Medical Groups Back Legislation that would Exempt Healthcare Workers from $100,000 H-1B Filing Fee

On March 17, 2026, bipartisan legislation was introduced by U.S. Representatives Mike Lawyer (R-NY), Sanford Bishop Jr. (D-GA), Yvette Clarke (D-NY), and Maria Elvira Salazar (R-FL) to exempt physicians and other healthcare workers from the Trump Administration’s $100,000 H-1B filing fee.

The bill, presently called the “H-1Bs for Physicians and the Healthcare Workforce Act,” proposes that the $100,000 H-1B filing fee shall not apply to any H-1B worker who is employed in the healthcare sector. The proposed fee exemption would broadly cover healthcare workers, including doctors, nurses, dentists, certified nurse midwives, psychologists, ambulance workers, and public health professionals as defined by Affordable Care Act.

The American Medical Association (AMA) and the American Hospital Association (AHA)—among other medical organizations—have endorsed this legislation. 

In its recent press release applauding the bill, the AMA wrote that the $100,000 H-1B filing fee raises hiring costs, which in turn worsens physician shortages, increases wait times, and reduces access care. The bill therefore aligns with AMA’s mission to build and maintain a strong healthcare workforce to serve all patient needs.

Similarly, AHA Executive VP Stacey Hughes expressed support for the bill, stating that it would maintain patient access to care by sustaining critical healthcare staffing in shortage areas.

Congress Implores DHS to Exempt Healthcare Workers from $100,000 H 1B Visa Fee

In February 2026, bipartisan members of Congress renewed calls for relief from the $100,000 H 1B visa filing fee for international healthcare workers. In an American Hospital Association (AHA)-supported letter sent to the U.S. Department of Homeland Security (DHS) on February 11, lawmakers urged the agency to exempt healthcare workers from the fee, warning that the policy threatens already‑strained hospital staffing nationwide.

The letter, led by Representatives Yvette D. Clarke (D‑NY) and Michael Lawler (R‑NY), was signed by 100 members of Congress and emphasized that hospitals and health systems rely heavily on international professionals to maintain access to care, particularly in rural and underserved communities.

 

Hospitals Warn of Worsening Workforce Shortages

 

Lawmakers cautioned that imposing a $100,000 fee on new H‑1B visa petitions would further exacerbate existing staffing shortages and push financially vulnerable hospitals closer to the brink. According to the letter, if healthcare employers are unable to petition for H‑1B workers without absorbing the additional cost, critical clinical positions may remain unfilled, reducing patient access to essential services.

 

AHA Continues Advocacy for a Healthcare Exemption

 

The AHA’s support for the congressional letter aligns with broader, ongoing advocacy efforts by hospitals, academic medical centers, and healthcare associations seeking an exemption from the $100,000 H‑1B fee. These organizations argue that restricting access to H‑1B visas will worsen workforce shortages across multiple healthcare professions and undermine the financial viability of care providers serving high‑need populations.

 

As DHS continues to evaluate implementation of the fee, healthcare stakeholders remain focused on securing targeted relief that recognizes the essential role international professionals play in sustaining the U.S. healthcare system.

US Healthcare Industry Continues to Push for Exemptions to $100,000 H-1B Fee

In September 2025, President Trump instituted a prohibitive $100,000 fee on new H-1B visas. While lawsuits against the fee have been ongoing, the fee currently remains in effect. Hospitals, medical schools, and other healthcare companies have continued their calls for an exemption from the fee for international healthcare professionals who are essential to the US healthcare system.

In a recent article, the American Association of Medical Colleges (AAMC) raised concerns about how the fee is already affecting major staffing decisions for US hospitals approaching national Match Day with graduating medical students on March 20, 2026.

AAMC reports that in a fall survey by the Greater New York Hospital Association (representing 260 hospitals across NY, NJ, CT, and RI), 25% of hospitals said they had paused, deferred, or limited recruitment of physicians requiring H‑1B visas. Those hospitals currently employ 1,100 H‑1B medical residents and 800 H‑1B attending physicians, highlighting the scale of potential disruption.

