Reps. Tokuda, Bacon Lead Bipartisan Effort to Protect Rural Health Care from New $100,000 H-1B Visa Fee

Washington, D.C. - U.S. Representatives Jill Tokuda (D-HI-02) and Don Bacon (R-NE-02), along with 31 of their colleagues, are urging Department of Homeland Security (DHS) Secretary Kristi Noem to exempt healthcare workers from U.S. Citizenship and Immigration Services' (USCIS) newly implemented $100,000 fee for workers located outside the United States.

In a bipartisan letter, the lawmakers warn that the unprecedented fee would further strain rural hospitals, clinics, and safety-net providers already facing severe workforce shortages - threatening access to care for patients in rural, frontier, and medically underserved communities, where alternative providers are often hours away.

"For small rural hospitals and clinics operating on thin or negative margins, the uncertainty and upfront costs alone are prohibitive," the lawmakers wrote in the letter. "With no categorical exemption, many facilities are being forced to pause or completely abandon recruitment of critically needed healthcare workers."

When qualified U.S. workers are unavailable, the H-1B visa program becomes a lifeline for rural health care. It allows doctors, nurses, and other clinicians to serve rural communities that might otherwise go without care. Between 2016 and 2022, more than 8,300 physician H-1B petitions supported care in rural counties, helping facilities keep doors open and services available. The new fee would impose a cost many rural providers simply cannot absorb.

While DHS allows for case-by-case waivers, the lawmakers argue the process is administratively burdensome, unpredictable, and unrealistic for small rural providers with limited staff and resources. The letter calls on DHS to adopt a clear, categorical exemption for healthcare workers to protect continuity of care and prevent further erosion of rural healthcare access.

Reps. Tokuda and Bacon were joined by Reps. Becca Balint (VT-AL), Sanford Bishop (GA-02), Sharice Davids (KS-03), Donald Davis (NC-01), Maxine Dexter (OR-03), Debbie Dingell (MI-06), Shomari Figures (AL-02), Steven Horsford (NV-04), Jeff Hurd (CO-03), Robin Kelly (IL-02), Raja Krisnamoorthi (IL-08), Kimberlyn King-Hinds (CNMI-AL), Susie Lee (NV-03), Teresa Leger Fernandez (NM-03), Ted Lieu (CA-36), Seth Magaziner (RI-02), John Mannion (NY-22), Sarah McBride (DE-AL), April McClain Delaney (MD-06), Carol Miller (WV-01), Kelly Morrison (MN-03), Seth Moulton (MA-06), James Moylan (GU-AL), Andrea Salinas (OR-06), Mary Gay Scanlon (PA-05), Hillary Scholten (MI-03), Terri Sewell (AL-07), Melanie Stansbury (NM-01), Mike Thompson (CA-04), Lori Trahan (MA-03), and Gabe Vasquez (NM-02).

The letter is endorsed by the National Rural Health Association and the National Association of Rural Health Clinics.

The full text of the letter is available here.

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