February 11, 2026
The Honorable Kristi Noem
Secretary of Homeland Security
U.S. Department of Homeland Security
3801 Nebraska Avenue NW
Washington, DC 20528
Dear Secretary Noem:
We are deeply concerned about the impact of the September 19 Presidential Proclamation,
“Restriction on Entry of Certain Nonimmigrant Workers,” on the health care workforce. The
Proclamation imposes a $100,000 fee on employers that petition for a new H-1B visa, but also
recognizes the Department of Homeland Security Secretary’s authority to grant sector-wide
exemptions, so long as it “is in the national interest and does not pose a threat to the security or
welfare of the United States.” We urge you to create a health care sector exemption to prevent
additional strain on the health care workforce.
Worsening workforce shortages across all health care professions are significantly diminishing
access to care in rural and urban communities across the nation. According to the Health
Resources and Services Administration, nearly 87 million Americans live in areas Federally
designated as lacking enough medical professionals to address the community’s health care
needs.1 Physician demand could exceed supply by up to 86,000 in the next decade and clinical
laboratory science programs are educating less than half the number of clinical laboratory
professionals needed.2 3 These shortages cannot be filled by the domestic workforce alone, and
projections will worsen if health care employers cannot continue to recruit and retain
international health care workers.
For over 30 years, health care employers have used the H-1B visa program to recruit and retain
the finest international talent, positioning the US as a global leader in health care delivery and
innovation. Many members of the care team—including highly skilled physicians, advanced
practice professionals, clinical laboratory workers, and researchers—come to the U.S. from
around the world to offer specialized services, deliver care in underserved areas, and contribute
to cutting-edge biomedical research.
Health care organizations must be able to recruit staff in the most cost-effective manner so they
can use their financial resources to hire as many caregivers as possible to take care of their
communities. Rural hospitals and urban safety net hospitals face uncommon recruitment and
retention issues and will most acutely feel the effects of the $100,000 fee. These hospitals rely heavily on the H-1B visa to maintain adequate staffing and offer comprehensive services in high-need
areas. 21 million Americans live in areas where foreign-trained physicians account for at
least half of all practicing physicians.4</sup?
Imposing a $100,000 fee for new H-1B visa petitions will exacerbate hospitals’ existing staffing
challenges and could push chronically underfunded hospitals to their financial brink. If these
hospitals cannot petition for new H-1B visas to address their staffing needs without also having
to pay this fee, it will further damage their financial viability. Critically needed open positions
will simply go unfilled, leaving rural and high-poverty urban areas without adequate access to
care.
We strongly urge you to exempt the health care sector from this burdensome fee. Thank you for
considering our request.
Sincerely,
Yvette D. Clarke
Member of Congress
Michael V. Lawler
Member of Congress
Lori Trahan
Member of Congress
Kirsten Gillibrand
United States Senator
Shontel M. Brown
Member of Congress
Madeleine Dean
Member of Congress
Frank J. Mrvan
Member of Congress
Grace Meng
Member of Congress
John W. Mannion
Member of Congress
Dan Goldman
Member of Congress
Hillary J. Scholten
Member of Congress
Nydia M. Velázquez
Member of Congress
Timothy M. Kennedy
Member of Congress
Bradley Scott Schneider
Member of Congress
Marc A. Veasey
Member of Congress
Chrissy Houlahan
Member of Congress
Teresa Leger Fernández
Member of Congress
Thomas H. Kean, Jr.
Member of Congress
Jennifer L. McClellan
Member of Congress
Raja Krishnamoorthi
Member of Congress
Jasmine Crockett
Member of Congress
James C. Moylan
Member of Congress
Becca Balint
Member of Congress
Suzan K. DelBene
Member of Congress
Ted W. Lieu
Member of Congress
Herbert C. Conaway, Jr.
Member of Congress
Terri A. Sewell
Member of Congress
Laura Friedman
Member of Congress
Kweisi Mfume
Member of Congress
Jerrold Nadler
Member of Congress
Betty McCollum
Member of Congress
Doris Matsui
Member of Congress
George Latimer
Member of Congress
Laura A. Gillen
Member of Congress
Josh Gottheimer
Member of Congress
Adriano Espaillat
Member of Congress
Patrick Ryan
Member of Congress
Brian K. Fitzpatrick
Member of Congress
Robin L. Kelly
Member of Congress
Seth Magaziner
Member of Congress
Donald G. Davis
Member of Congress
Melanie Stansbury
Member of Congress
LaMonica McIver
Member of Congress
Danny K. Davis
Member of Congress
Josh Riley
Member of Congress
Ami Bera, M.D.