Importantly, AAMC emphasizes that visa‑holding physicians do not displace U.S. graduates; in fact, 97.8% of U.S. MD seniors matched into residency positions in 2025.

International medical graduates make up about 25% of all practicing U.S. physicians. In fiscal year 2024 alone, approximately 11,000 new H‑1B visas were approved for physicians, who disproportionately practice in rural and high‑poverty counties and are more likely to work in primary care.

AAMC has cosigned multiple letters, joining medical organizations, institutions of higher education, and health professions education groups, in requesting that the U.S. Department of Homeland Security (DHS) exempt these groups from the fee. AAMC also sent a letter to DHS Secretary Kristi Noem in December 2025, warning that the proclamation will worsen the nation’s existing workforce shortage, further strain the health care workforce, and ultimately jeopardize patient access to care.

CALL FOR CONGRESSIONAL SUPPORT OF HEALTHCARE WORKFORCE RESILIENCE ACT

As discussed in a previous blog post, Musillo Unkenholt is pleased to report that the Healthcare Workforce Resilience Act (HWRA) has been reintroduced into Congress. The HWRA has bipartisan sponsorship of Senators Durbin and Cramer in the Senate and Representatives Brad Schneider and Don Bacon in the House.

The HWRA offers an immediate response to the U.S.’s nursing shortage crisis by recapturing 25,000 previously authorized but unused immigrant visas (Green Cards) for highly-qualified international nurses who meet strict professional requirements. The bill does not displace any U.S. nurses or increase the total number of available immigrant visas (Green Cards).

Musillo Unkenholt endorses the HWRA, an efficient and long-awaited step toward immigration reform that will work to meet the country’s growing need for a strong U.S. health care workforce.

The HWRA has the highest chance of passing in Congress with more co-sponsorship. If you or your employer would benefit from common-sense lawmaking to remedy the U.S. nursing shortage, contact your congressional representative about co-sponsorship of the HWRA.

HEALTHCARE WORKFORCE RESILIENCE ACT REINTRODUCED INTO CONGRESS

Musillo Unkenholt is pleased to report that the Healthcare Workforce Resilience Act (HWRA) has been reintroduced into Congress. The HWRA has bipartisan sponsorship of Senators Durbin and Cramer in the Senate and Representatives Brad Schneider and Don Bacon in the House.

As America grapples with a devastating nursing shortage that is directly undermining the quality, accessibility, and affordability of healthcare for millions of Americans in rural communities across the country, Musillo Unkenholt endorses policymakers taking immediate action.

The HWRA offers an immediate response to this crisis by recapturing 25,000 previously authorized but unused immigrant visas (Green Cards) for highly-qualified international nurses who meet strict professional requirements. The bill does not displace any U.S. nurses or increase the total number of available immigrant visas (Green Cards).

This bipartisan solution will help to ensure rural and elderly Americans receive the nursing care they need today while policymakers seek additional solutions to help America produce more nurses in the future and end this crisis once and for all.

Musillo Unkenholt endorses the HWRA, an efficient and long-awaited step toward immigration reform that will work to meet the country’s growing need for a strong US health care workforce.

Immigrant Caregivers are Crucial to Staff Direct Care Industry

President Trump’s “immigration crackdown” has elicited a warning from the direct care industry: immigrants are essential.

Although immigrants comprise 17% of the total American labor force, they make up 31% of the home care workforce and 21% of the residential care aide and nursing assistant workforce, according to a 2024 report from Leading Age, an organization representing nonprofit aging services providers.

 

A recent article by USA TODAY highlights the severity and scope of the direct care worker shortage, which is set to reach critical levels as the US faces even higher demand to care for aging Baby Boomers.

 

In 2020, 55.8 million people in the US were 65 and over, according to census data. A study in Health Services Research estimates that number will reach nearly 70 million by 2030.

 

From 2022 to 2037, a National Center for Health Workforce Analysis estimated the demand for home health aides will rise 35%, the demand for personal care aides will rise 38%, and the demand for nursing assistants will rise 41%.

 

Articles by Axios and AP News echo the essentiality of immigrant caregivers in US nursing homes, and warn of the effect President Trump’s immigration policies are already having on nursing home staffing in the US.

