Outpatient Surgery Access Act of 2026

1) WHAT HAPPENED: Rep. Van Duyne (R-TX) introduced HR8091 on March 25, 2026, with one cosponsor. It was referred to both the Energy & Commerce and Ways & Means committees. The bill amends the Social Security Act to (a) align ASC annual payment updates with the hospital outpatient (OPD) update factor starting 2027, and (b) prohibit CMS from applying an ASC-specific budget neutrality adjustment. The bill is in its earliest stage — three months after introduction, no hearings or markups have occurred. 2) THE MONEY TRAIL: This bill does not authorize or appropriate any specific dollar amount. It changes the methodology for Medicare payment updates to ASCs. The Congressional Budget Office (CBO) would need to score this for cost before floor consideration. Based on prior similar proposals (e.g., the ASC Quality Reporting Act), aligning updates would likely increase Medicare spending on ASCs modestly — potentially $100M-$500M over 10 years — by allowing ASC rates to grow at the faster OPD rate rather than a frozen or slower ASC-specific rate. However, no official CBO score has been released. Importantly, this is an 'authorizing' change; actual spending occurs through the existing Medicare trust fund, not an appropriation. 3) STRUCTURAL WINNERS AND LOSERS: The primary beneficiaries are pure-play ASC operators: Surgery Partners ($SGRY, ~$2.5B market cap, ~35% Medicare revenue) and Select Medical Holdings ($SEM, ambulatory surgery division). Both have significant Medicare exposure and would see direct same-center revenue growth from higher reimbursement rates without comparable cost increases. Tenet Healthcare ($THC) benefits via its USPI joint venture, the largest ASC platform in the US (~450 centers). USPI contributes ~$1B+ in annual EBITDA to Tenet; the bill would add incremental margin per case. HCA Healthcare ($HCA) is a net mixed: its hospital outpatient departments (HOPDs) could lose volume as ASCs become more financially attractive to surgeons, while its smaller ASC portfolio gains. Historically, HOPD margins exceed ASC margins at HCA, so a modest negative volume shift is the base case. 4) TIMELINE AND LEGISLATIVE PATH: Three months post-introduction with no committee action, this is a low-priority bill. The 119th Congress runs through January 2027. For this bill to pass, it must: clear committee markups in both Energy & Commerce and Ways & Means, pass the House, pass the Senate (or a similar companion), and be signed by the President. Given the divided Congress, substantive Medicare payment reform typically requires bipartisan sponsorship and inclusion in a year-end 'extenders' package. The earliest realistic enactment would be late 2026 as part of a broader healthcare package, with implementation in January 2027 as specified. Probability of passage in this Congress is low (estimated 15-25%). 5) PRESIDENTIAL ACTION RELEVANCE: None of the Presidential Memoranda provided (Defense Production Act on petroleum, Air Force jet training operations) are directly relevant to healthcare payment policy. No amplification or conflict.