In a political climate that is more challenging than ever, one thing remains consistent—lawmakers are receptive to the voice of their constituents.
When legislators want to understand the effects of policies and issues, they depend on constituents to explain the problem and offer solutions. Therefore, it is imperative that surgeons use their voices when it comes to matters related to the medical profession and the care of their patients.
Although some might find the thought of becoming an advocate intimidating, surgeons only need a desire to make an impact, according to Amy Liepert, MD, FACS. “Advocacy is teaching,” she said. “It’s using your training, expertise, and influence as a respected member of society.”
ACS members often hear about advocacy initiatives at the federal level; the College is also very active at the state level.
In 2025, the ACS tracked approximately 1,500 state bills. The following is a summary of activities.
State Advocacy Days
In 2025, ACS chapters planned and participated in state advocacy days in California, Delaware, District of Columbia, Florida, Indiana, New York, Tennessee, Virginia, and Wisconsin. Surgeons met with legislators at state capitol buildings about issues affecting their practices, patients, and businesses.
“Advocacy is a natural extension of our professional responsibility as surgeons. Just as we strive to achieve the best outcomes for our patients in the operating room, we must also stand up for our patients and profession at State houses across the country to ensure safe, timely, and equitable surgical care through policymaking and sustained advocacy,” said Kevin Koo, MD, MPH, FACS.
Prior Authorization
137 bills tracked
38 enacted
Improving health insurance prior authorization requirements to ensure timely access to care for patients remains a priority for the ACS. Prior authorization requirements interrupt care, divert resources from patients, and complicate medical decision-making.
The Texas “Gold Card” law made headlines when it was enacted in 2021 and again this past spring when the Texas Department of Insurance released a report showing only 3% of healthcare professionals received the prior authorization gold card.1 To achieve gold card status, health insurers must approve at least 90% of prior authorization requests. Texas enacted a law this year to extend the evaluation period for prior authorization exemption eligibility from 6 months to 1 year, and it requires health insurers to release an annual report detailing how many exemptions they have granted or denied.
At least nine other states enacted gold card laws.2 However, making the process more transparent and efficient on the insurer side would allow physicians to see their progress in trying to achieve gold card status.
Most prior authorization bills introduced in states share the following provisions:
- Prohibit or limit the use of artificial intelligence in denying prior authorization
- Establish shorter timeframes for insurers to respond (24 hours for urgent care, 48 hours for nonurgent care)
- Require the reviewing physician be licensed in the same state and have relevant experience with the specific medical condition
- Prohibit retroactive denials if care was pre-authorized and services were provided
- Make prior authorization valid for at least 1 year or the length of treatment for a chronic condition
- Require public release of prior authorization data to a state agency or on the insurer’s website (i.e., total number of monthly prior authorization requests, the number of prior authorization requests approved/denied per month)
- Require electronic submission or an online portal for prior authorization requests
Several states passed multiple prior authorization bills this year. For example, Montana enacted four pieces of legislation that:
- Prohibit a health insurer from rescinding prior authorization once the medical service is provided
- Require health insurers to use a state-licensed physician with a specialty relevant to the condition under review to make adverse determinations and grievance reviews
- Ensure approvals for chronic conditions last for the duration of the condition
- Require health insurers to honor prior authorizations for at least 90 days when enrollees switch plans
This piecemeal legislative approach suggests legislators are willing to take incremental steps to change their prior authorization laws.
Medical Liability Reform
110 bills tracked
14 enacted
Trial attorneys put surgeons on defense again this year with legislation seeking to remove caps on noneconomic damages and allowing more plaintiffs to join in a malpractice action. Many bills were defeated, and a few states were able to enact tort reforms this year.
The ACS Florida Chapter strongly opposed a bill removing a prohibition on recovery of noneconomic damages in medical negligence cases by the decedent’s children 25 years of age and older, as well as parents of a deceased child who was 25 years of age or older at the time of death. Chapter leaders successfully lobbied Governor Ron DeSantis (R) to veto the bill on June 2.
Georgia enacted a bill addressing how and when noneconomic damages can be introduced in court, limiting the recovery of special damages to the actual cost of medical expenses paid and allowing bifurcation of the trial. Bifurcation in medical malpractice trial means that first the jury decides if the defendant’s negligence caused the injury, then it decides how much compensation the injured party should receive. Governor Brian Kemp (R) signed the bill into law on April 21.
For the third year in a row, the Grieving Families Act failed to pass in New York. This legislation would expand the type of damages recoverable in a wrongful death action. The ACS New York Chapter and the College worked together using SurgeonsVoice to encourage surgeons to send emails to their state legislators opposing the bills. Governor Kathy Hochul (D) vetoed the bill again, but it is expected to be reintroduced.
Utah legislators enacted a law requiring plaintiffs to submit an affidavit of merit in professional liability cases. Many states require an affidavit of merit be filed early in a medical malpractice lawsuit to ensure there is a legitimate basis for the claim before it proceeds. This bill also capped the total amount of damages a claimant can receive to $1 million, except in cases involving death. Governor Spencer Cox (R) signed the bill into law on March 27.
Noncompete/Restrictive Covenants
34 bills tracked
4 enacted
Restrictive covenants are used to protect an employer’s interests by restricting when and where the employee can relocate for work, limiting a physician’s ability to practice medicine within a specified time period and geographic area.
Legislators in Arkansas, Indiana, and Wyoming enacted laws voiding restrictive covenant agreements in physician contracts entirely. In Texas, the law limits restrictive covenants to 1-year post employment, within a 5-mile radius from the former employer’s primary practice location, and includes a buyout option.
International Medical Graduates/Foreign-Trained Physicians
32 bills tracked
12 enacted
State legislators are researching ways to provide licensure pathways for internationally trained physicians (ITPs) and international medical graduates (IMGs). According to the Federation of State Medical Boards (FSMB), 18 states enacted legislation allowing qualifying ITPs to receive full licensure without accredited postgraduate training (PGT), and three states have licensure pathways for limited licensure without any additional graduate medical education.3
Several states enacted laws allowing ITPs to be licensed without completing PGT, and most states offer a limited license with the potential to convert to a full, unrestricted license.
The Advisory Commission on Additional Licensing Models—co-chaired by the FSMB, Accreditation Council for Graduate Medical Education, and Intealth—was established in December 2023 to guide and advise state policymakers.4 ACS staff continue to monitor state and federal requirements for IMGs and ITPs.
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