We are now just three weeks away from the November 3 midterm elections, and attention on Capitol Hill has largely shifted to the campaign trail. Democrats seem well-positioned to take the House, while the Senate map has become increasingly competitive. Regardless of the outcome, Congress will return for a short lame duck session with limited time to address outstanding priorities before the new Congress convenes in January. Government funding will be a central focus, leaving a narrow window for other legislative priorities. In the meantime, we continue to track several important regulatory and legislative developments affecting physician and provider recruitment.

H-1B Fee Update

The $100,000 fee on certain H-1B petitions remains tied up in litigation, but the fee is not currently being collected following a federal court ruling earlier this year. We are hearing encouraging reports that more H-1B petitions are moving through the approval process, although the legal uncertainty remains. The Administration renewed the underlying proclamation in September, and pending appeals could still change the situation. We will continue monitoring developments on this proclamation and encourage you to reach out with any questions.

Other Immigration Updates

Beyond the $100,000 fee, the Department of Homeland Security has proposed two additional regulations that could impact physician recruitment.

The first would establish a new $103,265 fee for cap-subject H-1B petitions, creating another significant cost barrier for healthcare employers that rely on international recruitment. The proposal would not apply to cap-exempt petitions, including those filed by certain universities and research organizations.

The second proposal would eliminate the current 60-day grace period that allows certain employment-based visa holders to remain in the United States after their employment ends while seeking a new position or immigration status. This could create additional challenges for physicians changing employers and healthcare organizations working to recruit them.

Neither proposal has been finalized. AAPPR will continue tracking both regulations and their potential impact on the physician workforce.

Medicare and Medicaid Updates

Congressional efforts to reform Medicare physician reimbursement remain an important priority, although the limited legislative calendar makes significant progress before year-end uncertain. We continue to monitor bipartisan efforts to provide greater payment stability and address longer-term reimbursement challenges that affect physician practices and access to care.

Meanwhile, states are preparing to implement significant Medicaid changes enacted last year, including new work requirements and more frequent eligibility reviews beginning in January 2027. These changes could affect coverage, hospital finances, and workforce needs, particularly in rural and underserved communities.

We will continue to keep members updated as these issues develop and as Congress returns following the elections.