Congress is close to wrapping up the legislative session for the year. Despite intense focus on health care costs and Affordable Care Act (ACA) tax credits, the drive for consensus has been bumpy and unproductive. After two failed votes in the Senate that would have extended the tax credits, the House GOP is trying to chart a path that appeases moderates key to their majority without upsetting the more conservative wing of the party. Lawmakers are also trying to pass appropriations packages, an effort to make some progress before the end of the year, with the next funding deadline just seven weeks away.
AAPPR’s CEO Carey Goryl and Policy Advisor Eli Greenspan visiting the congressional offices in Washington D.C.
AAPPR on the Hill!
AAPPR’s CEO Carey Goryl and Policy Advisor Eli Greenspan braced the December chill to meet with congressional offices this month. They introduced offices to AAPPR’s mission, membership, and the current state of physician recruitment and retention. It was a great opportunity to highlight our federal priorities, meet with staff to learn what they are hearing about these issues, and how we may be able to partner to improve the physician pipeline considering numerous challenges impacting this field and patients. Carey and Eli met with bipartisan offices from Michigan, Florida, North Carolina, New Jersey, California, and Ohio, with more follow ups into 2026.
This engagement is key to our growing presence in Washinton DC and identifying partners on Capitol Hill positioned to advance issues important to provider recruitment and health care delivery.
Student Loan Caps Update
As you are likely aware, the Department of Education plans to phase out Grad PLUS and set new loan limits starting July 1, 2026. There will be two caps: up to $20,500 per year (and $100,000 total) for most graduate programs, and up to $50,000 per year (and $200,000 total) for certain “professional” programs.
“Professional” will cover a short list of fields—medicine, dentistry, law, pharmacy, veterinary medicine, optometry, osteopathic medicine, podiatry, chiropractic, theology—and licensure‑leading PsyD/psych PhD programs. It will not include physician assistants, advanced practice registered nurses/nurse practitioners, occupational therapy, or other licensed health programs, meaning many students in high‑need fields could face federal loan limits below typical program costs.
The Department still has to publish a proposed rule (expected in early 2026) with ~30‑day comment period. The new limits would apply only to new federal borrowers after July 1, 2026; current borrowers keep their existing terms. AAPPR is closely monitoring this issue and welcomes your feedback if you have questions or concerns about this policy issue.
H-1B Fee Update
In September, the President instituted a policy that imposes a $100,000 fee on certain new H-1B petitions. The fee applies primarily to new H-1B applications who are coming from abroad, but the policy and lack of clarity has had significant effects on the healthcare industry, leading to many institutions simply pausing recruitment of H-1B physicians.
We will be publishing a new update this month, but oral arguments have been scheduled in the U.S. Chamber of Commerce and the Association of American Universities case against the Trump Administration, for December 19th. The plaintiffs have argued that the Trump Administration does not have unlimited authority to set fees.
If the court rules against the Administration, it could provide much needed clarity for health recruiters. Stay tuned for more updates this month.
Conrad 30 Update
While on Capitol Hill, Carey and Eli had several productive meetings on Capitol Hill which focused, among other things, on ways to advance the Conrad 30 legislation. The Conrad 30 legislation would extend the program for three years, improve the process for obtaining a visa, and allow for the program to be expanded beyond 30 slots if certain thresholds are met. It also would make the program more attractive to employers and prospective J-1 waiver candidates. We encouraged offices to not just work with us to build support for the legislation, but to explore attaching the bill to an appropriations bill or other moving vehicle. It will be difficult to overcome limited Republican opposition in this current environment, but we were pleased that offices were receptive to a more action-oriented approach to elevating this important issue.
In addition, as we have pointed out in recent months, we are moving closer to seeing the introduction of new legislation that could help boost recruitment of J-1 candidates in lower utilizing states. The idea is that J-1 candidates who miss out on waiver opportunities can opt in to a portal that facilitates information sharing between states with available slots and employers who need help filling gaps in their primary care or specialty workforce. This is an exciting development highlighting the importance of engagement and education to highlight AAPPR’s unique perspective when it comes to healthcare delivery.
An Interesting Article!
Dr. Scott Gottlieb, former FDA Commissioner, published a piece in JAMA on artificial intelligence titled, “How AI Will Help Solve Medicine’s Productive Challenges.” This is worth reading because it shows how smarter AI, clearer FDA rules, and better Medicare payment policies could safely automate routine tasks, improve outcomes, lower costs, and fairly reward doctors.
The Last Word
Thank you for reading throughout 2025 and your continued engagement on policy and advocacy. Looking forward to building on our successes in the new year.