This bill repeals specific Affordable Care Act provisions that limited Medicare exceptions to the prohibition on certain physician referrals to hospitals.
Beth Van Duyne
Representative
TX-24
The Patient Access to Higher Quality Health Care Act of 2025 aims to repeal specific provisions within the Affordable Care Act and related legislation that limited exceptions to the prohibition on certain physician referrals to hospitals under Medicare. This action effectively restores pre-ACA rules regarding physician referrals for hospital services. The bill focuses on modifying existing Medicare regulations concerning physician-hospital relationships.
Proposed Health Act Repeals Medicare Physician Referral Limits, Reverting to Pre-2010 Rules
The “Patient Access to Higher Quality Health Care Act of 2025” has one clear, immediate goal: to roll back specific parts of the Affordable Care Act (ACA) and related 2010 health laws. This bill isn’t adding new programs or creating new benefits; it’s hitting the delete button on regulations that govern how doctors can refer Medicare patients to hospitals.
Back to the Future: The Referral Rule Reset
Section 2 of this bill specifically repeals Sections 6001 and 10601 of the ACA, along with Section 1106 of the 2010 Health Care and Education Reconciliation Act. What did those sections actually do? They tightened up the rules around physician self-referrals—the practice of a doctor referring a patient to a facility (like a hospital or clinic) in which the doctor has a financial stake. The ACA provisions were designed to limit exceptions to the existing ban on these referrals, particularly within the Medicare system, to curb conflicts of interest and reduce unnecessary spending. By repealing these sections, the bill essentially restores the less restrictive rules that existed before 2010.
What This Means for Your Healthcare
If you’re a Medicare beneficiary, this change matters because it directly affects who decides where you get care. The provisions being repealed were put in place to protect patients from being steered toward higher-cost services or facilities simply because their doctor stood to make more money from the referral. For example, before 2010, it was easier for a doctor who was part-owner of a specialized surgical hospital to refer their Medicare patients there, even if a comparable, lower-cost option was available elsewhere. This move reopens the door to those kinds of financial incentives.
The Cost of Conflicts of Interest
When doctors have a financial stake in where they send patients, studies have shown that utilization—the number of tests, procedures, and services ordered—often goes up. This isn't just a theoretical problem; it’s a cost problem. Increased utilization drives up the overall cost of the Medicare program, which eventually impacts taxpayers and beneficiaries through higher premiums and deductibles. This bill removes a regulatory guardrail intended to prevent this kind of potential waste and fraud. While proponents of deregulation often argue it provides physicians with greater flexibility, the practical challenge is ensuring that financial incentives don't overshadow a patient’s best medical interest, especially when dealing with a publicly funded program like Medicare.