Why It Matters

Emergency physicians are navigating a policy environment that touches nearly every corner of federal health law. Medicare reimbursement rates have failed to keep pace with practice costs, the No Surprises Act remains incompletely enforced, and the legal status of mandated emergency abortion care under the Emergency Medical Treatment and Labor Act is unresolved following inconclusive Supreme Court action.

By the Numbers

The American College of Emergency Physicians (ACEP) disclosed $468,727 in first quarter 2026 lobbying expenditures, covering a broad agenda that spans physician payment reform, opioid policy, workplace violence, and the ongoing implementation of the No Surprises Act. The in-house lobbying disclosure filings reflect a slight dip from the fourth quarter 2025, when ACEP's in-house team reported $501,071, but remain consistent with the organization's sustained engagement on Capitol Hill.

This is one of two first quarter 2026 lobbying disclosure filings from ACEP. The second, filed by outside lobbying firm Capitol Counsel LLC, reported $50,000 in activity for the same period, bringing ACEP's combined First Quarter 2026 federal lobbying filings to $518,727.

ACEP has maintained this dual-track approach across recent quarters, with in-house lobbyists handling the larger share of activity, with Capitol Counsel supplementing on specific legislative priorities. Over the past year, ACEP's in-house filings alone total $1,765,934 across four quarterly disclosures, according to disclosure lobbying revenue data.

The in-house lobbying team is led by registered lobbyist Laura Wooster, who has appeared on ACEP's federal lobbying filings continuously since at least the first quarter 2024. She is joined by Fred Essis, Ryan McBride, Jeanne Slade, and one additional lobbyist whose name does not appear in the disclosure. Ryan McBride previously served as a legislative assistant to Rep. Joseph J. Heck (R-NV-3) and worked in the office of Rep. Jon Porter, giving the team some Republican congressional experience. Fred Essis interned with the House Budget Committee during the 115th Congress.

The Capitol Counsel lobbying firm client portfolio for ACEP in the first quarter 2026 includes Shannon Finley, Karen Stone, Luke Hatzis, Ann Jablon, John Martin, Jeff Carroll, and Chad Michaels, the same team that has represented ACEP through Capitol Counsel since at least the Second Quarter 2025.

Quarter-over-quarter, ACEP's in-house spending declined approximately six and a half percent from the fourth quarter 2025 figure of $501,071. That fourth quarter figure was itself the highest single-quarter total in the trailing year, up from $408,597 in the third quarter 2025 and $387,539 in the second quarter 2025.

The Agenda

ACEP's first quarter 2026 lobbying disclosure filings cover thirteen distinct issue areas. The breadth reflects the organization's position as the primary advocacy voice for roughly 40,000 emergency physicians. Key items on the agenda include:

  • Physician payment reform — Medicare reimbursement rates for emergency physicians have been a persistent pressure point. At a January 2026 meeting, Rep. Brian Fitzpatrick (R-PA-1) described discussing the Medicare Physician Fee Schedule and practice expense pressures directly with ACEP President Dr. Anthony Cirillo.
  • No Surprises Act implementation — ACEP has stated it "strongly supports" the No Surprises Enforcement Act, legislation aimed at holding insurers accountable for violations of the surprise billing law. Federal regulators have continued to extend enforcement discretion on how insurers calculate the Qualified Payment Amount benchmark.
  • Reproductive health, physician-patient relationship, and EMTALA — The legal obligation of emergency departments to provide stabilizing care, including in obstetric emergencies, remains contested following the Supreme Court's inconclusive handling of the Idaho EMTALA case.
  • Opioids, pain management, and the POWER program — ACEP is seeking federal appropriations to implement the "Preventing Overdoses While in Emergency Rooms" program, which supports overdose prevention protocols in emergency departments.
  • Fentanyl analogues scheduling extension — Congress passed and President Trump signed the HALT Fentanyl Act in July 2025, permanently scheduling fentanyl-related substances. ACEP continued to list this as an active lobbying item in the first quarter 2026.
  • H.R. 2028 — REDI Act — This bill would allow medical and dental residents to defer student loan interest during training. It was referred to the House Committee on Education and Workforce in March 2025 and remains pending.
  • H.R. 2992 — Preventing Roadside and Work Zone Deaths Act — ACEP has lobbied on this transportation safety bill, which would require the Department of Transportation to collect crash data on disabled roadside vehicles and work zone incidents. The bill was referred to the Subcommittee on Highways and Transit in April 2025.
  • Workplace violence prevention for health care workers — ACEP is listed as a supporter of the Save Healthcare Workers Act (S. 1600), introduced in the Senate in May 2025.
  • Federal funding for emergency medicine research and firearms safety and injury prevention research
  • Updating first aid kits and flight crew training requirements on commercial aircraft
  • Access to emergency medical supplies during public health emergencies

Broader Context

In a March 2026 hearing titled Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape, a witness cited ACEP's data on emergency department admissions in the context of healthcare transparency, noting that ACEP puts the relevant figure at up to 70 percent. The hearing touched on systemic cost drivers that intersect with ACEP's physician payment and No Surprises Act lobbying.

Multiple members met with ACEP President Dr. Cirillo in late 2025 and early 2026. Rep. Kim Schrier (D-WA-8) discussed Medicare access protections in November 2025. Rep. Mariannette Miller-Meeks (R-IA-1) met with Cirillo about ER wait times and rural emergency care access. Sen. Andy Kim (D-NJ) hosted ACEP at a Capitol Coffee hour in April 2026.

On EMTALA, Rep. Schrier joined Democratic colleagues in June 2025 to push back against the Trump administration's decision to rescind EMTALA guidance, calling it "yet another example of their attack on our health care."

Competitive Landscape

Several other medical organizations are lobbying on the same legislation as ACEP. On the REDI Act, ACEP is joined by the American Medical Association, American Dental Association, American Psychiatric Association, American College of Cardiology, American Congress of Obstetricians and Gynecologists, and others. On the Preventing Roadside and Work Zone Deaths Act, ACEP shares the field with the American Automobile Association, the National Asphalt Pavement Association, and the Associated General Contractors of America.

The Bottom Line

ACEP's first quarter 2026 lobbying activity reflects a well-established, consistent operation that has maintained a heavy presence in federal lobbying filings across multiple years. The agenda has remained largely stable quarter over quarter, centered on payment reform, surprise billing enforcement, EMTALA, and opioid policy. Spending dipped modestly from the prior quarter but remains in line with the organization's recent trajectory. The dual in-house and outside-firm structure has been in place throughout the period covered by available data.

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