Article
What the court decided
On June 8, U.S. District Judge Leo Sorokin of the District of Massachusetts ruled that the administration’s $100,000 charge on new H-1B petitions is unlawful and vacated it in full. The case was brought in December by California and 19 other states, which argued the fee would deepen hospital staffing shortages and reduce access to care.
The court reached two main conclusions. First, the payment works as a tax, and only Congress can impose one; the immigration statutes the administration cited do not hand that power to the president. Second, the policy was arbitrary and capricious, in part because the administration pointed to abuses in technology fields without weighing the effect on health care and education, and never considered an exemption for cap-exempt employers such as nonprofit and university-affiliated institutions.
A White House spokesperson said the administration will appeal and expects the order to be reversed, noting that a federal judge in Washington upheld a nearly identical policy. That split makes further litigation likely.
Why it matters for hospital staffing
H-1B visas are a major pipeline for foreign-trained physicians. In fiscal 2024, nearly 17,000 H-1B visas went to medicine and health roles, about half of them to physicians and surgeons. The country faces a projected shortage of 86,000 physicians by 2036.
Before the fee, regulatory and statutory charges for an H-1B petition ran from roughly $960 to $7,595, according to the ruling. Adding $100,000 per new hire from abroad led some systems, including UW Medicine and Fred Hutch, to pause petitions altogether.
What leaders should do now
- Revisit paused offers. Work with immigration counsel to decide which petitions to file while the ruling stands.
- Plan for reversal. Model the cost if the fee returns on appeal, and decide in advance which roles would still justify it.
- Protect residency pipelines. Graduate medical education leaders should confirm how the ruling affects incoming international residents and fellows.
- Support a permanent fix. A bipartisan House bill introduced in March would exempt health care workers from the fee. Legislation offers more certainty than a court order that can be overturned.
The ruling buys time, not certainty. Systems that rely on international clinicians should use the window to fill critical roles and build a recruiting plan that holds up under either outcome.
Archive entry for Jun 13, 2026, added Nov. 11, 2026.