A bipartisan group of lawmakers are reviving a bill that would allow up to thousands of unused green cards to be allocated to foreign-born doctors and nurses, despite increasing immigration restrictions that are already affecting the healthcare workforce in the US.

The Healthcare Workforce Resilience Act would “recapture” permanent residence visas that have been unused in the previous 32 years but have already been authorized by Congress. It would allocate up to 15,000 of these unused visas for immigrant doctors and up to 25,000 visas for immigrant nurses.

The proposed legislation, backed by some Republicans, would make it easier for foreign-born doctors to practice permanently in the US, but it also could compromise current Trump administration efforts to curb immigration. 

That’s because the bill is being introduced at the same time the Trump administration is implementing a new policy that could make it more difficult for some immigrant physicians to temporarily work in the US by requiring employers to pay a $100,000 fee for H-1B visas. H-1B visas differ from green cards since they typically allow individuals to stay in the US in 3-year increments, while green cards allow for permanent residence in the US. 

The conflicting efforts highlight the complexities of immigration policy and show that the Republican party isn’t united on how immigration or healthcare workforce shortages should be addressed. 

The legislation is sponsored by lawmakers across the aisle in both chambers of Congress, including Senate Minority Whip Dick Durbin (D-Ill) and Sen. Kevin Cramer (R-ND) It was reintroduced in early September and was originally introduced in Congress in 2020 as a policy proposal to help the strained healthcare workforce during COVID. 

“Highly trained immigrant doctors and nurses are a critical part of our workforce,” said Sen. Cramer in a statement on the bill. “In many cases, these clinicians provide the only specialty care that’s available in their community. Our bill recognizes this urgent need can be addressed in part at least through a realignment towards merit-based immigration.”

The bill would require employers to attest that healthcare workers receiving green cards aren’t displacing American workers. 

Any Immigration Bill Chances Are Iffy

Given the current partisan divide in Congress, any immigration bill is going to face difficulties, said Laurence Benenson, vice president of public policy for the center-right affiliated immigration advocacy group, National Immigration Forum. 

“As everyone knows at this point, it’s been a challenge to get Congress to move forward on immigration legislation,” said Benenson, whose group has endorsed the green card bill. 

Immigration reform has largely stalled in Congress after bipartisan border bill negotiations failed in early 2024.

“This is the sort of commonsense solution that I have hoped to see Congress tackle… it’s not a comprehensive immigration reform bill,” said Benenson. “Instead it’s targeted specifically to adding skilled physicians to our economy, which are desperately needed, especially in underserved communities.” 

If Congress did manage to somehow pass the green card bill, it would free up permanent residence visas for immigrant doctors to use. 

But the Trump administration has already been taking actions that could make it more difficult for foreign-born physicians to temporarily practice in the US. 

Immigration Restrictions Already Affecting Foreign-Born Doctors 

On Friday last week, the Trump administration announced in a presidential proclamation that employers who wish to bring in foreign workers through the H-1B program would have to make a payment of $100,000 to receive the visa. Typically, H-1B visas cost just a few thousand in fees and are issued for 3-year increments. 

H-1B visas are often used by healthcare systems to bring in highly-skilled doctors to work in US hospitals, particularly in underserved or rural areas, said Bobby Mukkamala, MD, president of the American Medical Association. Mukkamala’s own parents emigrated from India to the US to work as physicians. 

“If the entity that’s bringing them in is looking at a $100,000 bill, that’s going to be a major barrier,” Mukkamala told Medscape. “There’s no way that my parents would have been able to come into this country … I can’t imagine who’s going to be able to do that.” 

The White House raised the possibility of exempting doctors from the H-1B fee requirement earlier this week, per Bloomberg News, but no specific carve out has been issued yet.

Earlier this year, the State Department temporarily paused scheduling interviews for J-1 or short-term visas, which are used by international doctors to participate in US medical residency programs. The Department of Homeland Security is now weighing a policy proposal to set a fixed time period for J-1 visas. 

The US Workforce Already Depends on Immigrant Doctors 

Immigrants make up 27% of physicians at hospitals across the US, per recent data analyzed by KFF, a national health policy organization. International medical graduates are also more likely to practice primary care and work in rural or underserved areas.

Data also shows there’s no evidence that foreign-born doctors are crowding out American doctors. 

Mukkamala is concerned that if the Trump administration keeps implementing these H-1B and J-1 visa immigration restrictions, it will only exacerbate the current and projected healthcare workforce shortage. 

“Right now we’re predicting that shortage to be about 86,000 physicians by 2036… and that was before we have this potential H-1B issue, right?” said Mukkamala. “If physicians and international medical graduates are looking at these barriers, our shortage is going to get worse.”