The FAIR Act of 2025 would amend the Medicare statute to require hospitals with approved medical residency training programs to report annual data on residency applicants and acceptances by medical school type: osteopathic and allopathic. Hospitals would also have to affirm that they consider applicants from both types of schools and, if they require an exam score, accept either COMLEX-USA or USMLE at the applicant’s election. The reporting requirement would begin with fiscal year 2025, and the Secretary of Health and Human Services would be directed to publish the submitted information on a public website.
The bill also creates a financial enforcement mechanism tied to Medicare payments. Beginning with discharges on or after October 1, 2026, a hospital’s Medicare payment amount would be reduced by 2 percent for each prior fiscal year, starting with fiscal year 2025, in which the hospital failed to submit the required information. The measure includes a rule of construction stating that it does not federalize medical education or require residency programs to accept any particular number of osteopathic or allopathic students.
Impact
The bill would amend section 1886(d)(5)(B) of the Social Security Act, affecting Medicare disproportionate share hospital payment calculations by conditioning a portion of those payments on compliance with new residency reporting requirements. It would also add a new public reporting obligation for the Department of Health and Human Services and create a transparency regime for residency selection practices at hospitals with approved graduate medical education programs. The practical effect would be to pressure hospitals to disclose and potentially standardize how they evaluate osteopathic and allopathic applicants, while stopping short of mandating admissions decisions.
Sentiment
There is no recorded committee debate or vote history in the provided materials, so the bill’s sentiment must be inferred from its text and sponsorship. The measure appears broadly supportive of osteopathic physicians and applicants by seeking to promote fair access and transparency in residency selection. The bipartisan sponsorship by Senators Daines, Heinrich, and King suggests an intent to frame the bill as a noncontroversial fairness and disclosure measure rather than a major policy overhaul.
Contention
The main point of contention is likely to be the use of Medicare payment reductions to enforce compliance, since hospitals and residency programs may view the 2 percent annual penalty as coercive or administratively burdensome. Another possible concern is whether public reporting of applicant and acceptance data could create reputational pressure or unintended comparisons among programs. At the same time, the bill explicitly tries to limit controversy by stating that it does not federalize medical education or require programs to admit osteopathic or allopathic applicants in any particular numbers.