Federal Legislative Update (2011-10)

Below is the federal legislative and regulatory update for the legislative committee of the Society of Surgical Oncology (SSO). The Advocacy and Health Policy Division of the American College of Surgeons compiled the information in this report.


ACS Leaders Brief Members of Congress and Key Congressional Staff Regarding ACS Inspiring Quality Initiative, Success of ACS Quality Programs

On May 24, ACS leaders met with 17 key members of Congress and their staff on Capitol Hill to brief them on the American College of Surgeons' Inspiring Quality initiative. The College also reaffirmed its position as a leader in developing real-world models and programs that improve patient outcomes and lower costs by reducing preventable complications. The ACS leaders participating in the meetings included: L.D. Britt, MD, MPH, FACS, ACS President; Carlos Pellegrini, MD, FACS, Chair, ACS Board of Regents ; David Hoyt, MD, FACS, ACS Executive Director; J. David Richardson, MD, FACS, Member of the ACS Board of Regents; Clifford Ko, MD, FACS, Medical Director, Division of Research and Optimal Patient Care, Don Detmer, MD, FACS, Medical Director, Division of Advocacy and Health Policy, and Frank Opelka, MD, FACS, Assistant Medical Director, Division of Advocacy and Health Policy. DAHP staff accompanied ACS leaders to the meetings. Meetings included the following Senate and House offices:

  • Sen. Max Baucus (D-MT), Chair, Senate Committee on Finance
  • Sen. Ben Cardin (D-MD), Member, Senate Committee on Finance
  • Sen. Robert Casey (D-PA)
  • Sen. Orrin Hatch (R-UT), Ranking Member, Senate Committee on Finance
  • Sen. Mark Kirk (R-IL)
  • Sen. Mitch McConnell (R-KY), Senate Minority Leader
  • Sen. Patty Murray (D-WA), Chair, Democratic Senatorial Campaign Committee
  • Sen. Harry Reid (D-NV), Senate Majority Leader
  • Sen. Mark Warner (D-VA)
  • Rep. John Boehner (R-OH), Speaker of the House
  • Rep. Dave Camp (R-MI), Chair, House Committee on Ways and Means
  • Rep. Eric Cantor (R-VA), House Majority Leader
  • Rep. Steny Hoyer (D-MD), House Minority Whip
  • Rep. Kevin McCarthy (R-CA), House Majority Whip
  • Rep. Pete Session (R-TX), Chair, National Republican Congressional Committee
  • Rep. Pete Stark (D-CA), Ranking Member, Ways and Means Subcommittee on Health
  • Rep. Fred Upton (R-MI), Chair, House Committee on Energy and Commerce

On May 27, Drs. Britt, Pelligrini, and Hoyt sent an email alert to Fellows informing them of the visits and of the College's continued commitment to continuous quality improvement in surgical care.

ACS and Physician Organizations Call on White House and Congress to Address Medicare Physician Payments in Debt Ceiling Legislation

On June 27, 113 national and state physician societies and organizations, including the College, sent a letter to the President, Vice-President, Speaker of the House, the Senate and House Majority and Minority Leaders, and other key congressional leaders expressing support for including measures to address the Medicare physician payment system in the context legislation to reduce the deficit and raise the debt ceiling. Following the letter, ACS staff, along with the staff of several physician organizations, met with key Representatives and their advisors to discuss the physician community's support for including a permanent fix to the SGR in the deficit reduction package.

As a part of this advocacy effort, on July 25, the College joined with 10 additional physician organizations in releasing a video via the web that stressed the importance of addressing the SGR in the near-term. The video highlighted how if short-term measures to address the SGR continue that the cost to the federal treasury and to taxpayers will continue to rise.

ACS Praises Bipartisan Deficit Reduction Efforts, Inclusion of Provisions to Address Medicare Payments

On July 19, the Senate Bipartisan "Gang of 6," which had been convened by 3 Democratic and 3 Republican Senators, announced that they had reached an agreement on a deficit reduction package, which included a full repeal of the SGR. At the time, it was thought that the agreement might be the framework that would lead to an agreement on legislation to raise the debt ceiling. The bipartisan group included the following six Senators: Sen. Saxby Chambliss (R-GA), Sen. Kent Conrad (D-ND), Sen. Tom Coburn (R-OK), Sen. Mike Crapo (R-ID), Sen. Dick Durbin (D-IL) and Sen. Mark Warner (DVA).

