Major U.S. healthcare organizations are urging the Trump administration to exempt medical professionals from a proposed $103,265 H-1B petition fee, warning that the additional cost could make recruiting foreign-trained doctors financially impractical for hospitals already facing staffing shortages.
By yourNEWS Media Newsroom.
Some of the nation’s largest healthcare organizations are pushing the Trump administration to carve medical professionals out of a proposed $103,265 H-1B visa petition fee, setting up a clash between the administration’s immigration and workforce policies and hospitals that rely on foreign-trained physicians.
The public comment period for the Department of Homeland Security proposal, formally titled “Fee for Certain H-1B Petitions,” closed Thursday. The proposed fee would apply to H-1B petitions subject to the program’s annual statutory cap, including petitions qualifying for the advanced-degree exemption, and would be charged in addition to other applicable filing costs. DHS estimates the $103,265 fee would generate approximately $8.8 billion annually if applied to 85,000 cap-subject petitions.
Healthcare organizations submitted some of the strongest objections before the deadline.
The American Hospital Association, which represents nearly 5,000 hospitals, health systems and other healthcare organizations, asked U.S. Citizenship and Immigration Services to exclude healthcare workers from the additional charge.
“The AHA recommends that DHS make healthcare professionals exempt from any additional fees to ensure continued access to timely, high-quality care for all communities,” the organization wrote.
The AHA argues that foreign-trained healthcare workers fill positions that hospitals, particularly those in rural and underserved areas, struggle to staff domestically. Its submission said H-1B-sponsored healthcare professionals account for less than 5% of H-1B holders in the United States and that 11,080 H-1B-sponsored physicians represented about 1% of practicing U.S. physicians in fiscal 2024. The organization said the country nevertheless ended that year with a shortage of about 64,000 physicians.
The American Medical Association raised similar concerns in a letter to Homeland Security Secretary Markwayne Mullin, warning that imposing the fee on physicians could have “devastating consequences” for international medical graduates and healthcare providers attempting to recruit them.
“The proposed rule is likely a violation of the Major Questions Doctrine,” the AMA letter alleges.
The doctrine concerns whether executive agencies have clear congressional authorization when asserting regulatory powers involving matters of major economic or political significance. A congressional explanation of the Major Questions Doctrine describes it as a principle under which an agency may exceed its authority when taking economically or politically significant action without sufficiently clear authorization from Congress.
The AMA also argues that the proposed charge could put H-1B recruitment beyond the financial reach of smaller medical practices and hospitals. The association said the fee would particularly affect employers serving populations where physician recruitment is already difficult.
DHS presents the proposal differently.
The department says the additional charge would recover part of the federal government’s costs associated with administering the lawful immigration system across several agencies. The proposal identifies expenses involving immigration adjudications, fraud detection, national-security vetting, border inspection, immigration courts, consular processing and labor enforcement.
USCIS obtains most of its operating revenue from fees paid by applicants and petitioners seeking immigration benefits. DHS argues that federal law gives it authority to recover certain immigration and naturalization costs through such charges.
For fiscal 2026, DHS spending across its 16 components is listed through USASpending.gov at approximately $356 billion.
“Congress has established limits on the number of foreign workers who may be granted initial H-1B non-immigrant visas or status each fiscal year,” the proposed regulation states.
The H-1B program dates to 1990 and permits American employers to temporarily employ qualifying foreign nationals in specialty occupations requiring specialized knowledge, including jobs in medicine, technology, engineering and other professional fields.
Federal law generally limits new H-1B status to 65,000 workers annually, with another 20,000 positions available under an exemption for people who have earned qualifying master’s or higher degrees from U.S. institutions, according to the Department of Labor.
The new DHS proposal comes after a separate legal battle over an earlier Trump administration attempt to sharply increase the cost of employing new H-1B workers.
President Donald Trump issued a proclamation in September 2025 requiring a $100,000 payment in connection with certain new H-1B petitions. Global Nurse Force and a coalition that included labor, educational, religious and healthcare-related organizations subsequently filed a federal lawsuit on Oct. 3, 2025, challenging the administration’s authority to impose the payment.
That litigation remains pending, but the earlier $100,000 policy has also faced a separate legal setback. In June, a federal judge in Massachusetts vacated the government guidance implementing the payment after concluding that the executive branch lacked authority to impose what the court determined functioned as a tax without congressional authorization. The Trump administration appealed that ruling to the 1st U.S. Circuit Court of Appeals. DHS itself acknowledged the ruling and pending appeal in its August rulemaking.
The $103,265 proposal now under consideration is legally distinct from that earlier $100,000 payment. DHS is attempting to establish the new charge through formal agency rulemaking and says it relies on different statutory authority.
Congress is also considering whether to impose a large H-1B fee directly through legislation.
Republican Utah Rep. Mike Kennedy has proposed legislation that would establish a $100,000 H-1B fee through Congress after the earlier administration policy was struck down.
Kennedy argues that substantially increasing the cost of H-1B sponsorship would remove incentives for employers to use foreign labor to reduce personnel expenses and would strengthen protections for American workers.
“My dad is an immigrant. I’m a big fan of immigrants, but we need to make sure that immigrants are not taking advantage of the system — or employers aren’t taking advantage of the system — so that our American workforce is harmed,” Kennedy told the Daily Caller News Foundation in June.
Hospitals and physician organizations counter that healthcare presents a different workforce problem because many communities already struggle to recruit enough doctors and other specialized professionals.
The AHA said training additional domestic physicians cannot quickly eliminate those shortages because producing a new doctor can require seven to 15 years of education and training. It also warned that rural hospitals, many of which operate under severe financial constraints, could be disproportionately affected by a six-figure petition charge.
With the comment period now closed, DHS will determine whether to revise, abandon or move toward finalizing the $103,265 fee. The dispute leaves the administration weighing its effort to increase the cost of H-1B hiring and recover federal immigration expenses against warnings from hospitals and physicians that the policy could make recruiting medical professionals considerably more difficult.
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