Advocacy Under the Aegis of the ACS

As many of you know, I enjoy mythology. This summer, as a new film adaptation of The Odyssey appeared in theaters, I had a fresh opportunity to reflect on a philosophical concept that arose from Greek mythology and resonates strongly with the work of the ACS: aegis.

In one traditional use, the aegis was depicted as a shield or protective animal skin the goddess Athena carried; in other accounts, a thunderbolt wielded by Zeus. Thus, an aegis was classically defined as both a defensive object and a proactive one. In modern parlance, aegis has lost its literal forms but has retained its dual meanings. The word now connotes both protection and sponsorship, including by organizations or in governance.

Few words describe ACS advocacy efforts better. Since our founding, the ACS has served as both a shield and a champion, advancing policies that protect surgeons and strengthen surgical care. For more than 5 decades, we have built an increasingly strong federal and state advocacy infrastructure with two complementary goals: to advance beneficial laws and regulations and aggressively defend surgeons and patients against adverse policy changes.

Surgeons now face a convergence of challenges. Although we may not prevail in every battle, it is increasingly important to remain steadfast in ensuring surgeons’ voices are amplified wherever healthcare policy is shaped.

Protecting Evidence-Based Science

One of our most recent advocacy successes has focused on defending scientific research.

In May, the federal Office of Management and Budget (OMB) published a proposed rule that would fundamentally alter the federal grantmaking process for scientific research. Among its most striking changes is a proposal to shift decision-making authority over discretionary grants from scientific experts to political appointees. If implemented, these appointees would be permitted to disregard scientific peer review but required to block funding to grants that do not reflect administration policy priorities. They would also have authority to terminate grants during the award period if they were deemed inconsistent with shifting priorities.

Recognizing that replacing expert judgment with political preference would jeopardize research, erode the evidence base that guides surgical practice, and damage the early-career investigator pipeline, we, along with dozens of other academic and specialty societies, submitted a letter to the OMB expressing vociferous opposition to the proposed rule. In August, the Senate passed a continuing resolution that would sustain government funding at current levels until December 11 and temporarily block the OMB proposal. That bill now moves to the House. We remain vigilant about ensuring that appropriate rules remain in place for the rigorous science on which high-quality surgical care depends.

Fighting for Fair Compensation

The ACS also remains committed to opposing policies that would lower surgeon reimbursement.

In mid-2025, the Centers for Medicare & Medicaid Services (CMS) proposed a 2.5% reduction in work relative value unit payments, on the grounds of increased surgical efficiency. Research led by ACS Medical Director of Health Policy Research Thomas C. Tsai, MD, MPH, FACS, and lead author Christopher P. Childers, MD, PhD, showed that operative times had, in fact, increased. Despite this compelling evidence and our outspoken opposition, CMS finalized the policy, and it took effect January 1.

However, our work did not end there. More than 3,000 of you mobilized through SurgeonsVoice, and the ACS led a coalition of nearly 40 organizations to advocate on Capitol Hill for legislation reversing the reduction. As a result, US Representatives Ron Estes (R-KS) and Thomas Suozzi (D-NY) introduced the Efficiency Adjustment Delay Act (HR 7520), which would pause the payment cut.

Since the bill’s introduction, nearly 3,000 additional surgeons have used SurgeonsVoice to urge Congress to support HR 7520. As we continue advocating for its passage, I urge all US members to participate.

Improving the MPFS

Long-term payment reform remains a priority for the ACS. Currently, we are advocating for substantive improvements to the Patients First Act of 2026 (HR 9693), which was introduced this July by three Congressional Doctors Caucus leaders (including Greg Murphy, MD, FACS).

The bill provides new and increased funding to primary care, leaving significant payment issues among surgeons and other specialists largely unaddressed. The bill also does not reverse the Medicare physician payment reductions scheduled to begin in 2027. Because the recent 2027 Medicare Physician Fee Schedule (MPFS) proposed rule would further erode reimbursement for surgical care, assertive advocacy is now critical if we are to make this bill acceptable for our surgical colleagues.

Since 1992, increases of as little as $20 million in the MPFS have triggered across-the-board budget cuts. This legislation would helpfully raise the Medicare budget neutrality threshold and create an annual inflationary payment update, helping reduce competition among specialties for limited Medicare resources.

To date, we have submitted official comments to the US House Committee on Energy and Commerce, published evidence-based analyses in Health Affairs and STAT, and engaged directly with lawmakers on Capitol Hill. We are also actively reviewing the proposed MPFS rule and will continue pressing lawmakers for changes that support high-quality surgical care. As with all our advocacy efforts, each of us has a voice, and our participation is essential.

Steps Forward

Advocacy is not solely about defending against harmful policies. Using our aegis is also about looking forward, strengthening our profession, and improving patient care.

This year’s passage of the Consolidated Appropriations Act illustrates this. This law includes several decisions that align with ACS priorities, including increased funding for the Hospital Preparedness Program, military-civilian trauma training partnerships, the National Institutes of Health, and the US Centers for Disease Control and Prevention. It also sustains funding for firearm injury prevention and the Advanced Research Projects Agency for Health, extends the Dr. Lorna Breen Healthcare Provider Protection Act through 2030 and COVID-era Medicare telehealth flexibilities through 2027, and more.

Advancing Surgery Together

Surgeons, as leaders in the OR and a significant part of the engine that runs our hospitals, bring strategic leadership to patient care. The ACS strives to use a similarly principled approach to its advocacy for evidence-based policy, appropriate payment, and optimal care.

Just as we undertake aggressive surgical interventions when we must, so too must we speak out strongly to defend and serve our patients and our profession in these difficult times. Advocacy, strongly built on ancient principles, remains vital to our future.