In response to the announced agreement, the College issued a joint statement along 16 other physician organizations "[commending] the Senate Bipartisan "Gang of 6" for recognizing that reform of the Medicare physician payment formula - specifically a full repeal of the sustainable growth rate formula- must be included in deficit reduction legislation." The package ultimately did not garner sufficient support in Congress, and Congress approved an alternative deficit reduction package, which included provisions to increase the debt ceiling.

In Midst of Uncertainty, ACS Leaders Warn Fellows about Potential Implications of Debt Ceiling on Medicare Payments

As part of the ongoing effort to inform Fellows about the implications of discussions regarding the debt ceiling, ACS leadership on July 26 issued an email warning to all Fellows about the possible implications for Medicare reimbursement if Congress and the White House failed to reach an agreement on legislation to raise the debt ceiling. The message warned Fellows that if the debt ceiling was not raised that there was the possibility that Medicare payments may not be paid. The message was signed by L.D. Britt, MD, FACS, ACS President; Carlos Pellegrini, MD, FACS, Chair, ACS Board of Regents; Andrew Warshaw, MD, FACS, Chair, ACS Health Policy and Advocacy Group; and David Hoyt, MD, FACS, ACS Executive Director.

Congress Passes, President Signs Legislation to Raise the Debt Ceiling and Create Deficit Reduction Committee, Outlook for Medicare Payments Uncertain

On August 2, President Obama signed legislation to raise the debt ceiling and to reduce the deficit into law. The Budget Control Act (BCA) of 2011 (S. 365) was passed by the House on August 1 and Senate passage followed on August 2.

The legislation also included provisions to reduce federal discretionary spending by over $1 trillion over the next 10 years. In addition, S. 365 created a Joint Select Committee on Deficit Reduction tasked with cutting an additional $1.2 trillion to $1.5 trillion in federal spending over the next 10 years. The committee has broad authority to consider spending cuts, taxes, and other changes across both discretionary and mandatory government programs, including Medicare, Medicaid, and programs created under the Affordable Care Act last year. If the Committee and ultimately Congress is not successful in reaching an agreement to reduce federal spending by at least $1.2 trillion over the next 10 years, the BCA would require the sequestering of 2% of federal outlays effective in 2013. This sequester would impact several programs, including Medicare, and if left in place as is, would result in additional cuts to Medicare physician payments, on top of already scheduled payment cuts, in 2013. If the Committee reaches an agreement on a deficit reduction package smaller than $1.2 trillion then the 2 percent sequester would be reduced proportionately.

Should a majority vote of the Committee approve an agreement on a deficit reduction package, the Committee's recommendations would be forwarded to the full Congress for votes in the House and Senate. Should the Committee reach an agreement, the BCA provides for the expedited consideration of the package in both houses of Congress, meaning that procedural measures will not be able to either delay consideration. In addition, the BCA allows for passage in both chambers to be secured with simple majority votes-as opposed to the supermajorities that can sometimes be required for passage in the Senate.

Before the Joint Select Committee can forward its recommendations to the full Congress, those recommendations must be approved by a majority vote. Policy experts have expressed concerns about whether the committee will be able to develop consensus around a particular deficit reduction plan. The BCA requires to the Committee to vote on its recommendations by November 23, 2011. Assuming the Committee approves an agreement, the BCA requires lawmakers in both houses of Congress to vote on the Committee's bill by December 23, 2011. In August, it was announced that the Joint Select Committee will be co-chaired by Sen. Patty Murray (D-WA), who serves on the Senate Budget Committee, the Senate Health, Education, Labor & Pension (HELP) Committee, and the Senate Appropriations Committee, and Rep. Jeb Hensarling (R-TX), Chair of the House Republican Conference and a member of the House Financial Services Committee. The other members include Sen. Max Baucus (D-MT), Chair of the Senate Finance Committee; Sen. John Kerry (DMA), a member of the Senate Finance Committee; Sen. Jon Kyl (R-AZ), the Assistant Republican Leader and a member of the Senate Finance Committee; Sen. Pat Toomey (R-PA), a member of the Senate Budget Committee; Sen. Rob Portman (R-OH), also a Senate Budget Committee member and former Director of the Office of Management and Budget; Rep. Dave Camp (R-MI), Chair of the House Ways and Means Committee; Rep. Fred Upton (R-MI), Chair of the House Energy and Commerce Committee; Rep. James E. Clyburn (D-SC), the House Assistant Democratic Leader; Rep. Xavier Becerra (DCA), Vice-Chair of the House Democratic Caucus and a member of the House Ways and Means Committee; and Rep. Chris Van Hollen (D.-Md.), the Ranking Member of the House Budget Committee. The appointments to the Committee were made by party leaders in the House and Senate.

