Capitol Hill Report

Advocacy

Read the Academy's bi-weekly update on legislative and regulatory advocacy for neurology.

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July 7, 2025

What’s in the big reconciliation bill?

We want to make sure you know we have your back. We’re actively responding, relentlessly pushing forward, and ensuring your voice is heard loud and clear on Capitol Hill. Please keep reading Capitol Hill Report—and tell your colleagues—for a rundown of how your AAN is in overdrive advocating on your behalf. We’re analyzing and monitoring all changes made by Congress and the administration to evaluate any impacts on neurology and the patients we serve. If your practice, research, or patients have been impacted by recent changes at the federal or state level, please let us know by emailing advocacy@aan.com.

Issue in focus

The One Big Beautiful Bill Act was signed into law on Friday, July 4, after weeks of intense negotiations. This lengthy reconciliation bill contains a number of health care provisions that may affect you and your patients. Read on for details on some of the key issues the AAN has been following. 

What is a reconciliation bill, and why does it matter? 
Reconciliation is a special budget law procedure that allows one expedited bill that only includes direct budgetary effects per fiscal year, which can pass the Senate with a simple majority rather than the usual 60-vote filibuster threshold. With Republicans winning unified control of Congress and the presidency, this process was central to the party’s legislative strategy. 

The House of Representatives drafted the first version of the bill, which passed in late May and was sent to the Senate for amendments and passage. The Senate changed various provisions in the bill before it passed its version last Tuesday, and the bill was sent back to the House for a final vote. The House passed the Senate bill days later without changes, sending the package to President Donald Trump’s desk for his signature. 

Medicare reimbursement 
The final package includes a 2.5% increase to the Medicare Physician Fee Schedule conversion factor for 2026. While this is not a comprehensive solution to longstanding issues with the physician payment system, this is a provision that costs money to support physicians in a bill that largely is focused on cost cutting. Its addition shows the impact of AAN advocacy, as the first proposed version of the Senate reconciliation bill did not include any positive increase to the fee schedule. 

The AAN will continue to work towards a long-term solution to Medicare payment reform. Conversations surrounding this issue have already been taking place amongst key congressional leaders, and we will continue to work with Congress on a meaningful solution. 

Other notable provisions  
The AAN has expressed concerns during the reconciliation process about the impacts of several provisions in the proposed bill language, and remains concerned about provisions ultimately passed that will impact: 

Medicaid 

  • Requires states that have expanded Medicaid to conduct eligibility determinations twice a year rather than annually
  • Amends eligibility for Medicaid and CHIP coverage among people who are not US citizens 
  • Limits retroactive Medicaid expansion coverage to one month prior to a person’s application date and retroactive traditional Medicaid coverage to two months prior
  • Prohibits, for one year after enactment, Medicaid funds from being paid to certain prohibited entities
  • Requires states to establish work requirements for low-income adults without dependents
  • Allows states to impose additional cost-sharing requirements for the Medicaid expansion population 

Federal support for student loans 

  • Terminates the authority to provide subsidized loans to undergraduate students or Federal Direct PLUS Loans to graduate or professional students after July 1, 2026
  • Caps loan limits for graduate and professional students at $100,000 and $200,000 respectively
  • Caps borrowing for parents up to $65,000 in Federal Direct PLUS loans, regardless of how many students the parent is borrowing for 

Our advocacy staff and thousands of member volunteers are dedicated to advocating for neurology. Interested in joining the conversation on these important issues? Find out how to get involved, whether you have a few minutes to contact your representative or can commit to a full day or more for events like Neurology off the Hill. 

 
Latest advocacy news

AAN partners on congressional briefing celebrating NINDS 
The AAN partnered with the American Brain Coalition (ABC) late last month to sponsor a congressional briefing celebrating 75 years of the National Institute of Neurological Disorders and Stroke (NINDS). As part of the NIH, NINDS is committed to furthering our understanding of the brain and nervous system to reduce the burden of neurological disease. The briefing featured a panel of researchers and caregivers who showcased the breakthroughs made possible through NINDS funding and underscored the need for strong, sustained funding to build on this progress. 

AAN reviewing new CMS WISeR model 
The Centers for Medicare & Medicaid Services Innovation Center recently announced the Wasteful and Inappropriate Service Reduction (WISeR) Model, which expands prior authorization in Medicare fee-for-service for a number of procedures, including electrical nerve stimulator implants, skin and tissue substitutes, and knee arthroscopy for knee osteoarthritis. The model is set to go into effect on January 1, 2026, and providers in the six selected states will have the choice of either submitting a prior authorization request for the model’s selected items and services or going through a post-service/pre-payment review. The AAN is currently reviewing this model’s impact on neurological care delivery. 

New AAN position statement on novel therapies 
The AAN recently published a new position statement, This statement provides guidance to policymakers on a variety of therapies that may have neurological treatment benefits, but for which available evidence is limited or for which there is no FDA-approved indication.  


What we're reading

  • CMS study: Healthcare spending likely to grow by 7.1% in 2025 ()

  • How Fast Is Too Fast for FDA Drug Review? (Op-ed, )  

  • Global Health, Research and Trump Dominate Aspen Ideas: Health Conference ()  

Past Capitol Hill Reports

2025

2024

2023

2022