Advocacy & Public Policy

Kidney Health Advocacy

A Message From ASN President Prabir Roy-Chaudhury, MD, PhD, FASN

Dear Colleague:

As 2025 and my term as President of the American Society of Nephrology (ASN) comes to a close, I want to wish each and every one of you all the very best for the New Year.

The best part by far of my year as ASN President was that I was able to meet so many ASN members in this country and across the globe. I have nothing but the utmost respect and admiration for all that you do for your patients, for kidney science, and for our specialty. ASN has an outstanding leader in Samir Parikh, who will succeed me as ASN President tomorrow, and I know that Samir and you will do great things together. Finally, I want to thank all of you for your support, advice, and friendship during the last year. Without question, serving as ASN President has been the greatest honor and privilege of my professional life.

I am also pleased to share with you this month's advocacy update, which summarizes the many policy accomplishments in 2025. These efforts reflect the dedication of the ASN Council, ASN Health Care Justice Committee, ASN Policy and Advocacy Committee, ASN Quality Committee, and ASN Transplant Policy Committee, as well as the engagement of the society's members across the kidney community. Throughout 2025, ASN remained steadfast in advancing kidney health by defending research and innovation, promoting health equity, strengthening the workforce, and influencing policy to improve care for people living with kidney diseases.

1) Advancing Kidney Research and Innovation
ASN advocated for sustained federal investment in kidney research. ASN called on Congress to uphold its commitment to KidneyX by including $25 million in Fiscal Year 2026 funding to accelerate development of the world's first artificial kidney and advance prevention, diagnostics, and therapies. Responding to ASN's advocacy, both House and Senate appropriators included funding for KidneyX in their draft 2026 spending bills and called for "robust support for kidney research at NIDDK," encouraging NIDDK research into chronic kidney diseases and disparities in access to kidney transplantation.

ASN also urged Congress to preserve scientific research funding by opposing proposed cuts to the U.S. Department of Health and Human Services, the Centers for Disease Control (CDC) and Prevention, and the National Institutes of Health, while emphasizing the importance of vaccination access and data transparency. In addition, ASN released Transforming Kidney Health Research: A Research Agenda for the Future, a landmark report calling for $1.8 billion annually in federal investment to accelerate research, discovery, and prevention for the 37 million Americans living with kidney diseases.

2) Defending the Nephrology Workforce and Supporting International Medical Graduates
Because international medical graduates comprise approximately 50 percent of the nephrology workforce, ASN engaged extensively on immigration and visa policy. ASN urged the U.S. Department of Homeland Security to exempt physicians from a $100,000 H-1B petition payment, opposed a proposed weighted H-1B lottery system, and responded to the U.S. Department of State's pause on J-1 visa processing. ASN also strongly opposed proposals to end the "duration of status" framework for J-1 health care professionals, warning that these actions would destabilize training programs, increase administrative burden, and threaten access to kidney care nationwide. As part of a broader project with the Migration Policy Institute, ASN issued, "Data Detail: IMG Training and Practice Pathways," a comprehensive analysis of the complex pathways IMG nephrologists must navigate to train and practice in the United States.

ASN also continued to advocate for adequate physician reimbursement. In response to this year's proposed Medicare Physician Fee Schedule, ASN expressed concern about the growing gap between physicians' practice costs and Medicare payments and called for permanent baseline updates to the conversion factor that more accurately reflect increases in practice expenses, as measured by the Medicare Economic Index. In addition, ASN raised concerns about proposed changes to the practice expense methodology, noting the potential negative impact on nephrologists whose care is primarily facility based, including pediatric, transplant, and tertiary care providers who lack office-based services to offset reductions in facility-based payments. Finally, ASN urged the Centers for Medicare & Medicaid Services (CMS) to reconsider its proposal to apply a 2.5 percent efficiency adjustment to work relative value units and the corresponding intra service physician time.

3) Promoting Health Equity and Improving Data Collection
Health equity remained a central priority for ASN advocacy. ASN's Health Care Justice Committee received a $100,000 grant to support Encoding Equity: ASN eGFR Toolkit 2.0, an initiative designed to update the ASN eGFR Toolkit and address persistent misconceptions about the removal of race from estimated glomerular filtration rate calculations and improve best practices in clinical care.

ASN also urged CMS to reinstate collection of race and ethnicity data on Form CMS-2728 (End-Stage Renal Disease Medical Evidence Report). In concert with other members of the kidney community, ASN emphasized the critical role of demographic data in identifying disparities and improving outcomes for people with kidney diseases.

