Student visa rules threaten U.S. medical research

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With Erin Schumaker and Robert King
Driving The Day
VISITING FELLOWS UNDER THREAT — The National Institutes of Health's visiting fellows program could be hit hard by the Trump administration's plan to review and revoke visas for international students, Erin reports.
Last week, Secretary of State Marco Rubio said the State Department would 'aggressively revoke' visas for Chinese students and expand social media vetting for international students on exchange visas.
Collaboration across borders: More than 2,000 scientists worldwide participate in the program conducting basic and clinical research at the NIH campus and in field units nationwide, according to the NIH website, which notes: 'The NIH has long considered close interaction with foreign scientists in the conduct of collaborative research to be an essential ingredient in achieving its objectives.'
Sixty-eight percent of postdoc fellows at the NIH were part of the visiting fellows program last year, according to the NIH fellows union.
'This underscores the vital role international researchers play here at the NIH,' Marjorie Levinstein, a union representative, told Erin. 'International scholars, including those from China, are integral to research at the NIH and play essential roles in lifesaving research.'
Rubio was unclear about which visa types would be targeted, but many of the fellows enter the country on exchange visas. Pausing interviews for those visas would halt onboarding fellows, and revoking them would send active fellows home, potentially disrupting hundreds of studies.
Driving scientists to work elsewhere: Combined with the other challenges international postdocs face, like slashed research funding, canceled grants and layoffs, many question whether it's worth staying in the U.S., their colleagues say.
Threatening visas could encourage international scientists to take jobs in other secure countries, according to Dr. Ross McKinney, professor emeritus of pediatrics at Duke University School of Medicine and former chief scientific officer at the Association of American Medical Colleges.
U.S. institutions 'at the moment can barely make promises,' McKinney said, a dynamic that could play out this summer and fall as postdocs and Ph.D. students decide where to work.
'That money may not be there because of the way the NIH is being manhandled,' he added.
What's next: The ripple effect of a diminished workforce could extend beyond the fellows program. 'When we wipe out the universities' abilities to do this research by cutting back so much on a critical workforce, it's only a matter of time before the pharma industry gets really nailed, too,' McKinney said.
WELCOME TO MONDAY PULSE. I'm Carmen Paun, POLITICO's global health reporter, filling in today for Kelly. Can you believe it's June already?
Send your surprise reaction, tips, scoops and feedback to cpaun@politico.com, and khooper@politico.com and follow along @carmenpaun and @Kelhoops.
ICYMI: The Conversation kicked off with Dr. Oz
In the premiere episode of The Conversation, Dasha Burns sat down with Dr. Mehmet Oz — now leading the Centers for Medicare and Medicaid Services — for a candid talk on drug prices, potential Medicaid cuts and why he's getting early morning calls from President Donald Trump. Plus, POLITICO's Jonathan Martin dished on the Ohio governor's race (featuring Elon Musk, Vivek Ramaswamy and former Ohio State football coach Jim Tressel) and Kyle Cheney unpacked Trump's legal battle over 'Liberation Day' tariffs.
In Congress
THE BIG, BEAUTIFUL BILL — Congress returns this week, with the GOP domestic-policy megabill headed to the Senate, where an ideologically diverse group of Republicans is poised to have a big impact on the bill's final version.
Ranging from conservative Josh Hawley of Missouri to centrist Susan Collins of Maine, the senators found rare alignment over concerns about what the House-passed bill does to Medicaid, and they have the leverage to force significant changes in the Senate, POLITICO's Jordain Carney reports.
Other GOP senators, including Lisa Murkowski of Alaska, Jerry Moran of Kansas and Jim Justice of West Virginia, have also drawn public red lines over health care — and they have some rhetorical backing from President Donald Trump, who has urged congressional Republicans to spare the program as much as possible.
Why it matters: Based on estimates from the nonpartisan Congressional Budget Office, 10.3 million people would lose Medicaid coverage if the House bill were to become law — many, if not most, in red states. That could spell trouble for Majority Leader John Thune's whip count. He can lose only three GOP senators on the expected party-line vote and still have Vice President JD Vance break a tie. But Kentucky Senator Sen. Rand Paul (R-KY) also plans to oppose the bill if it includes raising the debt limit.
'If I vote for the $5 trillion debt [limit increase], who's left in Washington that cares about the debt?' Paul said on CBS's 'Face the Nation' on Sunday.
A WARNING — Health plans and state officials warn of 'immediate instability' for the Affordable Care Act's insurance marketplaces if a last-minute change to the House GOP's megabill becomes law, Robert reports.
The policy could lead to higher premiums for people who shop on the ACA's insurance exchanges and leave brokers and insurers with little time to understand how it would affect the market before open enrollment starts this fall.
The House's One Big Beautiful Bill Act would restart in 2026 federal payments to insurers that President Donald Trump canceled during his first term.
But the payments are restricted for plans that cover abortions. Plans are legally required to cover abortions in 12 states and the District of Columbia.
Insurers worry that the policy adds more uncertainty to an already chaotic market.
Other pressing changes to the marketplaces include the looming expiration of enhanced premium subsidies and stricter eligibility changes, which could create 'immediate instability,' said lead insurance trade group AHIP.
'This policy, if coupled with inaction on extending the premium tax credits, will have the opposite effect, and lead to millions of Americans facing steep premium hikes for coverage in 2026,' spokesperson Tina Stow said in a statement.
