May 20, 2026
Mr. Steube introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To amend title XVIII of the Social Security Act to prohibit payments for graduate medical education costs attributable to individuals who are not citizens or nationals of the United States under the Medicare program.
Section 1. Short title
This Act may be cited as the Our Doctors First Act of 2026
.
Sec. 2. Prohibiting Federally-funded graduate medical education for non-citizens under Medicare
(a) Hospital payments for direct graduate medical education costs
Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended—
(1)
in paragraph (1), by inserting , subject to paragraph (11)
after of this subsection
;
(2)
in paragraph (4), by adding at the end the following new subparagraph:
(L) Non-citizen residents
Such rules shall provide that, effective for cost reporting periods beginning on or after the date that is 1 year after the date of the enactment of this subparagraph, an individual shall not be counted as a resident unless such individual is a citizen or national of the United States.; and
(3)
by adding at the end the following new paragraph:
(11) Sanctions for counting non-citizen residents
(A) In general
Effective for cost reporting periods beginning on or after the date that is 1 year after the date of the enactment of this paragraph, a hospital that submits a cost report counting 1 or more individuals who such hospital knows or should know are not citizens or nationals of the United States as interns or residents for purposes of payment under this subsection in violation of paragraph (4)(L) or payment under paragraphs (5)(B) and (11) of subsection (d) in violation of subsection (d)(5)(B)(xiv) shall be subject to the following sanctions:
(i)
In the case of the first cost reporting period for which such hospital submits such a cost report, a civil monetary penalty equal to 25 percent of the payment amount that would be attributable to the individuals so counted pursuant to such cost report if such individuals were permitted to be so counted under this subsection and subsection (d)(5)(B).
(ii)
In the case of the second cost reporting period for which such hospital submits such a cost report, a civil monetary penalty equal to $1,000,000.
(iii)
In the case of the third cost reporting period for which such hospital submits such a cost report, such hospital shall be excluded from receiving payments under this subsection and paragraphs (5)(B) and (11) of subsection (d) for a period of 5 years.
(iv)
In the case of each subsequent cost reporting period for which such hospital submits such a cost report, such hospital shall be excluded from receiving payments under this subsection and paragraphs (5)(B) and (11) of subsection (d) for a period of 10 years.
(B) Procedures
(i) Civil monetary penalties
The provisions of section 1128A (other than subsection (a) and (b) of such section) shall apply to civil monetary penalties under this paragraph in the same manner as such provisions apply to a penalty or proceeding under subsection (a) of such section.
(ii) Exclusion from payments
The provisions of subsections (c)(1) and (f) of section 1128 shall apply to an exclusion from receiving payments under this paragraph in the same manner as such provisions apply to exclusions from participation under such section.
(b) Hospital payments for indirect costs of medical education
Section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d))—
(1)
in paragraph (5)(B)—
(A)
by striking The Secretary
and inserting Subject to subsection (h)(11), the Secretary
; and
(B)
by adding at the end the following new clause:
(xiv)
For discharges occurring on or after the first July 1 occurring on or after the date that is 1 year after the date of the enactment of this clause, an individual shall not be counted as an intern or a resident under this subparagraph unless such individual is a citizen or national of the United States.; and
(2)
in paragraph (11)(A), by inserting subject to subsection (h)(11),
before the Secretary
.
(c) Nonhospital provider payments for direct costs of medical education
Section 1886(k) of the Social Security Act (42 U.S.C. 1395ww(k)) is amended by adding at the end the following new paragraph:
(3) Non-citizen residents
(A) In general
Effective for cost reporting periods beginning on or after the date that is 1 year after the date of the enactment of this paragraph, payment may not be made under this subsection for direct costs of medical education incurred with respect to residents who are not citizens or nationals of the United States.
(B) Penalties
(i) In general
Effective for cost reporting periods beginning on or after the date that is 1 year after the date of the enactment of this paragraph, a qualified nonhospital provider that submits a cost report requesting payment under this subsection for direct costs of medical education incurred with respect to 1 or more residents who such qualified nonhospital provider knows or should know are not citizens or nationals of the United States in violation of subparagraph (A) shall be subject to the following sanctions:
(I)
In the case of the first cost reporting period for which such qualified nonhospital provider submits such a cost report, a civil monetary penalty equal to 25 percent of the payment amount requested pursuant to such cost report for direct costs of medical education incurred with respect to such residents.
(II)
In the case of the second cost reporting period for which such qualified nonhospital provider submits such a cost report, a civil monetary penalty equal to $1,000,000.
(III)
In the case of the third cost reporting period for which such qualified nonhospital provider submits such a cost report, such qualified nonhospital provider shall be excluded from receiving payments under this subsection for a period of 5 years.
(IV)
In the case of each subsequent cost reporting period for which such qualified nonhospital provider submits such a cost report, such qualified nonhospital provider shall be excluded from receiving payments under this subsection for a period of 10 years.
(ii) Procedures
(I) Civil monetary penalties
The provisions of section 1128A (other than subsection (a) and (b) of such section) shall apply to civil monetary penalties under this subparagraph in the same manner as such provisions apply to a penalty or proceeding under subsection (a) of such section.
(II) Exclusion from payments
The provisions of subsections (c)(1) and (f) of section 1128 shall apply to an exclusion from receiving payments under this subparagraph in the same manner as such provisions apply to exclusions from participation under such section.