20 States and Employer Coalition Launch Separate Court Fights Against $100,000 H‑1B Fee

Update - 12/22/25

Two major lawsuits are moving forward to block the Trump administration’s $100,000 H-1B visa fee, a policy critics say could worsen healthcare staffing shortages and limit patient access.

20 States Challenge Fee as Unlawful and Harmful to Healthcare

In December 2025, 20 states led by California Attorney General Rob Bonta filed a federal lawsuit arguing the $100,000 H-1B fee exceeds presidential authority and was imposed without congressional approval or required public notice.

The states warn the policy threatens essential public services, including healthcare. According to the complaint, without access to H-1B professionals, “public research centers would lack staffing to support cutting-edge research, and hospitals would lose capacity to treat seriously ill patients.”

Attorney General Bonta called the fee “unlawful” and said it harms healthcare, education, and other critical systems that rely on skilled workers.

National Coalition Seeks Injunction After Filing Federal Lawsuit

In a separate case already filed in federal court, a national coalition of employers, including schools and health care providers, represented by the Justice Action Center, is now asking a judge in the Northern District of California to block enforcement of the fee through a preliminary injunction while the lawsuit moves forward.

The coalition argues the six‑figure fee functions as a barrier that effectively shuts out many high‑skilled workers, including nurses, and that the policy is “effectively a KEEP OUT sign to future teachers, scientists, nurses, and others who fill critical labor shortages that keep America running.”

The coalition has also filed a motion for class certification, arguing the fee is causing immediate and irreparable harm to healthcare systems and communities that rely on international professionals.

Courts will now determine whether enforcement of the fee is paused while both cases proceed.

What Nurses Should Know

• H-1B visas are commonly used to staff hard-to-fill healthcare roles, particularly in specialty units and underserved or rural areas.
• A $100,000 fee may deter hospitals from hiring international healthcare workers, even when patient demand is high and staffing shortages persist.
• Both lawsuits argue the policy could reduce hospital capacity and strain frontline staff, including nurses, rather than protect U.S. jobs.
• The coalition lawsuit was filed earlier this fall. Current court filings seek an injunction to stop enforcement of the fee while judges consider the merits of the case.
• The outcome of these cases could have direct implications for staffing levels, workload, and patient care nationwide.

Update - 10/6/25

A major update in the ongoing H-1B visa debate: a prominent global nurse-staffing agency, together with several unions and healthcare groups, has filed a federal lawsuit challenging the Trump administration’s new $100,000 H-1B visa fee.

This legal action, spearheaded in California, argues that the fee is unlawful, unconstitutional, and would force hospitals and agencies to either pay excessively or navigate uncertain “national interest” exemption processes likely to be selectively enforced.

Legal challenge launched

A coalition of healthcare providers, recruitment firms (including Global Nurse Force, a nursing staffing agency), labor unions, educational institutions, and religious organizations have filed a federal lawsuit in the Northern District of California seeking to block the fee. 

They argue the proclamation:

• Exceeds presidential authority by imposing what amounts to a steep tax without Congressional authorization. 
• Was implemented too quickly (36-hour lead time) without proper regulatory rulemaking or public comment. 
• Threatens critical sectors (healthcare, education) that rely on access to global talent. 

The plaintiffs are already pushing for an injunction to stop enforcement of the fee.

Sens. Shelley Moore Capito (R-W.V.) and Joni Ernst (R-Iowa) said in recent interviews that hospitals in their states, both of which rely heavily on immigrant healthcare workers, have urged them to advocate for an exemption or carveout from the new $100,000 H-1B visa fee. The senators noted that rural and underserved communities in West Virginia and Iowa could face severe staffing shortages if the policy isn’t adjusted to protect foreign-trained nurses and clinicians.

Original Article - 9/22/25

The Trump administration’s abrupt $100,000 H-1B visa fee hike has set off alarm bells across both technology and healthcare companies, with doctors, nurses, and hospital leaders warning of potential repercussions for patient access and workforce shortages. Here’s what nurses need to know about this new policy shift, the evolving exemption debate, and its wider implications for staffing and care delivery.

H-1B Visas: Dominated by Tech, Crucial for Healthcare

An H-1B visa is a temporary, employer-sponsored work permit that allows U.S. companies to hire foreign professionals in specialty occupations requiring at least a bachelor's degree or equivalent specialized knowledge.

H-1B visas mostly go to technology companies, but the Trump administration’s $100,000 fee hike affects healthcare workers too—especially those from India and China.

• Tech Dominance: About 75% of H-1B approvals go to tech roles at companies like Amazon, Microsoft, and Meta.
• Healthcare companies use far fewer—only around 2% (about 8,000 visas annually).
• Who’s Most Impacted: Indian nationals receive about 71–75% of all H-1Bs; China follows at 12%.

What’s in the New H-1B Visa Fee Hike?

The administration’s new rule imposes a $100,000 annual fee for each new H-1B visa application, up from under $5,000 previously. H-1B visas are occasionally used by hospitals to hire international physicians, nurses, and other highly skilled medical staff, especially to fill hard-to-recruit roles and plug crucial gaps in underserved areas.

According to Commerce Secretary Howard Lutnick, this move is meant to deter entry-level or training roles for foreign workers, prioritizing only senior-level professionals or jobs deemed “high-value.”

Hospitals, often stretched on budgets, could now face the prospect of paying far more for filling medical residency slots—positions that frequently pay around $55,000 per year. The policy keeps the current quota system (65,000 regular visas, plus 20,000 for advanced degree holders), but many expect a sharp drop in applications due to the higher costs.

Nurses, Doctors, and Hospitals: Are Exemptions Coming?

The White House has signaled that exemptions may be forthcoming for specific professions. The policy language allows “national interest” waivers, which have included physicians, nurses, and care workers in the past (during the Covid-19 crisis).

Still, until detailed rules are issued, confusion and anxiety persist among foreign-trained nurses and physicians. Immediate impact falls on new applicants—current H-1B holders and their renewals are reportedly unaffected.

What It Means for U.S. Healthcare Staffing

International medical graduates account for over 30% of U.S. residents, with many of the 43,000 residency slots filled annually by H-1B visa holders. Losing access to this vital workforce risks compounding shortages, particularly in rural and underserved communities.

The logistical, legal, and ethical ramifications are already being debated by lawmakers, advocacy groups, and hospital executives, with some warning this will weaken America’s competitive edge and deepen primary care shortages.

Nurses know that hospital staffing shortages ripple everywhere—impacting care, patient throughput, and the well-being of staff already bearing historic levels of burnout. Internationally educated medical professionals remain an essential part of the workforce. Any barrier—regulatory, financial, or political—risks further pressuring those who stay.

 

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