Although the $100,000 H-1B visa fee has been blocked by the courts since this summer, the White House just extended it for another year. That leaves ASCs that recruit foreign-trained clinicians with no clear answer about what their next hire might cost.
A presidential proclamation signed Sept. 19, 2025, imposed the $100,000 fee on new H-1B petitions. The U.S. Citizenship and Immigration Services described exceptions as “extraordinarily rare.” Then, on June 8, a federal court in Massachusetts vacated the policy nationwide in California v. Mullin, finding the fee amounted to a tax imposed without congressional authorization and violated the Administrative Procedure Act. U.S. District Judge Leo Sorokin briefly paused his order on June 12. The 1st U.S. Circuit Court of Appeals lifted that pause July 24 and declined to reinstate the fee while the government appeals.
On Sept. 18, the administration extended the proclamation through September 2027. USCIS can’t collect the fee while the court order stands, but the appeal is still pending. A federal court in Washington, D.C., upheld the fee in a separate December 2025 case brought by the U.S. Chamber of Commerce. With two courts split on the question, the fee could come back.
The fee’s reach is also narrower than it first seemed. It applies only to new petitions. Extensions, amendments and changes of status for workers already in the U.S. in valid status are exempt. That exemption covers many international medical graduates who move from J-1 or F-1 status to H-1B after residency. For ASCs, the risk is concentrated in new hires recruited from abroad, not clinicians already on staff.
Hospitals are planning for that risk anyway. The American Hospital Association surveyed its members in November 2025, with more than 1,000 health systems and hospitals represented. More than 70% of respondents said they expect the fee to directly affect patient care. Among hospitals that used or planned to use the H-1B program, 64% said they would pause, defer or limit recruitment. Clinical roles accounted for 57% of the positions that would have gone to H-1B holders.
Healthcare makes up a small slice of the program. According to the AHA, fewer than 5% of current H-1B visa holders are health professionals. A 2025 study published in JAMA found H-1B-sponsored physicians made up about 1% of practicing physicians in fiscal year 2024, or 11,080 people. Even with those physicians, the U.S. ended 2024 short 64,000 physicians, according to the AHA. The National Center for Health Workforce Analysis projects that gap will grow to more than 141,000 by 2038.
The JAMA study also cuts against the idea that ASC specialists are most exposed. H-1B-sponsored physicians tend to practice primary care rather than specialty medicine, according to the AAMC. The study’s sample did include nurse anesthetists, along with nurse practitioners and physician assistants. That puts anesthesia coverage, which ASCs are already struggling to staff, within the fee’s reach. The U.S. is projected to be short 6,300 anesthesiologists by 2036.
Geography adds to the risk. The JAMA study found H-1B-sponsored clinicians are concentrated in rural counties, high-poverty areas and regions that already have workforce shortages. In those markets, hospitals can cover gaps by moving staff between departments or bringing in locum tenens.
A second fee aims more directly at ASCs. On Aug. 25, DHS proposed a $103,265 charge on cap-subject H-1B petitions through formal rulemaking, a route that would not depend on the proclamation surviving in court. The proposed fee would apply even to workers already in the U.S. changing status, such as F-1 students. It would exempt cap-exempt employers, including universities and nonprofits affiliated with them, which leaves academic medical centers largely insulated. Most for-profit ASCs don’t qualify for that exemption. Comments on the proposal close Sept. 24.
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