Member of Congress
Eric Swalwell
Member of Congress
Julie Johnson
Member of Congress
Alexandria Ocasio-Cortez
Member of Congress
Mike Thompson
Member of Congress
Joseph D. Morelle
Member of Congress
Nanette Diaz Barragán
Member of Congress
Mary Gay Scanlon
Member of Congress
Emilia Strong Sykes
Member of Congress
Steve Cohen
Member of Congress
Chris Deluzio
Member of Congress
Ritchie Torres
Member of Congress
Valerie P. Foushee
Member of Congress
Debbie Dingell
Member of Congress
Maggie Goodlander
Member of Congress
Lloyd Doggett
Member of Congress
Thomas R. Suozzi
Member of Congress
Vicente Gonzalez
Member of Congress
Veronica Escobar
Member of Congress
Paul Tonko
Member of Congress
Shomari Figures
Member of Congress
Nikema Williams
Member of Congress
Sylvia R. Garcia
Member of Congress
Jimmy Panetta
Member of Congress
Chris Pappas
Member of Congress
Jan Schakowsky
Member of Congress
Maxine Dexter
Member of Congress
Jefferson Van Drew
Member of Congress
James P. McGovern
Member of Congress
Bill Foster
Member of Congress
Lucy McBath
Member of Congress
Donald S. Beyer Jr.
Member of Congress
Suhas Subramanyam
Member of Congress
SETH MOULTON
Member of Congress
Sheila Cherfilus-McCormick
Member of Congress
Gregory W. Meeks
Member of Congress
Gilbert Ray Cisneros, Jr.
Member of Congress
Dina Titus
Member of Congress
Emanuel Cleaver, II
Member of Congress
Brendan F. Boyle
Member of Congress
Shri Thanedar
Member of Congress
Nellie Pou
Member of Congress
Joaquin Castro
Member of Congress
Wesley Bell
Member of Congress
Eleanor Holmes Norton
Member of Congress
André Carson
Member of Congress
Henry C. “Hank” Johnson, Jr.
Member of Congress
Judy Chu
Member of Congress
Linda T. Sánchez
Member of Congress
Stephen F. Lynch
Member of Congress
Kelly Morrison
Member of Congress
Zoe Lofgren
Member of Congress
James R. Walkinshaw
Member of Congress
Bennie G. Thompson
Member of Congress
Robert J. Menendez
Member of Congress
Supporting Organizations (40):
American Hospital Association (AHA)
Association of American Medical Colleges (AAMC)
Greater New York Hospital Association (GNYHA)
Hospital Association of New York State (HANYS)
American Psychiatric Association (APA)
NYC Health + Hospitals
America’s Essential Hospitals (AEH)
California Medical Association (CMA)
Advocates for Community Health (ACH)
Association of Clinicians for the Underserved (ACU)
American Academy of Neurology
American College of Obstetricians & Gynecologists (ACOG)
Miles for Migraine
American Gastroenterological Association, Association for Advancing Physician and Provider Recruitment (AAPPR)
Hope for HIE
American College of Radiology (ACR)
American Geriatrics Society
MLD Foundation
Society of Teachers of Family Medicine (STFM)
Association of Department of Family Medicine
American Society for Clinical Pathology (ASCP)
Society of Hospital Medicine (SHM)
The Society of Thoracic Surgeons
American College of Surgeons (ACS)
National Society for Histotechnology
American Academy of Family Physicians (AAFP)
American Society for Cytopathology
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
American Society of Hematology (ASH)
American Academy of Pediatrics (AAP)
NAPCRG
American Society for Clinical Pathology’s Board of Certification
Infectious Diseases Society of America
HIV Medicine Association
Commission on Laboratory Accreditation (COLA)
Philippine Association of Medical Technologist-USA, Inc. (PAMET-USA, Inc.)
Association of Academic Leaders of Neurology
American Society for Radiation Oncology (ASTRO)
American Clinical Laboratory Association (ACLA)
References:
- HRSA. Fourth Quarter Summary of Fiscal Year 2025 Designated HPSA Quarterly Summary. September 30.
- https://www.aamc.org/media/75236/download?attachment
- GNYHA Position Paper: Hospitals and Other Health Care Organizations Should Be Exempt from the H-1B Visa Fee.
- https://www.ama-assn.org/health-care-advocacy/advocacy-update/oct-3-2025-national-advocacy-update