Advocacy is a defining pillar of leadership for the American Association of Neurological Surgeons (AANS) and for the neurosurgical community it represents. It reflects a fundamental truth: the ability to deliver timely, high-quality neurosurgical care depends not only on clinical skill and innovation, but also on the policies, payment systems and regulatory frameworks that shape modern health care. Effective advocacy is therefore inseparable from improved treatment pathways and better patient outcomes.
Decisions made in Congress, federal agencies, state legislatures and by private insurers have direct and often immediate consequences for patients with neurological disease. Prior authorization requirements can delay urgent surgeries. Inadequate reimbursement that fails to keep pace with medical inflation threatens the sustainability of complex, high-acuity services. Workforce policies and training standards influence whether communities will have access to neurosurgical care in the years ahead. Organizational leadership in advocacy means ensuring that clinical expertise, data, and an understanding of the real-world consequences for patients and families inform these decisions.
The AANS has demonstrated this leadership over decades through sustained investment in a comprehensive advocacy infrastructure. The AANS/CNS Washington Committee, which recently celebrated its 50th anniversary, stands as a testament to the profession’s long-standing commitment to constructive engagement with policymakers and thoughtful federal health policy leadership. NeurosurgeryPAC, which recently marked its 20th anniversary, reinforces the importance of ensuring neurosurgery has a credible, bipartisan and consistent voice in the political process. NeurosurgeryPAC’s mission is simple: support candidates for federal office who support neurosurgeons. Complementing these efforts, the AANS/CNS Council of State Neurosurgical Societies coordinates advocacy at the state level, where many practice-defining decisions are made. Together, these entities enable neurosurgery to lead proactively rather than respond reactively.
Current advocacy priorities reflect both patient needs and the evolving realities of practice.
Reforming Prior Authorization. The AANS is working tirelessly to rein in abusive insurance company tactics, particularly prior authorization processes that delay medically necessary care and disrupt treatment pathways. The Washington Committee has been leading the charge in advancing regulations and legislation to reform prior authorization in the Medicare Advantage (MA) Program, collaborating with the Regulatory Relief Coalition on this initiative. The U.S. Department of Health and Human Services has implemented regulations to streamline prior authorization in MA, Medicaid, and other plans it regulates. Additionally, with 65 co-sponsors in the U.S. Senate and 249 in the House of Representatives, momentum is building in Congress to pass the Improving Seniors’ Timely Access to Care Act (S. 1816/H.R. 2514). This legislation would curb excessive prior authorization requirements in MA by streamlining approvals, increasing transparency and ensuring seniors receive medically necessary care without harmful delays.
Sustaining Neurosurgical Practices. The AANS continues to advocate for reform of the Medicare physician payment system to better reflect rising practice costs and medical inflation. We are working to advance legislation that reflects organized medicine’s principles for reform. Leading the way with our coalition partners, including the Alliance of Specialty Medicine, the AANS has endorsed H.R. 6160, the Strengthening Medicare for Patients and Providers Act, which would provide an annual inflationary update for Medicare physician payment tied to the Medicare Economic Index. In addition, the AANS is leading efforts to ensure that health plans appropriately reimburse neurosurgeons for out-of-network care, including support for the No Surprises Act Enforcement Act (S. 2420/H.R. 4710). Finally, consolidation in the health care system has resulted in less competition, fewer choices and higher health care costs. To ensure that neurosurgeons have a full range of practice options, the AANS has been working with Physician-Led Healthcare for America to advance policies that improve competition in health care, including efforts to repeal Section 6001 of the Affordable Care Act, which would allow neurosurgeons to own hospitals and help sustain viable private practices.
Funding Research and Education. Equally critical, the AANS champions expanded federal research funding to drive innovation and advance cures for neurological disease — ensuring tomorrow’s breakthroughs build on today’s discoveries. Our own Neurosurgery Research & Education Foundation (NREF) is a key partner in augmenting scarce research dollars. Indeed, approximately 30% of NREF grantees also receive funding from the National Institutes of Health, and since NREF’s inception, this has translated into more than $350 million in funding. Addressing physician workforce shortages and ensuring the profession remains in the driver’s seat in setting residency training standards are also central priorities that directly affect access to care, quality and patient safety. Partnering with the Association of American Medical Colleges and the GME Advocacy Coalition, the AANS has backed the Resident Physician Shortage Reduction Act (S. 2439/H.R. 4731), which would provide funding for an additional 14,000 Medicare-supported residency positions and help ensure the country has enough physicians — including neurosurgeons — to meet patients’ needs.
Through advocacy, AANS recognizes that leadership extends well beyond the operating room. By shaping the systems that govern care delivery, advocacy protects neurosurgeons’ ability to provide timely, lifesaving and life-changing care — today and for generations to come. Please join the AANS on this advocacy journey by contributing to NeurosurgeryPAC each year and adding your voice to the public policy process. Together, we can make a difference.
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For more information, visit https://www.aans.org/advocacy/
Katie O. Orrico, Esq., serves as the AANS CEO and has represented organized neurosurgery for 40 years.
