We are roughly six weeks into the year and Congress has spent more time finishing 2025 than laying the groundwork for 2026. Still, there’s a lot of activity impacting the physician pipeline and health care employers. We expect the year to take shape in the coming weeks as Congress returns from its recess, the President delivers his State of the Union, and the next appropriations cycle gets underway. We continue to work with stakeholders and Congressional offices to elevate key issues like H-1B visa fees, Conrad 30 improvements, and other administrative actions impacting healthcare costs and delivery.

H-1B Visa Fee Developments

The Trump Administration’s $100,000 H-1B visa fee, implemented in September 2025, remains in effect and continues to pose recruitment challenges for healthcare organizations seeking international physicians and providers. While the administration has indicated it may consider national interest exemptions, no exemptions have been granted in the healthcare sector to date. Three federal lawsuits are currently pending, with a DC Circuit appeal expected this month following a December 2025 district court ruling that upheld the fee. On the legislative front, bipartisan congressional pressure is mounting: a letter led by Representatives Yvette Clark (D-NY) and Mike Lawler (R-NY) garnered 100 bipartisan signers and the support of 40 national healthcare organizations, including AAPPR, and new bipartisan legislation to exempt healthcare workers from the fee is expected ahead of the H-1B cap lottery registration.

Healthcare employers should closely monitor these legal and legislative developments, as favorable rulings or passage of an exemption could provide near-term relief. In the meantime, the Conrad 30 J-1 Visa Waiver Program remains a viable alternative pathway for physician recruitment, as international medical graduates transitioning from J-1 to H-1B status are not subject to this fee. We encourage you to assess recruitment timelines and consider engaging with congressional champions to educate them on the implications of this policy.

Proposed Federal Student Loan Rule Threatens Nursing Education Pipeline

On February 3, 2026, the Department of Education published a proposed rule implementing student loan provisions of the One Big Beautiful Bill Act (OBBB), with significant implications for the nursing workforce pipeline. The proposed rule explicitly excludes Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP) degrees from the definition of “professional degree,” meaning nursing students will be subject to the lower graduate student loan limits: $20,500 annually and $100,000 in aggregate, rather than the $50,000 annual and $200,000 aggregate limits available to medical, dental, and other professional students. The Department of Education justified this exclusion by reasoning that nurses are already licensed when entering these programs and that nurse practitioners in many states cannot practice independently without physician supervision.

This classification change, combined with the OBBB’s elimination of Graduate PLUS Loans for new borrowers effective July 1, 2026, will substantially reduce federal loan access for advanced practice nursing students. Healthcare organizations should be aware that this policy shift may create financial barriers to nursing education, potentially affecting the supply of nurse practitioners and other advanced practice nurses entering the workforce in coming years. Comments on the proposed rule are due by March 5, 2026. Please reach out if you have any questions.

Closing Word

If you or your organization are encountering challenges related to the H-1B visa fee, Conrad 30 program, or any other issues affecting your ability to recruit and retain physicians and providers, we want to hear from you. Please don’t hesitate to reach out as your insights help us make the case to policymakers and shape effective solutions.