ACS Meets with Key Congressional Committees about ACS Quality Efforts and Role in Medicare Payment Reform, ACS Letter to Deficit Committee Highlights Quality Efforts, Need to Repeal SGR

On August 31, David B. Hoyt, MD, FACS, ACS Executive Director; Don Detmer, MD, FACS, Medical Director for the ACS Division of Advocacy and Health; Frank Opelka, MD, FACS, Assistant Medical Director for the ACS Division of Advocacy and Health Policy; and ACS DAHP staff met with key advisors to Rep. Dave Camp (R-MI), Chair of the House Committee on Ways and Means, and to Sen. Max Baucus (D-MT), Chair of the Senate Committee on Finance, to discuss the College's commitment to optimal care and how the ACS quality improvement programs, such as the ACS National Surgical Quality Improvement Program (ACS NSQIP®), the Commission on Cancer, and the Committee on Trauma,can help improve outcomes and lower costs. Drs. Hoyt, Detmer and Opelka also discussed the College's support for repealing the SGR and how the College believes that ACS quality improvement efforts can help achieve Medicare payment reform that improves outcomes and lowers health care costs.

On August 31, Dr. Hoyt also participated in a conference call hosted by Rep. Wally Herger (R-CA), Chair of the House Ways and Means Subcommittee on Health. The call was part of a series of calls hosted by Rep. Herger with the a working group of 12 Ways and Means Republican Members, including Rep. Tom Price, MD, FACS, and Rep. Charles Boustany, MD, FACS, that have been tasked with developing legislation to replace the SGR with a new Medicare payment formula and system. During the call, Dr. Hoyt provided a presentation of the College's quality improvement programs and how the College believes that these efforts can help achieve Medicare payment reform that improves outcomes and lowers costs. On September 1, the College sent letters to the twelve members of the Joint Select Committee on Deficit Reduction advocating for the elimination of the Sustainable Growth Rate (SGR), and offering the College's proven quality programs as models of how Congress can reduce costs, prevent complications, and improve quality.

Utah Surgeons Host Key Finance Committee Staff for Discussion of ACS Quality Programs

On August 23, health policy advisors to Sen. Orrin Hatch (R-UT), the Ranking Republican Member of the Senate Finance Committee, participated in a meeting at the University of Utah Hospital and Clinics, Salt Lake City. The meeting included presentations and a discussion of how ACS NSQIP has helped to improve surgical outcomes at the university hospital and at Intermountain Medical Center in Murray, Utah. ACS Fellows participating in the meeting included the following surgeon from the University of Utah: Leigh Neumayer, MD, FACS, Member of the ACS Board of Regents; Sean Mulvihill, MD, FACS; Robert Glasgow, MD, FACS; and Larry Kraiss, MD, FACS. Attending from Intermountain Medical Center was Mark Ott, MD, FACS. Staff from the ACS Divisions of Advocacy and Health Policy and of Research and Optimal Patient Care also attended and participated in the meeting.

MedPAC Recommends Payment Cuts for Surgery, Payment Freeze for Primary Care

On September 15-16, the Medicare Payment Advisory Commission (MedPAC) held its first meeting of the 2011-2012 term. On September 15, MedPAC released a draft recommendation that would finance a 10-year freeze on Medicare payments to primary care physicians by cutting Medicare payments to surgeons and other non-primary care physicians by 5.9 percent annually for three years. The three years of cuts to non-primary specialties would be followed by a seven-year payment freeze. Following the three years of payment cuts, it is estimated that the Medicare conversion factor for surgeons and other specialists would be $28, while the conversion factor for primary care physicians would remain at the current level of approximately $34. While most commissioners indicated their support for the recommendation, the recommendation will not be formally approved until MedPAC's October meetings. In addition, MedPAC issued a draft recommendation that Congress direct the Secretary of Health and Human Services to collect data on service, volume, and work time to establish "more accurate" work and practice expense values. The data would be collected only from "efficient" practices, instead of all practices as is presently the case. The commissioners have not defined the term "efficient." An additional draft recommendation would ask Congress to direct the Secretary to use the data to redistribute funds within the fee schedule. MedPAC also released a fourth draft recommendation that would allow physicians who join accountable care organizations to be given a higher spending benchmark.

