Health experts warn new $100,000 H-1B visa fee could strain red-state hospitals

A presidential proclamation signed on Friday imposes a $100,000 annual fee on H-1B visas for highly skilled foreign workers, a policy shift that health experts say could ripple through the U.S. health-care system. NBC News medical analyst Dr. Vin Gupta warned that the higher cost could shrink the pipeline of foreign-trained physicians and other clinicians at a time when hospitals rely on international graduates to staff busy facilities, particularly in states that lean red. Gupta told MeidasTouch that the policy’s impact will be felt not immediately, but in the medium term, noting that the country’s health system relies on a continuous influx of trained talent from abroad.

The new fee structure could be paid by either the visa holder or the corporate sponsor, depending on the sponsor’s arrangement. Prior to Friday’s proclamation, administrative fees for H-1B visas averaged about $1,500, according to BBC reporting cited by Axios. Gupta said the shift could complicate a workforce pipeline that already carries long timelines: it takes anywhere from four to six years for a medical resident to graduate, become skilled, and credentialed. He warned that the changes are not simply a short-term disruption but a reform with delayed effects that could accumulate over years. “This is going to have significant impacts, not just in the short term, but very much in the medium term here and that’s the irony of a lot of these policies, they’ll impact red states, and it’s not going to be felt immediately,” Gupta said in the interview.

Gupta emphasized that foreign medical graduates are crucial across disciplines to care for an aging population. He noted that the higher costs could deter hospitals from sponsoring skilled workers who would otherwise fill essential roles in busy facilities. As he explained, “we need foreign medical graduates, across the spectrum, wherever they’re coming from, to care for an aging society.” The conversation around the new policy also touched on the broader supply dynamics in health care, including the substantial presence of international medical graduates among residents who staff many hospital wards.

The political geography of U.S. health care looms large in Gupta’s assessment. He said the policy could disproportionately affect red states because they tend to have more community and rural hospitals and fewer sites where American medical graduates readily choose to practice. “If you have less people populating and being willing and able to take those jobs, what’s going to happen? Same thing that’s happening with immigration more broadly, in our farms and other places,” Gupta observed. In red states, the result could be a tighter labor market for physicians and other clinicians, potentially increasing workloads for remaining staff and affecting patient access to care.

Gupta also pointed to the cost calculus for hospitals. He argued that attracting and retaining a board-certified physician remains more expensive for institutions than keeping a resident or a trainee, a factor that could be amplified if visa sponsorship becomes more burdensome or expensive. The policy’s ripple effects, he warned, may not surface in the near term but could widen staffing gaps as residents advance through training and eventually require sponsorship for independent practice in the United States.

The health-care implications extend beyond the immediate staffing line. Gupta warned that the policy’s medium-term impact could resemble other funding and staffing shifts that have altered research and clinical pathways in recent years. “It’s going to show impacts once Trump’s out of office, just like NIH cuts,” he remarked, underscoring a broader concern that tighter immigration and funding measures can intersect with clinical capacity and research activity in ways that unfold gradually.

In practical terms, hospitals may face a shrinking pool of internationally trained physicians and other specialists who would traditionally fill gaps in high-demand areas. The combined pressures of an aging population, ongoing staffing shortages, and the need to maintain patient access to timely care could be exacerbated if visa sponsorship becomes substantially more expensive or complicated. While the immediate effects of a $100,000 H-1B visa fee are not visible in daily hospital operations, experts say the longer arc of credentialing, recruitment, and retention will determine how broadly patient care is affected across regions.

A second image is provided to illustrate the broader health-care staffing context, showing hospital caregivers in a typical U.S. facility as they navigate patient loads and staffing constraints.

As hospitals seek to plan for these potential shifts, policy makers and health-system leaders will need to weigh the trade-offs between national immigration objectives and the practical needs of front-line care. The debate over the H-1B visa policy highlights a longer-running tension between workforce planning and the funding and regulatory environment that governs U.S. medical training. In the months ahead, health systems will likely monitor applicant pools, sponsor costs, and staffing models to determine how best to maintain patient access while navigating the evolving immigration landscape. The ultimate health impact will depend on how quickly alternative staffing strategies can compensate for any contractions in foreign-trained talent, and how policymakers respond to the mid- and long-term needs of hospitals serving diverse communities across the country.