Tokuda joins US House members in call to exempt overseas healthcare workers from a new $100,000 visa fee

US Reps. Jill Tokuda of Hawaiʻi and Don Bacon of Nebraska are leading a bipartisan group of 33 lawmakers in a call for Department of Homeland Security Kristi Noem to exempt healthcare professionals recruited from outside the United States from a new $100,000 H-1B visa fee.

In a letter sent to Noem, the lawmakers warned that the fee for impacted workers creates a significant barrier for rural hospitals and clinics already struggling with workforce shortages.

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

The H-1B program allows US employers to temporarily hire foreign professionals in specialty occupations, such as physicians and nurses, when local candidates are unavailable. The $100,000 fee specifically applies to health care workers recruited from abroad, a move lawmakers say threatens the primary pipeline for staffing remote clinics in Maui County areas like Hāna or Lānaʻi.

Waiver proponents argue that the H-1B visa program is a vital tool for rural healthcare providers when qualified US workers are unavailable. According to the lawmakers, more than 8,300 physician H-1B petitions supported care in rural counties between 2016 and 2022.

The new $100,000 fee was recently implemented by US Citizenship and Immigration Services. While the department allows for case-by-case waivers, the lawmakers said the process is administratively burdensome and unpredictable for small providers with limited resources.

The letter requests a clear, categorical exemption for healthcare workers to ensure continuity of care in medically underserved areas.

The effort is endorsed by the National Rural Health Association and the National Association of Rural Health Clinics. Supporting lawmakers include representatives from 21 states and two territories, including US Rep. James Moylan of the territory of Guam and US Rep. Kimberlyn King-Hinds of the Commonwealth of the Northern Mariana Islands.