HEALTH FUNDING
BUDGET CUT — The Trump administration seeks to cut the HHS budget next fiscal year by a third compared with current levels. The administration seeks $94.7 billion for fiscal 2026 — a decrease of about $31.3 billion from fiscal 2025.
That includes cuts to most of America's health agencies, with the NIH seemingly poised for a 40 percent cut. That alarmed several health groups and Democratic lawmakers.
'Slashing federal research funding at a time when science is revolutionizing cancer care risks leaving millions of patients without the promise and potential of life-saving breakthroughs,' Dr. Clifford Hudis, chief executive director of the Association for Clinical Oncology, said in a statement. The association, which represents cancer doctors, was reacting to a proposed cut of some $2.7 billion in the National Cancer Institute's budget.
'You might as well gift wrap the future and hand it to China,' Sen. Patty Murray (D-Wash.), the top Democrat in the Senate Appropriations Committee, said in a statement about the proposed NIH cuts.
OMB's take: Russ Vought, director of the Office of Management and Budget, defended the cuts to cancer research Sunday. 'It's more about the NIH, and the NIH has been a bureaucracy that we believe has been weaponized against the American people,' he told CNN.
He then referred to the agency's funding of coronavirus research at China's Wuhan Institute of Virology, which many Republicans allege is where the pandemic started.
Three U.S. government agencies — the Department of Energy, the FBI and the CIA — claim a lab leak caused the pandemic, but that theory has no scientific consensus. Many virologists back the theory that Covid-19 was caused by a spillover of the virus from animals to people.
'It's still important to have cancer research,' Vought said, adding that the administration wanted a strong NIH. But the money shouldn't go to funding universities' indirect research costs at levels higher than billionaire philanthropist Bill Gates' foundation allows, Vought argued.
GLOBAL HEALTH SLASHED, TOO — Other groups are similarly concerned about the State Department's planned cuts to global health funding by more than 60 percent, as outlined in its budget, released Friday.
The $3.8 billion budget request for fiscal 2026 focuses on preventing infectious diseases and 'providing lifesaving assistance to those suffering from HIV/AIDS, tuberculosis, polio, and malaria,' according to the State Department's Congressional Budget Justification.
PEPFAR: The budget would allocate $2.9 billion to the President's Emergency Fund for AIDS Relief, down from $4.8 billion this year. The administration wants to phase out the program by focusing its 'resources only on the most cost-efficient, life-saving HIV treatment, and delivery models, and developing and executing country handover plans to transition towards greater recipient government responsibility and financing,' the State Department wrote.
'Congress must reject these deadly cuts,' said Asia Russell, executive director of Health GAP, a nonprofit working on access to HIV treatment in developing countries.
However, the State Department intends to back targeted prevention campaigns that include using lenacapavir, a twice-a-year HIV injection the FDA is expected to approve this month. PEPFAR and The Global Fund to Fight AIDS, Tuberculosis and Malaria committed last year to securing its access for at least 2 million people over three years.
But the State Department hasn't yet decided whether to continue support for The Global Fund, an international partnership. The U.S. has been its largest donor since it was founded in 2002.
If the State Department decides to provide funding, the U.S. would limit its contribution to only a quarter of the fund's budget, it said. The U.S. contribution has typically been about a third of the its budget.
Gavi: The State Department won't request funding for Gavi, the Vaccine Alliance, which helps low-income countries procure and deploy vaccines, because the organization is 'a Swiss NGO which reports a reserve of over $7.0 billion in its most recent statutory financial statements.'
Other cuts: The State Department said its budget request 'eliminates funding for programs that do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and non-emergency nutrition.'
AROUND THE AGENCIES
MAKARY TALKS VAX RECS — During a Sunday appearance on CBS's 'Face the Nation,' FDA Commissioner Marty Makary tried to clarify the federal government's Covid-19 vaccine recommendations for healthy children and pregnant women.
Makary endorsed Health Secretary Robert F. Kennedy Jr.'s announcement last week that the shots would be removed from the list of recommended vaccines for the two groups.
But later in the week, the CDC included the Covid vaccine on the children's immunization schedule with a note specifying that healthy children 'may' get the vaccine if their health care provider and parent or guardian believe they should.
Asked why he didn't wait for the CDC's Advisory Committee on Immunization Practices to debate the change in recommendations, as in the past, Makary told CBS' Margaret Brennan, 'That panel has been a kangaroo court where they just rubber stamp every single vaccine put in front of them.'
DR. OZ: CMS CAN HELP — Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, told POLITICO that his agency can help states implement work requirements introduced in the House-passed One Big, Beautiful Bill.
Attempts by some states to introduce such requirements in the past led to some Medicaid beneficiaries losing their insurance because they failed to submit required paperwork, even when they complied with the work requirement.
'If the reason not to do something that we all think we should do is we don't think we're capable or competent to do it, that's a problem,' Oz told POLITICO's Dasha Burns.
He said CMS would try to help states implement the requirements once they become law. The system should be available within a year, Oz said.
WHAT WE'RE READING
POLITICO's Alice Miranda Ollstein looks at how the Trump administration's targeting of legal immigrants threatens the health sector.
STAT covers the FDA's approval of a next-generation Covid vaccine from Moderna, with restrictions.
The Associated Press reports on how 'deep cuts erode the foundations of U.S. public health system, end progress, threaten worse to come.'

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