S-2715-119
Read twice and referred to the Committee on Finance.
Sponsored by Steve Daines (R-MT)
What it does
This bill would require hospitals with Medicare-funded medical residency programs to annually report to the Department of Health and Human Services the number of applicants and accepted residents from osteopathic (DO) and allopathic (MD) medical schools, and to affirm that they consider candidates from both types of schools. Hospitals would also be required to affirm that they accept either the COMLEX-USA or USMLE licensing exam score — whichever the applicant chooses — as a prerequisite for admission. Hospitals that fail to submit this information would have their Medicare inpatient payment rates reduced by 2 percent for each year of non-compliance, starting with discharges on or after October 1, 2026. The reported data would be published on a public government website.
Who benefits
Osteopathic medical school graduates (DO students), who have historically faced barriers entering residency programs that were originally designed for allopathic (MD) graduates. Medical students at osteopathic schools who take the COMLEX-USA exam and may have been disadvantaged by programs requiring only the USMLE. Patients in underserved areas, where DO graduates are disproportionately represented, who may benefit from a larger and more diverse physician pipeline. Researchers and policymakers who gain access to publicly reported data on residency selection patterns. Osteopathic medical schools and their accrediting bodies.
Who is hurt
Hospitals that currently do not track or report applicant data by school type, who would face new administrative and compliance costs. Hospitals that fail to comply — intentionally or due to administrative error — would face a 2 percent reduction in Medicare inpatient payments, which could be financially significant for high-volume facilities. Hospital residency program directors who may view the reporting requirement as an indirect pressure on their selection autonomy, even though the bill explicitly does not mandate acceptance quotas. Allopathic medical school graduates who may face increased competition for residency slots if programs broaden their applicant pools.
Supporters argue
Supporters argue that since the 2020 merger of osteopathic and allopathic residency matching systems, DO graduates have competed in the same pool as MD graduates but some programs have continued to screen out COMLEX scores or informally deprioritize DO applicants — creating a structural disadvantage for roughly 25% of U.S. medical school graduates. They contend that transparency and public reporting, without mandating outcomes, is a minimally intrusive tool that allows market forces and public accountability to correct discriminatory patterns, while the financial penalty for non-reporting — not non-acceptance — ensures compliance without dictating admissions decisions.
Opponents argue
Opponents argue that the bill's financial penalty structure — reducing Medicare payments by 2 percent per year of non-compliance — creates implicit pressure on hospitals to alter admissions decisions to avoid the appearance of bias in publicly reported data, effectively functioning as a soft quota system despite the bill's rule of construction to the contrary. They contend that residency program directors need flexibility to select candidates based on the full range of qualifications, and that mandating acceptance of two different licensing exams may complicate standardized evaluation, since COMLEX and USMLE are scored on different scales and test partially different content domains.