 

AP News reports:

 

“The aging of the massive Baby Boom generation is poised to fuel even more demand for caregivers, both in institutional settings and in individuals’ homes. BLS projects more growth among home health and personal care aides than any other job, with some 820,000 new positions added by 2032.”

 

Due to high demand and Department of State backlogs, immigrant nursing aides who qualify for a Green Card are currently waiting more than three years to enter the U.S. after their cases are approved.

 

Because of lengthy backlogs, staffing companies employing nursing assistants and nurse aides are best equipped to withstand immigration delays in their business models; however, meeting the demand for direct caregiving in the US in the coming years will require policies to extend temporary work authorization for direct care workers and policies to alleviate Department of State backlogs for permanent immigration solutions.

E-Verify Launches New Report on Revoked EADs

On June 20, 2025, the Department of Homeland Security (DHS) launched a new report to allow employers to identify E-Verify cases with Employment Authorization Documents (EADs) that have been revoked.

EADs allow employees to work in a broad range of occupations and industries, including healthcare, IT, and engineering.

 

EAD Revocations by DHS

 

DHS may terminate parole and revoke aliens’ EADs at any time. Employees with revoked EADs may still possess an EAD that appears valid, although their employment authorization has been revoked.

 

In late May 2025, DHS was permitted to terminate parole for Cubans, Haitians, Nicaraguans, and Venezuelans (CHNV).

 

What Employers Need to Know

E-Verify will no longer provide case alerts for EADs that have been revoked. Instead, employers should generate the Status Change Report upon logging in to E-Verify.

The new Status Change Report allows E-Verify employers to review cases for any employees who presented an EAD for employment verification which has now been revoked by DHS.

DHS has also published EAD Revocation Guidance For E-Verify Employers regarding these changes on E-Verify’s website.

Immigration Policy Essential to Ease U.S. Healthcare Staffing Crisis

Legal immigration pathways remain necessary to meet U.S. healthcare staffing needs for positions throughout the industry, including Registered Nurses, physicians, and nursing aides. A recent article from NPR highlights how Trump administration policies limiting legal pathways for nurses and other healthcare workers compromise healthcare throughout American hospitals, nursing homes and the entire healthcare system.

Citing research analysis by JAMA Network, a consortium of peer-reviewed, general medical and specialty publications, NPR emphasizes the prevalence and essentiality of foreign-born workers in the U.S. healthcare system:

• 25% of physicians in the U.S. were born outside of the U.S.
• Nearly 17% of the total healthcare workforce, or roughly 3.4 million workers, were born outside the U.S.
• 1.1 million healthcare workers in the U.S. are noncitizens without permanent residency in the U.S.

The Trump administration has enacted a series of measures and threatened others to end legal protections for millions of U.S. immigrants, creating uncertainty not only for immigrants, but for their employers. The administration has attempted to end Temporary Protected Status (TPS) for millions of legally authorized workers in the U.S. and has threatened the status of immigrants, including doctors and nurses, brought to the country illegally as children who receive legal protection through the Deferred Action for Childhood Arrivals, or DACA, program.

Even prior to President Trump’s reelection, staffing shortages in the U.S. healthcare workforce have restricted access to healthcare in the U.S. A 2024 survey from the American Healthcare Association found that nearly half of nursing homes in the U.S. said they’ve had to limit new admissions because of staffing shortages, and the JAMA Network letter reports that shortages of nurses and other personnel caused two-thirds of hospitals to operate below full capacity in 2023.

If Trump administration policies continue to restrict legal immigration pathways, current healthcare staffing shortages will be further exacerbated, hospitals will face bottlenecks and healthcare facilities will be unable to meet healthcare needs in the U.S. Legal immigration pathways for nurses and healthcare workers are an essential tool in providing healthcare in the U.S.

Healthcare Workforce Coalition meets with Lawmakers on Increasing Nurse Visas

 In March 2025, the Healthcare Workforce Coalition issued a press release on their recent meetings on Capitol Hill. The purpose of their meetings was to urge lawmakers to swiftly pass legislation to ease serious US healthcare workforce shortages.

