The State Affairs team at the American College of Surgeons (ACS) diligently reviews hundreds of bills that are introduced every week in the
state legislatures, marking many for closer monitoring and potential grassroots advocacy. From state
health exchanges implemented through the Affordable Care Act (ACA), to the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA), to determining a legislative definition of surgery—2015 looks
like it will be a productive year for state legislatures.
This article reviews state legislative issues that are
priorities for the ACS in 2015.
ACS identifies key issues
Identifying and defining those issues that are being
debated at the state level that will affect surgery and
patient care is a complex task. The annual input of
the College’s Health Policy and Advocacy Group
(HPAG) has helped narrow the most pressing issues
of particular interest to surgeons in 2015, providing
guidance to State Affairs staff about how to address
these matters as they arise. Priorities for 2015 that
the HPAG has identified are as follows:
•ACA implementation. States are largely responsible
for implementing many of the provisions in the ACA,
and as the process continues, the College is closely
monitoring related issues that are emerging. Specific
concerns include the narrowing of insurance networks
and the tiering of health care providers based on the
cost and quality of care they deliver and how these
practices may affect access to care. Some states that
haven’t expanded Medicaid are exploring their options,
and these activities are also being closely monitored.
•Bariatric surgery coverage. Bariatric surgery is not classified as an essential health benefit (EHB) in 25 states,
even though the procedure is a proven method for treating obesity. The College has been collaborating with the
American Society for Metabolic and Bariatric Surgery
(ASMBS) to include coverage for bariatric surgery as
an EHB in states with their own insurance exchanges.
•Medical liability reform. Medical liability reform is
a perennial issue for surgery. The ACS will actively
engage in efforts to improve the medical liability climate at the state level, and will continue to oppose
any efforts to remove reforms in states where they
have been adopted.
•Scope of practice. Scope of practice was a hot topic in
2014 and continues to be an important issue in 2015.
Of particular concern is legislation that expands the
scope of practice for optometrists, allowing them to
perform certain surgical procedures. The College will
continue to work with its specialty society partners
to oppose these efforts and to support the rest of the
medical community as states try to expand the scope of
practice for many other nonsurgeons, including podiatrists, audiologists, physical therapists, and advanced
practice registered nurses (APRNs).
• Trauma. The College will continue to advocate for
stronger injury prevention legislation at the state level,
including protecting existing helmet laws, strengthening distracted driving laws, and ensuring safe driving
•UEVHPA. The College is renewing efforts to expand
the number of states that have adopted the UEVHPA.
State legislative activities
A significant amount of activity around key issues
has already been observed this year.
Implementation of the ACA
Health care networks in some states, in order to provide
seemingly affordable insurance products to subscribers, have offered insurance plans with limited access
to health care providers and no out-of-network coverage. This practice led policymakers in California to
issue emergency regulations on January 30 aimed at
addressing these concerns. 1 The emergency regulations mandate that health care networks take the following actions: