The federal government is open again after a 43‑day shutdown. It is the longest shutdown in U.S. history, and the deal to reopen the government failed to resolve the key issue raised by Democrats: the expiring Affordable Care Act (ACA) tax credits. The deal extended funding through January 30, 2026, giving Congress just over two months to pass FY26 appropriations bills and address pending policy items, which include several major health policies beyond the ACA credits, such as telehealth flexibilities. The sharp increase in health costs will also be a topic of intense debate. We cover this and more in the November update below.

The $100K H-1B Update

As you are aware, the President’s proclamation, “Restriction on Entry of Certain Nonimmigrant Workers,” imposes a $100,000 fee upon applying for an H‑1B visa. This proposal jolted the healthcare industry, given international medical graduates are critically important to upholding healthcare access, and it will make staffing more challenging.

As it currently stands, most healthcare hires changing status in the U.S. are not subject to the administration’s $100,000 fee under current guidance. This includes residents and fellows moving from J‑1 or F‑1 to H‑1B, as well as H‑1B extensions and transfers. However, the fee still applies to new H‑1B hires coming from abroad.

We have been working with congressional offices on a letter to the administration that would exempt all healthcare providers from the fee. Only four percent of approved H‑1B workers were in medicine or health occupations, meaning exempting such providers would not upend the broader policy aims. We appreciate congressional offices weighing in on this important issue and will continue to encourage offices to reach out to ensure this policy does not place undue constraints on healthcare recruitment.

ACA Premium Tax Credits Vote Expected Next Month

As part of the deal to reopen the government, Senate Republicans agreed to a vote on a one‑year ACA subsidy extension in mid‑December. There is no guarantee this will pass the Senate, but a growing number of members realize the pitfalls of letting the tax credits expire without a clear path forward.

In fact, a small but key group of moderate House Republicans would like to help the Senate craft an ACA subsidy extension that can also pass the House. The challenge is that the majority of House Republicans are against extending the subsidies without significant changes. While there are risks for Speaker Johnson in jamming House Republicans on this vote, most lawmakers and observers recognize that rising health costs are a bigger risk to their majority than a short‑term extension of the tax credits.

We will continue to monitor the debate on extending ACA tax credits, as well as discussions of a broader health reform package.

CMS Finalizes Medicare Physician Reimbursement Increase

Last month, CMS finalized separate payment rate updates for 2026 under the Medicare Physician Fee Schedule. Physicians in value‑based models (APM “Qualifying Participants”) will have a conversion factor increase of 3.77%, and other clinicians will have a conversion factor increase 3.26%. In plain terms, this means modest across‑the‑board increases intended to support access to care.

AAPPR advocated for more predictable, sustainable payment updates and highlighted downstream workforce impacts in its comment letter to the proposed rule.

ICYMI: AAPPR Policy Webinar on Medicaid

Last month, AAPPR hosted a webinar on the upcoming Medicaid changes contained in the One Big Beautiful Bill Act. The webinar unpacked the policy implications—from Medicaid redeterminations to provider taxes—and what states and health systems should expect. You can listen to the webinar by clicking here: You can listen to the webinar by clicking here.

We’ll continue to share updates and track developments on this pivotal issue as we head into 2026.