The Healthcare Workforce Coalition is made up of healthcare industry leaders, including Ascend Learning, Brickyard Health, Fisher Titus Medical Center, Greater Baltimore Medical Center, LifeBridge Health, MedPro International, MedStar Health, Meritus Health, PRS Global, and St. Joseph’s University.

Representatives of the Healthcare Workforce Coalition met with the offices of US Senators and Representatives from both parties to urge support for measures to make visas for foreign-educated Registered Nurses and physicians immediately available.

POTENTIAL GOVERNMENT SHUTDOWN: HOW IT AFFECTS YOUR IMMIGRATION CASE

Unless Congress passes a spending bill in the coming week, the US government will shut down at midnight on Sunday, Oct. 1. However, not all immigration processes will halt immediately in light of a shutdown.

Immigration cases proceed through several different government agencies. A shutdown will affect certain agencies (and thus their processes) differently than others. 

What will Halt as of an Oct. 1 Shutdown 

DOL

Most significant to employment-based immigration cases, the Department of Labor (DOL) will not operate during a government shutdown.

Labor Condition Applications (LCAs), required for H-1B and E-3 filings, and Permanent Labor Certifications (PERMs), required for I-140 filings, cannot be drafted or filed during a government shutdown, and pending LCAs and PERMs will not be issued during a shutdown.

Further, the DOL confirmed to the American Immigration Lawyers Association (AILA) that the full FLAG online filing system will be disabled during a government shutdown. LCA and PERM records cannot be accessed online or printed from the FLAG system during a shutdown.

The DOL and MU recommend that all LCA and PERM filings be filed this week, prior to the potential shutdown. While LCAs typically take at least 7 days to be adjudicated by the DOL, the DOL indicated that it will attempt to adjudicate LCAs that are received this week prior to the potential shutdown.

Finally, the DOL may allow flexibility for employers who miss filing deadlines due to the government shutdown; if such guidance is issued, MU will update its blog accordingly.

What May Proceed after an Oct. 1 Shutdown?

USCIS

Cases that will be filed with or are currently pending with US Citizenship and Immigration Services (USCIS) will likely proceed without issue during a shutdown. In past shutdowns, USCIS has accepted late immigration filings that could not be timely filed due to the government shutdown.

DOS

Embassy services, such as visa appointments, are run by the Department of State and are also unlikely to be affected during a shutdown.

CBP

Entries to the US, including Canadian TN appointments, are handled by Customs and Border Patrol and are also unlikely to be affected by a shutdown.

If you are unclear how the shutdown will affect your case, clients are encouraged to contact their MU attorney for best strategies in the week ahead and during the potential government shutdown.

FAIRNESS FOR HIGH SKILLED IMMIGRANTS ACT COULD PASS SOON

The Fairness for High Skilled Immigrants Act has been a hot legislative item all year.  On several occasions, the bill has looked to be set into law, until a last minute Senate hold out has blocked the law’s progress.  One of the final holdouts, Sen. Durbin (D-IL), has just agreed to a compromise with Sen. Mike Lee (R-UT).  Sen. Lee is bill’s lead sponsor.

The bill, including Sen. Durbin’s amendments, would make these changes to Employment-Based Immigration:

Changes to the Green Card Quota and Process

• Eliminate the per-country visa caps on employment-based workers over a three-year phase in period.  This will speed up processing Indian EB2 and EB3 retrogressed immigrants.
• Allow all nonimmigrants in the US to file an I-485 Adjustment of Status 270 days (9 months) after the filing of their I-140, Petition for Alien Worker.  This will allow more job flexibility and protect Indian and Chinese H-1B and L-1 workers and their immediate families.  These Adjustment applicants must maintain qualifying employment and the entire family will retain their priority dates even if they would otherwise age-out.  This provides a great relief to long-retrogressed families.
• There is a 4,400 visa carve-out for Schedule A workers.  As with current law, their immediate family members also take visas at the same time.  This provision will end in 2026.
• There is also a second carve-out for non-Indian and Chinese nationals who have not worked in the US.  Our sense is that this will largely be used by non-H-1B occupations, such as Registered Nurses.  This provision ends in nine years.