ACS Opposes MedPAC Recommendation to Cut Medicare Payments for Surgical Care

On September 16, ACS leadership issued press statement strongly opposing MedPAC's draft recommendation to cut Medicare payments to surgeons and other physicians by 5.9 percent per year over the next three years. The statement was signed by L.D. Britt, MD, FACS, ACS President; Carlos Pellegrini, MD, FACS, Chair, ACS Board of Regents; Andrew Warshaw, MD, FACS, Chair, ACS Health Policy and Advocacy Group; and David Hoyt, MD, FACS, ACS Executive Director. In the statement, the ACS leaders stated the College's belief "that a replacement of the SGR needs to be created that leverages quality, bends the cost curve, pays down the SGR debt and incentivizes value in the future."

ACS Leads Letter Against Graduate Medical Education Cuts

On July 14th the College led 18 surgical organizations in sending a letter to President Obama and congressional leaders voicing the profession's opposition to cuts in funding for graduate medical education (GME). The letter, sent in response to proposals to reduce investments in GME as part of deficit-reduction proposals, notes that reduced federal support would only exacerbate projected workforce shortages in surgery and other specialties.

ACS States Support for ASC Quality and Access Act of 2011

On July 22, ACS Executive Director, David B. Hoyt, MD, FACS expressed the College's support for the Ambulatory Surgical Center Quality and Access (ASCQA) Act of 2011 (S. 1173, H.R. 2108). Dr. Hoyt expressed support for the ASCQA Act in letters to the bill's bipartisan Senate and House sponsors-Sen. Ron Wyden (D-OR), Sen. Mike Crapo (R-ID), Rep. Pete Sessions (R-TX), and Rep. John Larson (D-CT). In the letter, Dr. Hoyt stated that the legislation is consistent with the College's principles of improving patient access to care, promoting high quality care, and curbing rising health care costs. The ASCQA Act would replace the current update mechanism for ASCs with the same market basket update that is used to update Medicare payments to HOPDs. The legislation would also establish quality reporting for ASCs, and it would implement a value-based purchasing (VBP) program for ASCs, under which part of the savings produced by the VBP would be shared between Medicare and the ASCs participating in the VBP.

Idaho Surgeon Hosts ASC Visit for Key Member of Senate Finance Committee

On September 1, Mark Savarise, MD, FACS, a general surgeon in Sandpoint, ID, and the Pend Oreille Surgery Center hosted Senator Mike Crapo (R-ID), a key member of the Senate Finance Committee, for a tour of their ambulatory surgery center (ASC). The meeting included a discussion of efforts to improve Medicare payments for care provided in ASCs. Senator Crapo is the lead Republican cosponsor of the Ambulatory Surgical Center Quality and Access Act of 2011 (S. 1173) in the Senate.

MedPAC Releases June Report, ACS and Physician Organizations Oppose Recommended Payment Cuts for Imaging Services

On June 15, the Medicare Payment Advisory Commission (MedPAC) released its June 2011 Report to the Congress. The report included a discussion of possible alternatives to the current Medicare physician payment system as well as recommendations that would cut Medicare reimbursement for imaging services provided in physician offices and would require prior authorization for imaging services ordered by some physicians. Following the report's release, the Coalition for Patient-Centered Imaging (CPCI), of which the College is a member, released a statement expressing disappointment with the recommendations. The statement, which was signed by eighteen physician organizations, including the College, also expressed concern that MedPAC's recommendations could undermine efforts to promote the delivery of integrated, patient-centered care that could improve outcomes and help curb rising health care costs. The CPCI statement highlighted MedPAC's failure to acknowledge that the volume of imaging services provided outside the hospital has been trending downward since 2007 and that in 2010 volume for both standard and advanced imaging services per fee-for-service beneficiary actually fell below the 2009 levels.

