H-1B visa: Doctors, nurses, care workers may be spared from $100,000 fee

Trump's $100,000 H-1B visa fee sparks panic among Indian doctors, nurses and IT firms, though exemptions for healthcare may soften the blow

A steep $100,000 fee for H-1B visa applications, announced by the Trump administration and now in effect, has unsettled Indian doctors and nurses hoping to work in the United States.

 

Right after Trump's announcement of H-1B visa fee hike, Nicholas Mark, a Seattle-based pulmonologist, wrote on X, “This will be absolutely devastating in the medical field. About 30 per cent of residents are international medical graduates and 10,000 of 43,000 residency spots are filled by doctors with H-1B visas. No hospital will pay a 100,000 fee for a 55,000 resident salary.”

 

But they may be spared, as healthcare professionals could fall under a national interest exemption, even as hospitals and employers weigh the economics of hiring foreign-trained workers.

 

Exemptions in national interest

 

Immigration attorney Sukanya Raman, country head at Davies and Associates law firm, explained that the proclamation leaves room for flexibility. “Doctors and nurses, and other health care workers, if need arises may be exempt from the fee,” she told Business Standard.

 

She recalled how panic spread among H-1B workers right after the announcement. “Just after the fee hike announcement, I got a call from a client who is in India at the moment but works in the US on H-1B visa. He wanted to know if he should book his flight for the US immediately. I told him to wait and see how things pan out,” she told Business Standard. “That was a good thing, as the White House later clarified that the fee would apply only to new visas and not existing ones. Most importantly, healthcare has historically been recognised as national interest.” 

 

What the proclamation says

 

The proclamation, titled “Restriction on Entry of Certain Nonimmigrant Workers”, spells out conditions under which the Secretary of Homeland Security can waive the fee. Under Section 1(c), the Secretary has discretion to exempt:

 

An individual alien

All aliens working for a specific company

All aliens in a particular industry

 

This is possible if hiring them is considered in the national interest of the United States and does not threaten its security or welfare.

 

That discretion is broad. For example, shortages of physicians in rural areas or the need for foreign specialists in medical research could justify an exemption. 

 

Precedent from 2020 restrictions

 

Healthcare has in the past been treated as a matter of national interest. In June 2020, Trump signed Proclamation 10052, suspending entry for several categories of nonimmigrant workers, including H-1B, H-2B, L-1 and certain J visas. The suspension was framed as protecting US jobs during the Covid-19 downturn, but exemptions were granted where foreign workers were deemed necessary.

 

At that time, the Departments of State and Homeland Security clarified who qualified. Categories included:

 

1. Doctors and nurses coming to treat Covid-19 patients or working in areas of acute medical shortage

2. Medical researchers focusing on Covid-19 or other public health diseases

3. Public health professionals directly linked to the pandemic response

 

Other groups granted exceptions in 2020 included food supply chain workers, defence and law enforcement personnel, and specialists whose work supported major US investments.

 

Impact on Indian IT firms

 

While healthcare may yet find protection under the “national interest” clause, other industries face tougher choices. Neeti Sharma, CEO of TeamLease Digital, told Business Standard, “In the short term, lesser number of H-1B visas would mean lesser number of Indian engineers that will be sent as onsites. Indian IT companies will now have to rethink their H-1B strategy. They will reserve the ‘expensive’ H-1B visas for super specialised skills for roles that can justify the 100,000 fee and give them the ROI on their investments. The other areas of concern will be on companies hiring a higher volume of local talent in America. For the Indian IT companies, this would mean a spike in their costs, thus reducing margins and spending capabilities.”