Florida Rep. Greg Steube is taking direct aim at how America trains its doctors, rolling out a two-bill package that would force hospitals to disclose the citizenship status of their medical residents and cut off Medicare funding for training residents who are not U.S. citizens or nationals. The proposals, the GME Transparency Act of 2026 and the Our Doctors First Act of 2026, would tie federal graduate medical education dollars to hospitals’ reporting and compliance, with steep penalties for those that do not fall in line.
What the bills would require
Under the GME Transparency Act, hospitals would have to report aggregated counts of how many residents are U.S. citizens, green card holders, or temporary visa holders, without naming individuals. The federal government would then publish a yearly state-by-state report. As reported by the Tampa Free Press, hospitals that refuse to share those numbers could lose Medicare funding for their training programs. Similar transparency ideas have surfaced on Capitol Hill before, including the GME Data Transparency Act, which would require CMS to collect and publish GME data for public use, according to Congress.gov.
Ban on noncitizen residents and penalties
The companion Our Doctors First Act goes further. It would prohibit Medicare from paying to train any resident who is not a U.S. citizen or U.S. national, and it would create a tiered penalty system for hospitals that “knowingly request funds” to train noncitizen residents. A first violation would cost a hospital 25 percent of the Medicare funding tied to that resident’s training. A second violation would trigger a $1 million fine. Repeat offenses could result in the loss of medical education funding for five to ten years. “Taxpayers deserve transparency on how federal healthcare dollars are being spent,” Steube said in a statement to the Tampa Free Press.
The money at stake
The financial stakes are huge. Federal funding that supports residency training is estimated at roughly $12 billion to $14 billion a year from two major public programs, Medicare and Medicaid, with Medicare historically the largest single source. Medicare distributes those dollars through direct graduate medical education (DGME) payments and indirect medical education (IME) adjustments, tools that help teaching hospitals cover resident stipends, faculty salaries, and related training costs. The National Academies documents the $12–14 billion estimate, and CMS explains the DGME and IME payment structure.
Local programs would feel the change
In Tampa Bay, teaching hospitals such as Tampa General Hospital and USF Health’s graduate medical education programs train hundreds of residents across dozens of specialties, so any shakeup in Medicare GME rules would ripple quickly through those local pipelines. The Association of American Medical Colleges reports that nearly one quarter of residents are graduates of international medical schools, and peer-reviewed research shows international medical graduates make up a disproportionately large share of family medicine providers and physicians serving underserved communities. Restricting Medicare funding for noncitizen trainees could tighten the physician pipeline in specialties and locations that already struggle to recruit. USF Health, the AAMC, and research published in BMC Family Practice document those trends.
What happens next
Both bills have been officially introduced in the U.S. House and sent to committee for review. If they pass both chambers of Congress and are signed by the president, their funding restrictions and penalties would kick in one year after enactment. The proposals are expected to spark hearings and pushback from academic medical centers, physician groups, and hospital associations that warn of unintended hits to an already strained workforce. For now, local hospital leaders and residency program directors are watching the committee process and gearing up to explain how GME dollars support care in their communities.