ACS and Coalition Successfully Advocate for Removal of Imaging Payment Cuts from Trade Legislation

On June 28, it was reported that staff to Senate Finance Committee Chairman Max Baucus (D-MT) and House Ways and Means Committee Chairman Dave Camp (R-MI) had agreed to include provisions to cut Medicare payments for imaging services by increasing the equipment utilization rate for imaging equipment under Medicare in the Trade Adjustment Assistance Extension Act of 2011(S. 1286). The inclusion of the provisions in S. 1286 was part of larger agreement between the two chambers to move several trade agreements through Congress.

In response, the College and its coalition members in the CPCI reached out to members of both Committees to express opposition to the inclusion of these provisions in S. 1286. In addition, the CPCI sent a June 29 letter to both the Senate Committee on Finance and the House Committee on Ways and Means expressing strong opposition to these provisions and expressing concern about the negative impact that these provisions would have on patient access to imaging and diagnostic services. Late on June 29, it was reported that during a meeting of Senate Finance Committee Democratic members that Senators John Kerry (D-MA) and Maria Cantwell (D-WA) had expressed their concerns about and opposition to including these provisions in S. 1286; as a result, these provisions were removed from S. 1286.

To date, S. 1286 and the accompanying trade agreements have yet to pass the House and Senate. In addition, this proposal has also been floated for possible inclusion in other legislation, and the CPCI continues to monitor other legislative proposals, including deficit reduction efforts, that may include this proposal.

ACS Success in Pandemic All Hazards Preparedness Reauthorization

The College successfully gained inclusion of language in the U.S. House of Representatives Energy and Commerce Committee's reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), H.R. 2405, that would focus government efforts on our nation's trauma and emergency care systems to ensure that they are adequately equipped to respond to public health emergencies. On Thursday, July 28, the Energy and Commerce Committee approved H.R. 2405 and the bill will now go before the House for a vote. The Senate is working on its own version of reauthorization and the College will continue to pursue language in that measure as well.

ACS Works with House for GAO Study on Trauma

The Chairman of the House Energy and Commerce Committee, Rep. Fred Upton (R-MI), committed to submitting a letter to the Government Accountability Office (GAO) asking GAO to examine the availability, capacity and preparedness of health systems to provide surge capacity to address public health emergencies. Specifically, GAO has been asked to study:

A. Current surge capacity within health systems, including patient capacity in hospital emergency departments and trauma centers; the number and sufficiency of the providers of emergency and trauma care; the sufficiency of community EMS systems; the degree of integration with surrounding regional health care assets; and whether these health systems are prepared to handle a public health emergency, including a mass-casualty event without notice;

B. The impact of current federal grant programs, including the Hospital Preparedness Program and the Public Health Emergency Preparedness grants, on (A.);

C. Gaps in the collection of data related to the adequacy of these health systems;

D. Recommendations to address any issues identified under (A), (B), (C), and to ensure appropriate medical response of day-to-day operations and the ability to surge such capacity for public health emergencies.

ACS Trauma Surgeon Hosts HHS Region 1 Meeting Regarding Support for Trauma Funding:

As a result of a successful meeting Ronald I. Gross, MD, FACS (Tufts University School of Medicine - Baystate Medical Center) had with Representative Joe Courtney (D-CT) during the 2011 Committee on Trauma (COT) Advocacy Day, members of the COT New England region were able to meet with the Department of Health and Human Services Region 1 Director, Christine Hager, JD, MPH on Friday, August 19 in Boston. Dr. Gross, along with COT State Chairs Kimberly A. Davis, MD, FACS, FCCM (CT - Yale University School of Medicine - Yale-New Haven Hospital); Hasan B. Alam, MD, FACS (MA - Harvard Medical School -Massachusetts General Hospital); Rajan Gupta, MD, FACS, FCCP (NH - Dartmouth-Hitchcock); and Division of Advocacy and Health Policy staff made a compelling case to fund the trauma programs authorized in the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The provisions included in ACA were derived from legislation that received strong bipartisan support over many years. This funding amounts to 71 cents per person, and would ensure system readiness and protect the public. Specifically, this federal investment would support: National Trauma Center Stabilization Act: The ACA reauthorized the national Trauma Center Stabilization Act (NTCSA) and provides two grant programs:

  • Trauma Care Center Grants: $100 million per year for a program of federal grants to trauma centers to allow them operating funds to maintain their core missions, to compensate them for losses from uncompensated care, and to provide emergency awards to centers at risk of closure.
  • Trauma Service Availability Grants: An additional $100 million per year for Trauma Service Availability Grants that would be channeled through the States and used for a number of activities to address shortfalls in trauma services and improve access to and the availability of these essential lifesaving services.