 Changes to the H-1B visa

• Employers with more than 50% H-1B / L-1 workers would be barred from the H-1B program.
• H-1B Cap petitions must be posted on an on-line government job board prior to the filing of the H-1B cap petition.
• Elimination of the B-1 in Lieu of H-1B business visa rule.
• Additional wage protection for H-1B workers.
• Additional protections for H-1B whistleblowers. 

Next Steps

Sen. Lee is expected to try to pass the bill in the Senate this week, perhaps as soon as today.  The bill will need to go back to the House of Representatives, where it is expected to pass, perhaps before the end of the year.  After that the President will need to sign the Bill into law, which is expected.

UPDATE ON THE FAIRNESS FOR HIGH SKILLED IMMIGRANTS ACT

After several weeks of contentious negotiations, a deal has been struck to preserve nurse immigration into the US through the Fairness for High-Skilled Immigrants Act (H.R. 1044).  The AAIHR, of which Musillo Unkenholt is the only law firm member, led the fight to preserve these visas.  The AAIHR issued this press release in which they thanked Senators Perdue (R-GA), Paul (R-KY),and Young (R-IN) who were instrumental in crafting the deal.

The deal is still subject to two hurdles:

First, any Senator can block the deal.  While most Senators have signed off on the deal there may still be some Senators who are holding out.  Senator Durbin (D-IL) remains a block on the bill. In this video, Sen. Durbin explains his reasoning for holding out.

Second, the deal is still subject to approval by President Trump, who is expected to sign the bill into law if it can get past the Senate.

If the two hurdles are not overcome, the status quo stays in place, which means 12-15-year delays for many EB-2 and EB-3 Indians.

If the bill goes through, the new law will:

First, over a three-year phase-in, eliminate the per-country cap on employment based green cards.  This would be great news for Indian-born immigrants, halving their retrogression to 7-8 years.

Second, preserve 4,400 visas for Schedule A occupations – Registered Nurses and Physical Therapists.  Additionally, 2,800 visas will be used for derivatives (spouses and children) of RNs and PTs.  Unfortunately, this means that there will be a retrogression for spouses and children of RNs and PTs starting in early 2020.  This derivative retrogression is the price that others Senators demanded in order for the deal to be struck.

Third, there will be additional burdens on H-1Bs in all industries.  The details of the additional H-1B rules are forthcoming.

Again, the bill is not law.  Negotiations remain ongoing between Sen Lee (R-UT), who is the Fairness Act’s champion, and Sen. Durbin.

SEN. PAUL’S BELIEVE ACT IS MERIT BASED IMMIGRATION

Sen. Ran Paul (R-KY) has introduced a bill, the BELIEVE Act, that greatly improves the US employment-based visa system. 

Sen. Rand Paul’s act expands employment-based immigration visas, provides additional visas for Schedule A shortage occupations, ends per-country caps on employment-based immigration green cards, and allow spouses and children of temporary workers to legally work.  All while still providing all the same protections for American workers in an economy where nearly every qualified American worker currently has a job.

As the Cato Institute says, the

The BELIEVE Act would do more to move the United States toward a merit-based system than any other legislation introduced this congress. No legislation since the 2013 immigration reform bill that passed the Senate would increase skilled immigration more than this bill. A fourfold increase in employment-based permanent immigration would bring the United States more in line with the Canadian system.

Importantly, the BELIEVE Act considers the needs of US healthcare patients.  It provides additional visas for nurses and physical therapists, which will help all Americans, especially in rural communities where the nursing shortage is most dire.

For instance, Chattanooga area healthcare facilities and hospitals just announced that they cannot find nurses, despite Chattanooga area schools producing 500 nurses per year and despite more than 6,500 registered nurses living in the county.  CHI Memorial is now offering $20,000 sign-on bonuses to new nurses.  These shortages are rampant throughout the US.

Sen. Paul should be commended for producing legislation that serves all interests needs, except those who want to restrict immigration into the US.  Musillo Unkenholt strongly supports this bill.  If you are a healthcare facility or hospital who is willing to help support this bill, please contact Chris.