4) Strengthening Transplant Policy and Living Donor Protections
ASN advocated for policies that expand access to kidney transplantation and protect living donors. In supporting the reintroduction of the Living Donor Protection Act (H.R. 4582 and H.R. 4583) and the Senate companion bill (S.1552), ASN advocated for legislation that would codify family and medical leave protections for living donors, prohibit insurance discrimination, and strengthen education about organ donation. ASN also urged the Health Resources and Services Administration (HRSA) to strengthen pre-waitlisting referral and evaluation data collection

In addition, ASN was instrumental in the introduction of the Honor Our Living Donors (HOLD) Act, which would shift eligibility determination for reimbursement from the organ recipient to the living donor. The society was also influential in securing Congressional confirmation that HRSA can continue to collect patient waitlist registration fees, crucial to the continual functioning of the U.S. transplant system. Moreover, ASN collaborated with Rep. Beth Van Duyne and Congressional Kidney Caucus co-chair Rep. Suzan Del Bene on the introduction of legislation that would require organ procurement organizations (OPOs) to get automated electronic referrals from donor hospitals.

ASN also successfully advocated for appropriations language that:

• Prioritizes the development of a modern, dynamic organ candidate matching technology system
• Increases funding for HRSA's living donor reimbursement program
• Uses organ tracking technology to provide OPOs real-time updates on an organ's location to improve safety and efficiency

5) Elevating Kidney Health in Preventive and Global Health Policy
ASN joined leading medical societies in urging Congress to protect the independence of the U.S. Preventive Services Task Force, emphasizing its vital role in ensuring access to evidence-based preventive care for people with or at risk for kidney disease. ASN also advanced kidney health on a global stage by urging United Nations Member States to support a World Health Organization resolution prioritizing kidney health and successfully advocating for the inclusion of kidney diseases in the Political Declaration of the 2025 United Nations High-Level Meeting on Noncommunicable Diseases and Mental Health. ASN commends the International Society of Nephrology (ISN) for its leadership in this effort. "The explicit inclusion of kidney health in the political declaration is a historic milestone, reflecting its growing recognition as a global health priority," said ISN President Marcello Tonelli, MD, MS, MSc.

Finally, lawmakers included numerous kidney and transplant care priorities for which ASN advocated in draft health care spending bills for fiscal year (FY) 2026. Ranging from calls for robustly funding kidney research funding at NIDDK, reiterating the importance of modernizing the transplant system and adopting technology that can improve our allocation system, bolstering focus on earlier kidney screening at CMS and CDC, and continuing to prioritize KidneyX, appropriators clearly heard the kidney community's voice. Thanking appropriators, ASN and the National Kidney Foundation penned a joint letter of appreciation last week that also urged lawmakers to ensure these foci and related funding priorities are included in final FY 2026 spending bill negotiations in January.

On behalf of ASN, thank you for your dedication to patients, to medicine, and to advancing kidney health. Looking ahead to the coming year, I encourage all members to remain engaged in ASN's advocacy efforts and to help advance ASN policy priorities via ASN's Legislative Action Center. Together, through ASN's advocacy efforts, we are making a meaningful difference for the kidney community and for millions of people living with kidney diseases.

Sincerely,

Prabir Roy-Chaudhury, MD, PhD, FASN
President

Advocating for Transformative Change

ASN—both individually and as a member of healthcare, medical, and scientific coalitions—routinely engages Congress and the Trump Administration, advocating for policies to create transformative changes in kidney health. ASN relies on its Health Care Justice Committee, Policy and Advocacy Committee, Quality Committee, and Transplant Policy Committee when formulating, prioritizing, and accomplishing annual policy priorities. A summary of ASN's most recent advocacy efforts follows—including for fiscal year (FY) 2026 kidney health research—in reverse chronological order.

Additional Advocacy Resources

February 2025: How Trump's Medical Research Cuts Would Hit Colleges and Hospitals in Every State (New York Times).

Council on Governmental Relations Facilities and Administrative Cost Reimbursement Advocacy Materials.

Association of American Medical Colleges Advocacy Resources on Facilities & Administrative (F&A) Costs:

• A fact sheet outlining key messages and a frequently asked questions overview.
• A comparison of foundations' support for F&A to government support.
• An infographic illustrating what types of expenses are and are not supported by F&A reimbursement.

January 2025: Research!America releases results of national survey showing Americans want President and Congress to assign higher priority to medical progress.