Healthcare affordability has taken center stage in the national political discourse, from the fights against AI-driven payer denials to antitrust efforts and lapsed ACA marketplace subsidies.
For ASC operators paying close attention to the ballot box in November, a few policies have the potential to significantly shape ASC market dynamics, administrative burdens and reimbursement rates.
The premium math shaping who shows up for surgery
Enhanced ACA subsidies expired at the end of 2025 after Congress declined to extend them, and insurers, anticipating that healthier enrollees would abandon their marketplace plans as a result, responded with rate increases. Sen. Jon Husted, R-Ohio, proposed a temporary extension paired with a minimum monthly premium meant to discourage fraudulent enrollment, but the bill stalled.
Sen. Susan Collins, R-Maine, co-sponsored similar legislation that also failed to advance.
ACA insurers have already proposed a median premium increase of about 15% for 2027, a number that will shape how many commercially insured patients show up for elective procedures next year regardless of who wins in November.
A payer-mix problem hiding inside HR 1
Republican candidates have largely embraced HR 1’s Medicaid provisions: work requirements, more frequent eligibility checks and tighter limits on the provider taxes and state-directed payments many states use to keep Medicaid reimbursement viable.
Sen. Dan Sullivan, R-Alaska, backed the law, noting Alaska hadn’t previously relied on either financing mechanism. Texas Attorney General Ken Paxton called it “historic legislation.” His Democratic opponent in the state’s Senate race, Texas state Sen. James Talarico, said the law “gutted our health care.” For ASCs, especially those in states leaning on provider taxes to prop up Medicaid rates, the practical stakes are eligibility churn and a payer mix that could shift with little warning.
Who controls where the patient has surgery
UnitedHealth Group, CVS Health, Elevance Health and Cigna all now operate across insurance, pharmacy and provider businesses, drawing congressional hearings earlier this year over how far that consolidation should be allowed to go. Mr. Talarico partnered with Cost Plus Drugs co-founder Mark Cuban to push the Break Up Big Medicine Act, introduced by Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo.
“This is not a free market,” Mr. Talarico said. “This is coverage by cartel.”
Mr. Cuban has argued the legislation could lower costs “overnight.” For independent, physician-owned ASCs, the more immediate concern is referral steering: as insurers acquire more physician practices, they gain more influence over where those physicians’ patients end up having surgery.
The denial that cancels a case, not just a claim
Sen. Jon Ossoff, D-Ga., co-sponsored a Senate resolution calling for the repeal of the Wasteful and Inappropriate Service Reduction model, an AI-enabled prior authorization pilot CMS is testing on traditional Medicare in select states. Senate Republicans blocked the resolution in a party-line vote, keeping the pilot in place.
UnitedHealth is already facing litigation over allegedly wrongful denials generated by AI algorithms, and insurers, despite scrutiny from senators in both parties, are continuing to invest heavily in the technology. For ASCs, where a canceled case means an empty operating room that day, an algorithmic denial can create a scheduling problem with a dollar figure attached.
The fight to improve ASC payments
ASCs generated $27.9 billion in Medicare savings between 2019 and 2024, even as their reimbursement has drifted from roughly 85% of hospital outpatient department rates to about 62%.
Reps. Beth Van Duyne, R-Texas, and John Larson, D-Conn., introduced the Outpatient Surgery Access Act of 2026 in March, a bipartisan bill that would permanently tie ASC payment updates to the hospital market basket instead of letting them revert to the general Consumer Price Index, and would eliminate a budget-neutrality adjustment unique to ASCs. A companion bill has since drawn support from ASC advocates in the Senate.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
