or social determinants of health.
- A note regarding a calculation error that negatively impacted cardiac surgeries, reporting that instead of cutting reimbursement by 4.7%, CMS will increase it by 2.4% over 2025 rates.
3. Trump rolls back competition order: Mr. Trump evoked Executive Order 14036 on Aug. 13, ending a Biden-era directive that called for heightened scrutiny of consolidation across industries, including healthcare. Existing antitrust laws remain in place.
ASC and physician leaders say the repeal could reduce regulatory friction for mergers and partnerships, potentially speeding consolidation and shifting negotiating leverage.
Jason Sansone, MD, president of Orthopedic & Spine Centers of Wisconsin in Madison, told Becker’s the shift could accelerate consolidation among orthopedic and spine practices.
“The revocation of Executive Order 14036 is expected to ease regulatory oversight of mergers and partnerships, creating a more favorable environment for consolidation,” Dr. Sansone said. “For spine and orthopedic groups, such as OSCW, this will likely accelerate activity as practices pursue opportunities to grow, align with hospitals or health systems and strengthen their negotiating position with insurers and suppliers.”
4. One Big Beautiful Bill Act becomes law: President Trump signed OBBBA on July 4 after Congress approved the package July 3. The law includes several healthcare and coverage provisions, including:
- A temporary 2.5% bump in the Medicaid Physician Fee Schedule for “exceptional circumstances” next year
- Restrictions on student loan borrowing limits for professional degrees.
- Tighter eligibility for ACA premium tax credits
- Limits on the ACA special enrollment period unless certain criteria are met
- New restrictions on state-directed payments and hospital provider taxes
- Medicaid work requirements beginning as early as January 2027
- Increased federal oversight of Medicaid provider taxes
- $50 billion over five years for a Rural Health Transformation program
5. CMS updates drug price negotiations: List prices for 10 of the nation’s most expensive drugs will drop to their CMS-negotiated price Jan. 1. House lawmakers introduced a bill Nov. 20 to expand these annual negotiations to 50 medications.
Under current law, CMS can negotiate with manufacturers selling medicines with no generic or biosimilar competition. In the first cycle, the Inflation Reduction Act stipulates CMS could select 10 medications for 2026, with eligibility growing to 20 by 2029. The proposed legislation aims to extend the negotiation program to private insurers, as the program solely covers Medicare. The bill also seeks to reverse a provision in the One Big Beautiful Bill Act that exempts medications approved for “one or more rare diseases or conditions” from the negotiations.
7. Trump signs executive order on price transparency: Mr. Trump signed an executive order Feb. 25 targeted at boosting healthcare price transparency. The order directs HHS and the Labor and Treasury departments to “rapidly implement and enforce” healthcare price transparency enforcement regulations. The order refers to regulations that President Trump introduced during his first term, which he said the Biden administration was “slow walking,” according to a Feb. 25 White House fact sheet.
8. Trump taps healthcare leadership appointees: Mr. Trump solidified several key appointments for national healthcare leadership, including:
- Mehmet Oz, MD, as administrator of CMS. Dr. Oz gained national prominence as host of “The Dr. Oz Show,” earning nine Daytime Emmy Awards. He also served as a health expert on The Oprah Winfrey Show for six seasons. In 2022, Dr. Oz was the Republican nominee for the U.S. Senate in Pennsylvania. He lost the general election to Democrat John Fetterman. Dr. Oz has faced scrutiny for promoting unverified weight-loss products, leading to a 2014 U.S. Senate hearing where he admitted some promotional language was overly “flowery.: A 2014 BMJ study found fewer than half of recommendations on medical talk shows, including his, were evidence-based. Additionally, during the COVID-19 pandemic, Dr. Oz promoted hydroxychloroquine as a potential treatment, citing early feedback from health experts, CNBC reported.
- Robert F. Kennedy Jr., as HHS secretary. Mr. Kennedy was confirmed after a narrow 14-13 vote in the Senate Finance Committee on Feb. 4, with approval largely split along party lines. His confirmation followed two hearings on Jan. 29 and 30, after being nominated by President Donald Trump on Nov. 14, 2024. Physicians and industry groups have expressed concerns about Mr. Kennedy’s potential confirmation as well. In early January, 15,000 physicians signed a letter pushing senators to vote against the confirmation of Mr. Kennedy.
- In May, President Donald Trump nominated Casey Means, MD, for the position of surgeon general, replacing his former nominee, Janette Nesheiwat, MD. Dr. Means’ confirmation hearing, originally scheduled for Oct. 30, has been postponed as Dr. Means’ went into labor prior to her hearing.
