Rural America's disproportionate reliance on immigrant doctors could widen gaps in care as the Trump administration tightens immigration restrictions.

The big picture: Changes like the new $100,000 fee for H-1B visas are threatening already-stretched rural hospitals that could be left with even fewer primary care doctors and specialists.

Where it stands: Rural areas are more than three times as dependent on immigrant doctors than what's expected given their overall immigrant populations, researchers wrote this week in JAMA Internal Medicine.

• "As our population ages, we're going to have a crisis where we need more and more humans to help support our people who are sick," said Manav Midha, lead author and a medical student at Mt. Sinai Icahn School of Medicine.

The big picture: Rural parts of the country have a harder time attracting young doctors and are more prone to physician shortages.

• They've closed gaps in the past by turning to foreign-born and internationally trained clinicians: Congress for more than two decades has allowed up to 30 immigrant physicians a year in each state to stay in the U.S. after finishing their residencies, if they practiced in a rural or underserved area.
• Many health systems also sponsor H-1B visas as a way to attract professionals with specialized skills.
• About 1% of all doctors practicing in the U.S. have an H-1B visa, and the percentage of physicians with the visa is nearly two times higher in rural counties than urban ones.

Where it stands: President Trump last year dramatically increased the H-1B visa fee to $100,000 from about $3,500. Medical groups say this will accelerate looming physician shortages and have asked that health workers be exempt.

• The State Department last month also paused issuing immigrant visas for people from 75 countries. Workers from 69 of those countries make up 8% of the U.S. health care workforce, per a KFF analysis.

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The health care package that was approved as part of the government spending deal yesterday includes a one-year delay in scheduled Medicare cuts for lab and diagnostic tests, delivering a win for companies like Quest and LabCorp.

Why it matters: Congress has delayed the cuts for six years running, making them an annual rite without enacting a permanent "fix."

Driving the news: Testing labs argued that flawed methodology stemming from a 2014 law forced steeper-than-expected cuts of up to 15% for more than 800 commonly ordered tests that were due to take effect on Jan. 31.

• The issue has gained visibility because of the growth in demand for clinical lab services and because congressional scorekeepers changed their forecasting to conclude that delaying the cuts would cost, not save, money.

The spending deal also revived an FDA program that expired at the end of 2024 and gives drugmakers priority review vouchers for treatments for rare pediatric diseases.

• The voucher allows specified drugs to go through the FDA review process faster than they otherwise would.
• The manufacturers also get another voucher to use — or sell to other companies to use — on a future product.

The professional society for plastic surgeons yesterday recommended its members delay transition-related breast, genital and facial surgery on youths until they turn 19, saying there wasn't enough evidence of benefits and risks.

Why it matters: The new guidance comes amid the Trump administration's widening crackdown on gender care, which has put doctors and other providers in the middle of a showdown between federal power, privacy protections and, in some cases, state laws.

Driving the news: The American Society of Plastic Surgeons issued a position statement saying ongoing reviews of clinical evidence "have not resolved earlier uncertainties regarding treatment benefit" and that in some instances, had "contributed to a clearer understanding of potential harms."

• The group also cited "substantial uncertainty" about the long-term benefits and risks of puberty blockers and hormone therapy without issuing guidance for those treatments.
• The group cites an HHS review and a 2020 U.K. report on gender-affirming care as key to its position. Both studies have been criticized by other medical experts for poor methodology and unsubstantiated claims.

Top Trump administration health officials were quick to praise the plastic surgeons' guidance. But the recommendations diverge from some other medical associations that say surgery for youths can be an option in some cases.

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Taxpayers account for more than half (51.2%) of net spending on outpatient prescription drugs, according to Drug Channels' analysis of recently released national health spending for 2024.

Why it matters: It shows how public spending on health care may be even higher than the CMS figures — and how growing demand for GLP-1 weight-loss drugs could keep fueling rapid growth.

By the numbers: Spending on outpatient prescription drugs hit $467 billion in 2024, equal to 8.8% of total health care spending.

• The increase came from factors like more prescription drug use and greater demand for higher-priced drugs, not from higher net prices.
• Medicare and Medicaid paid for more than 46% of total outpatient drug spending.
• But federal and state government employees accounted for more than 10% of employer-sponsored insurance spending, so total taxpayer spending is even higher than government-reported figures, per Drug Channels.

Yes, but: The increase in drug spending still was smaller than the spending growth for hospitals and professional services.

💊 Florida Gov. Ron DeSantis' Canadian drug importation program was expected to save the state close to $180 million. But the effort has stalled after failing to win over drugmakers. (Politico)

👀 HHS' inspector general is investigating whether a top FDA official misled the federal government by using a sham divorce to avoid running afoul of conflict-of-interest rules. (Bloomberg)

🌳 Colorado could become the first state to use ibogaine — a psychedelic found in the roots of an African shrub — for regulated medical treatment. (Axios)