GOP States’ Halt to H-1B Labor Squeezes Health-Care Providers

New restrictions on public-sector hiring of H-1B workers in Texas and Florida promise punishing effects on health-care employers and patients even as they burnish the anti-immigrant bona fides of state leaders.

Best known for use by tech firms, the specialty occupation visa program is the primary employment pathway for foreign workers with at least a bachelor’s degree—including thousands of health-care workers. Now, amid a shakeup of H-1B rules at the federal level, two Republican governors are using levers over state hiring to further limit the program.

Although Texas and Florida are leading the way with restrictions on foreign workers, other GOP-led states are likely to follow, said Ammon Blair, senior fellow at the Texas Public Policy Foundation, a conservative think tank in Austin.

“You’re going to see that 100% throughout every state that has a Republican governor and Republican legislature,” he said.

Texas Gov. Greg Abbott ordered state agencies last month to halt H-1B hires for the next year. Florida Gov. Ron DeSantis has announced a similar policy that the board of governors for state universities will finalize soon.

While the Texas order applies to all public employers, universities and academic health science centers are its biggest users by far, sponsoring workers to fill medical specialty roles and hire physicians for rural hospitals. Already facing recruitment barriers from the White House fee, the Abbott order blocks access to the program entirely.

“Intentionally or unintentionally, they’re going to leave their states with fewer potential doctors,” said Connor O’Brien, a fellow at the Institute for Progress, a Washington, DC, think tank.

Worker Shortages

In a Jan. 27 letter, Abbott directed that state agencies pause filing of new petitions for H-1B workers until May 31, 2027—the end of the next state legislative session. Until then, new petitions will only be allowed with approval from the Texas Workforce Commission.

Over the past six years, Texas hospitals have sponsored more than 500 doctoral students through the H-1B program, whose hiring would have been blocked were the directive in place, according to the Institute for Progress.

University of Texas Health Science Center in Houston received approval for more than 1,100 workers on H-1B status between the 2021 and 2025 fiscal years, according to the US Citizenship and Immigration Services website. MD Anderson Cancer Center, also in Houston, received approval for more than 600 employees through the visa program.

Those numbers may pale in comparison to hiring by IT giants like Infosys and Cognizant Technology Solutions, who aren’t affected by the Abbott directive. But the hiring freeze affects a wide range of occupations, including research scientists, physicians, and other health-care workers, said Caroline Tang, an immigration attorney and shareholder at Ogletree Deakins in Austin.

“They may already have issues filling those positions,” Tang said. “If they’re not able to sponsor H-1B visa holders for those roles, it may exacerbate health-care worker shortages.”

‘Bad Actors’

Abbott wrote that evidence suggests the H-1B program has been exploited by “bad actors.”

Rather than serving its intended purpose of filling specialized and unmet needs, “the program has too often been used to fill jobs that otherwise could—and should—have been filled by Texans,” he said.

Abbott’s letter didn’t specify instances where US-born workers had been displaced by H-1B hires. But Kathleen Campbell Walker, chair of the immigration practice group at Dickinson Wright, said it doesn’t reflect the reality of federal laws governing the program.

Employers can adopt a policy that they won’t hire job candidates who require sponsorship, she said, but they can’t limit their search to just US citizens or state residents either.

“Is a Texan the same as a US citizen, a permanent legal resident, or somebody else authorized to work?” she said. “That wouldn’t necessarily mean that the person resides in Texas.”

Labor Impact

Health-care employers are waiting on further information for requesting exemptions to the hiring freeze, Walker noted.

An Abbott spokesman didn’t respond to questions about exceptions or the potential impact of the pause. Texas Workforce Commission spokeswoman Sara Fischer said the agency will soon issue guidance to state agencies.

Rural counties in West Texas are already facing a crisis-level shortage of primary care physicians. Employers there rely on options like the Conrad 30 program to fill physician openings, said Dahlia French, an immigration attorney and former managing director of immigration compliance at Texas Tech University Health Sciences Center in Lubbock.

The program allows physicians training in the US on exchange visitor visas to get a waiver for a two-year home residency requirement if they agree to work in underserved areas.

“We had to be very creative,” French said. “You just don’t have enough physicians, especially in primary care.”

Conrad 30 waivers become available in October, so universities and affiliated hospitals are typically making new hires over the summer. The H-1B freeze threatens to derail those hiring plans, French said.

Immigration Politics

The impact of the policy will also be felt in major urban areas where teaching hospitals are located, said the Institute for Progress’ O’Brien. Both policies were so “sloppily designed,” he said, that their authors may not have considered the impact on health care at all.

“I don’t expect these policies to be reversed, but I do hope that there are at least exemptions that both Texas and Florida can carve out for hospitals and research centers,” O’Brien said. “Playing politics with people’s health is a bad look.”

GOP-led states are taking their cues from the Trump administration, which has restricted H-1B hiring and disrupted enrollment of international students, said David Bier, director of immigration studies at the Cato Institute.

“It’s going to result in worse health care for Texans and worse medical innovation,” he said of Abbott’s order. “Clearly, he thinks that’s a cost worth bearing to prevent these H-1B workers from working in Texas.”