Government Shutdown

The government shutdown is taking up all the oxygen in Washington D.C. as it stretches now into the third week of October. Democrats are making this shutdown about the expiring Affordable Care Act premium tax credits, which have helped millions of Americans maintain health coverage the last five years. The reality of this shutdown is that it is about the minority party seat at the negotiating table. This is a fundamental issue and a concern that goes back to the early days of the Republic. We will spare you the history lesson today, but you can read more about these latest political dynamics by clicking here.

Once the government reopens, there will be a flurry of activity on the legislative and regulatory side, including finalizing rules on Medicare payment for 2026 and addressing the lapsed authorization for various Medicare programs, including telehealth flexibilities.

Government Sued for H-1B Fee Proposal

Last month, President Trump signed a proclamation imposing a $100,000 fee for each new H-1B visa, arguing the new fee will encourage companies to hire more American workers. The H-1B program allows employers to hire nonimmigrant foreign professionals in specialty positions, and is used successfully by health systems, hospitals, and other health settings to address acute workforce shortages in areas that struggle to recruit American health workers.

The proposal set off immediate pushback, with concerns from hospitals that such a fee would be uniquely disadvantage the health industry, or worse, stop the recruiting of H-1B physicians with no suitable short-term alternative. We have joined stakeholders and Members of Congress highlighting the need for exemptions for the health care sector.

A lawsuit was filed by a group of unions and other organizations earlier this month challenging the decision to charge $100,000 fee, highlighting the disruption is far wider than just health or tech. We will continue to closely monitor this case and provide updates on this issue.

Conrad 30 Flexibility Proposal

We have had discussions with congressional offices and other stakeholders this summer about ways to improve the Conrad 30 program. The Conrad 30 program grants each state 30 waivers each year to recruit international medical graduates (IMGs) completing their medical residency program on a J-1 visa. As a condition of their visa, these IMGs must practice in a rural or underserved area for at least three years. Each state may use up to 10 ‘flex’ waivers for sites outside designated shortage areas, provided those sites serve patients who reside in underserved areas.

We have discussed targeted flexibility for rural and other low utilization states that routinely use all 10 flex waivers but do not reach their overall cap of 30. Allowing such states a limited number of additional flex waivers the following year would better align the program with the realities of sparsely populated regions and persistent provider shortages.

We will continue to explore and discuss other flexibilities to strengthen this program and improve recruitment and retention of physicians. Please reach out if you have any ideas or questions!

Closing Word

AAPPR is continuing to advocate for improving Medicare reimbursement long-term, increasing the number of Graduate Medical Education (GME) slots, and improving the pipeline of physicians through leveraging international medical graduates (IMGs).

These latest announcements around changes to the H-1B program present serious obstacles, but they are being challenged in court while we and other stakeholders pursue carveouts for the healthcare industry. All this attention on how this impact the health care workforce is an opportunity to educate policymakers and others about the reality of confronting health workforce shortages. We will continue to elevate these issues and ensure our collective voices are heard.

Stay tuned for more updates across these issues.