Medicare caps ASC coinsurance, raising facility reimbursement

What it does

This bill caps the coinsurance (patient cost-sharing) that Medicare beneficiaries must pay for certain surgical procedures performed in ambulatory surgical centers (ASCs). When the coinsurance would exceed the annual inpatient hospital deductible, Medicare reduces the patient's out-of-pocket cost to match that deductible amount and reimburses the ASC facility for the difference. The change takes effect January 1, 2026.

Why we flagged it

The bill's operative mechanism is a direct cost-control measure for beneficiaries paired with a reimbursement increase for ASC facilities. It is a targeted amendment to Medicare payment policy, not a broad reform or deregulation.

What the text implies

• By capping coinsurance at the inpatient deductible, the bill may incentivize shift of procedures from inpatient hospital settings to ASCs, potentially fragmenting care and reducing hospital revenue.
• The bill guarantees ASC reimbursement for the coinsurance reduction, creating a new cost to Medicare with no spending cap or sunset; long-term fiscal impact depends on procedure volume and pricing trends.
• Beneficiaries with high coinsurance exposure gain relief, but the bill does not address underlying ASC pricing or whether coinsurance levels are clinically justified—it is a cost-shifting measure, not a pricing reform.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries gain lower out-of-pocket costs for certain ASC procedures, improving affordability. However, the bill shifts cost burden to Medicare (and ultimately taxpayers), and by raising ASC reimbursement, may increase overall program spending or premiums without addressing whether ASC pricing is justified.

Who stands to gain

• ambulatory surgical centers (ASC operators and owners)
• Medicare beneficiaries (lower out-of-pocket costs)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare, ambulatory surgical centers (ASCs), Social Security Act Section 1833, Social Security Act Section 1813(b)

Where it stands

22 cosponsors: 11 Democrats, 11 Republicans.

• Apr 24, 2025 — Introduced · Congress.gov: “Introduced in House”
• Apr 24, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

6 lobbying clients named this bill on 7 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $2,146,331 in lobbying spend. A filing names 5 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 82% of bills with at least one filing.

Mike Kelly, the sponsor, reported $955,974 in PAC receipts in the 2026 cycle. $8,000 of that came from 2 PACs tied to these lobbying clients.

• Johnson & Johnson Services Inc — $1,440,000 on 1 filing
• American Academy of Otolaryngology-head and Neck Surgery — $286,331 on 1 filing
• Zimmer Biomet, Inc. — $190,000 on 1 filing
• Ambulatory Surgery Center Association — $120,000 on 2 filings
• Ambulatory Surgery Center Association — $60,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.