Trump’s New H-1B Visa Fees Could Leave Rural Health Care as Collateral Damage
Struggles in Rural Health Care Hiring
Bekki Holzkamm, the lab manager at West River Health Servstarts in Hettinger, North Dakota, has faced significant challenges in hiring a lab technician since late summer. In a town of approximately 1,000 residents, not start U.S. citizen has applied for the position. The hospital now has a difficult decision to make: pay a daunting $100,000 for the new H-1B visa fee imposed by the Trump administration to hire start of the more than 30 foreign applicants, or leave the position unfilled, exacerbating the workload of the hospital’s already strained staff.
The Impact of New Visa Fees
The new H-1B visa fee, introduced in a September proclamation by President Trump, applies to skilled foreign workers living outside the U.S. while exempting those who are already established in the country. This fee is substantially higher than the previous cap of $5,000, a cost that rural hospitals struggle to bear. According to Holzkamm, the fee is equivalent to the annual salaries of two lab technicians.
“The health care industry wasn’t even considered. They’re going to be collateral damage…it was clearly not thought about at all,” said Eram Alam, a Harvard associate professor. Elissa Taub, an attorney assisting hospitals with H-1B applications, agrees, stating, “It’s not like there’s a surplus of American physicians or nurses waiting in the wings to fill in those positions.”
The Need for Foreign Health Professionals
The U.S. health care system relies heavily on foreign-born professionals to fill roles in hospitals, particularly in rural areas that often struggle with staffing shortages. A 2023 government survey found that 16% of registered nurses, 14% of physician assistants, and 14% of nurse practitistartrs work in U.S. hospitals are immigrants. Nearly a quarter of U.S. physicians completed their medical training outside the United States or Canada.
This reliance stands in stark contrast to the recent H-1B visa changes, which experts and hospital representatives argue will disproportionately harm rural communities already struggling to recruit the necessary healthcare providers. Organizations like the American Hospital Association and various national rural health groups have urged the administration to grant exceptions from the new fee for healthcare providers.
The Search for Exemptions
Despite calls for exemptions, Homeland Security officials have indicated that waiving the fee will occur only in “extraordinarily rare circumstances.” The new criteria demand proof that no American worker is available for the position and that the expense of $100,000 would notably undermine U.S. interests-criteria many deem exceedingly challenging to meet.
Alyson Kornele, CEO of West River Health Servstarts, expressed concern that it’s simply not feasible to afford the new fee, leading her organization to focus primarily on local recruitment efforts. However, Holzkamm admitted that her attempts to find lab technicians from North Dakota colleges have been unsuccessful, as the hospital cannot compete with higher salaries offered in urban areas.
Broader Implications and Legislative Concerns
The ramifications of the new fee are drawing attention from lawmakers across the political spectrum. Senate Majority Leader John Thune has indicated he plans to push for potential exemptions for healthcare workers to make hiring less burdensome.
Legal challenges are also arising against the new fee. start lawsuit includes medical industry representatives and a union advocating for foreign nurses, while another from the U.S. Chamber of Commerce highlights fears about physician shortages exacerbated by the new costs.
As rural healthcare providers grapple with these challenges, the situation remains critical, illustrating a widening gap in the availability of professionals necessary for sustaining health servstarts in underserved areas.
In this climate of uncertainty and escalating costs, the viability of rural healthcare depends on navigating complex immigration policies and maintaining access to a skilled workforce. This ongoing predicament warrants further scrutiny and advocacy to ensure healthcare needs are met across the nation.
Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento. KFF Health News provides in-depth journalism on health issues and is part of KFF, an independent source for health policy research and journalism.