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Key Takeaways:
- The Trump administration has given no indication it will exempt healthcare workers from the $100,000 H-1B visa fee imposed in September 2025, leaving employers in an increasingly difficult position as they navigate international healthcare provider recruitment decisions.
- Three federal lawsuits are currently challenging the fee, including a fast-tracked DC Circuit appeal and a preliminary injunction hearing set for February 26, 2026, while bipartisan congressional pressure continues to build with over 100 House members calling for a healthcare exemption.
- With the H-1B visa registration cap lottery approaching in early March, healthcare employers should evaluate whether to pursue individual exemption requests under the proclamation's national interest provision for critical hires serving underserved communities.
Despite building pressure from Congress, national healthcare organizations, and ongoing litigation, the Trump administration has offered no indication it will exempt healthcare workers from the $100,000 H-1B visa fee imposed in September 2025. As the administration holds its cards, healthcare employers face increasingly difficult decisions about international provider recruitment, with real consequences for care delivery in underserved communities.
The Fee and Its Impact
President Trump's September 2025 proclamation requires U.S. employers filing certain new H-1B petitions for workers outside the country to pay a $100,000 fee, up from approximately $5,000 previously. The impact on healthcare delivery is significant: in FY24, nearly 17,000 H-1B petitions were approved for occupations in medicine and health, and over 60% of international medical graduates requiring H-1Bs practice in medically underserved areas. Many health employers are being forced to pause or limit recruitment of providers who require H-1B visas, leaving critical positions unfilled.
Administration Silent on Healthcare Exemptions
The proclamation includes a potential exemption if the Secretary determines that hiring a specific H-1B worker "is in the national interest and does not pose a threat to the security or welfare of the United States." A broad-based exemption would greatly help the industry dealing with persistent workforce shortages and health delivery challenges, and would not undermine the administration's broader efforts in the H-1B space. However, there have been no known exemptions granted in the healthcare sector to date, and the administration has offered no clarity on whether healthcare employers might receive relief.
Legal Challenges Underway
Three lawsuits are currently challenging the fee:
- Chamber of Commerce v. DHS: The DC Circuit will hear a fast-tracked appeal after a district court upheld the fee in December 2025.
- Global Nurse Force v. Trump: A preliminary injunction hearing (along with motions to certify class and stay) is set for February 26, 2026.
- California v. Noem: Twenty state attorneys general filed for summary judgment on February 9, 2026, arguing the fee amounts to an unauthorized tax that causes "predictable harms to schools, hospitals, universities, and other state and local agencies" that rely on H-1B workers to fill critical shortages. The government must respond by March 9, 2026.
Congressional Activity
Bipartisan pressure continues to build in the House of Representatives. In February, Representatives Yvette Clarke (D-NY) and Mike Lawler (R-NY) led a bipartisan letter with 100 signers calling for a healthcare exemption, attracting support from 40 national healthcare organizations. In January, Representatives Jill Tokuda (D-HI) and Don Bacon (R-NE) led a separate bipartisan letter with 31 signers focused specifically on rural healthcare concerns. The New Democrat Coalition also sent a letter in January urging the administration to reverse the policy.
State-Level Restrictions Compound Challenges
Adding to federal pressures, some states are independently restricting H-1B hiring at public institutions. Texas has paused new H-1B petitions at state agencies and public universities through May 31, 2027, with exceptions requiring approval from the Texas Workforce Commission. Florida is proposing to ban all new H-1B hires at public universities through January 5, 2027, following Governor DeSantis' earlier order to curtail H-1B usage. While these freezes apply to public institutions rather than private employers, they affect academic medical centers that rely on international researchers, faculty and clinical staff. Public universities have expressed concern that reduced access to global talent may lead to staff shortages in medical centers, labs and classrooms, slowing research and innovation.
It remains unclear how these states will handle exemption requests, and whether healthcare is a primary target of these policies or is instead caught up in broader efforts to restrict H-1B usage in other industries.
What Healthcare Stakeholders Should Do Now
With the administration silent on relief, litigation outcomes uncertain, and some states adding their own restrictions, continued engagement is essential:
- Monitor key litigation dates: The DC Circuit appeal and the February 26 preliminary injunction hearing may yield rulings that pause the fee.
- Contact your congressional delegation: Sustained bipartisan pressure is essential to signal the urgency of this issue. Members who represent employers relying on H-1B workers need to hear directly about the impact on care delivery.
- Assess recruitment timelines: With the H-1B cap lottery registration approaching next month, evaluate whether pending physician hires can proceed under alternative visa categories or should be deferred.
- Explore individual exemption requests: We are positioned to assist healthcare employers in preparing and advocating for individual exemption requests under the proclamation's national interest provision, should the administration signal a willingness to grant relief.
- Prioritize J-1 Visa Waiver pathways: The Conrad 30 J-1 Visa Waiver Program remains largely unaffected and offers a viable near-term alternative for physician recruitment.
The path forward remains uncertain, but healthcare stakeholders must continue pressing for relief. Sustained engagement with Congress is critical to ensuring the administration understands the real-world consequences of these policies for healthcare delivery, particularly in underserved communities that depend on international physicians to meet patient needs
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