Trauma Care Systems Planning and Development Act: The ACA reauthorizes the Trauma Care Systems Planning and Development Act (TCSP) and incorporates a new Regionalization of Emergency Care Pilot Program. The ACA authorizes $24 million for all grant programs provided under the TCSP, of which $12 million was intended to be designated for implementation of the Regionalization of Emergency Care Pilot Program.

  • Trauma Care Systems Planning Grants: The ACA reauthorizes the Trauma Care Systems Planning grants to support state development of trauma systems.
  • Regionalization of Emergency Care Systems: The ACA authorizes funding for no fewer than four multi-year pilot projects to design, implement, and evaluate innovative models of regionalized emergency care systems.

The College continues to work with members of the trauma community to push for funding and recently agreed to sign on to a letter to HRSA and ASPR to ask for inclusion in the President's budget.

Commission on Cancer Participates in the One Voice Against Cancer (OVAC) Lobby Day

On May 23-24, five members of the ACS Commission on Cancer participated in the One Voice Against Cancer lobby day. After a day of training and information sessions, over 125 participants from 19 OVAC member organizations met with their members of congress to request funding for cancer research and prevention programs.

As a whole, OVAC called on Congress to:

  1. Support funding for the National Institutes of Health (NIH), National Cancer Institute (NCI), and National Institute on Minority Health and Health Disparities. Ongoing cancer research is on the verge of making great progress in the prevention, detection, and treatment of cancer.
  2. Support funding for the CDC cancer programs. The CDC state-based cancer programs provide vital resources for cancer surveillance, breast and cervical, and colorectal cancer screening, and awareness initiatives targeting skin, prostate, ovarian, and blood cancers. Cuts in funding would reduce the number of people being served by life-saving screening and outreach programs.
  3. Support funding for the HRSA Patient Navigator Program to help cancer patients navigate the health care system and overcome barriers to access cancer care.
  4. Support funding for the FDA to further integrate cutting-edge science that will streamline the translation of cancer research from early stage discovery to clinical application.

ACS Supports Orthopedic Colleagues in Injury Prevention

On September 13th the College sent a letter to Congressman Burgess (R-TX) thanking him for introducing H.R. 2020, legislation to prevent cuts to in-office osteoporosis screenings The letter thanked the Congressman for his efforts, which will help prevent falls and fractures through early diagnosis and treatment of osteoporosis.

ACS Joins in Support of Funding for Pediatric Loan Repayment Program

The American College of Surgeons (ACS) and 25 other organizations with members who are concerned about the adequacy of the pediatric workforce sent a letter on July 26 to House and Senate appropriators in support of funding for the pediatric subspecialty loan repayment program. The program was created under the Affordable Care Act and, if funded, would provide up to $35,000 in loan repayments per year for up to three years for pediatric surgeons and other pediatric specialists who agree to practice in shortage areas for at least two years. The program was authorized at $30 million for each fiscal year (FY) between 2010 and 2014, but to date has received no funding. Given the current difficult budget environment, the letter requests a modest appropriation of $5 million for the program for FY2012, which begins October 1, 2011. 

On August 31, ACS staff along with representatives of several groups interested in the pediatric loan repayment program and Children's GME attended a meeting with Office of Management and Budget staff on the importance of including funding for these issues in the President's FY13 Budget.

ACS Fellow Honored with Re-Introduction of Congressional Gold Medal Legislation

On Wednesday, September 21, Congresswoman Jackie Speier (D-CA) reintroduced legislation to award a Congressional Gold Medal to Dr. Ernie Bodai, a Fellow of the American College of Surgeons, for his efforts to promote cancer research and awareness. Dr. Bodai is known for being the driving force behind the Breast Cancer Research Stamp, which has raised approximately $75 million dollars for cancer research since 1998. He has also undertaken efforts to introduce similar stamps in countries around the globe. ACS Staff have worked to build support and cosponsors for this legislation.