Comment by shagie

Not everyone wants to relocate to rural hospital areas (where they're often most in demand as a fraction of the total workers). The wages are often tied to what insurance (and medicare) can reimburse and that rate isn't necessarily going up fast enough to properly staff hospitals.

Bigger ones in the cities with more expensive procedures can afford it better. The smaller hospitals an hour or two drive away from a city are the ones that are hurting the most.

https://www.marketplace.org/story/2025/11/14/how-trumps-100k...

> Frederick Health Hospital in rural Frederick County, Maryland, is ground zero for the hurdles the new fee has created. The hospital is the only emergency room in a county that’s approximately 650 square miles in size. Patients would have to drive as far as 50 miles to get to another facility.

> “We see about 70,000 to 80,000 emergency department visits — one of the busiest emergency departments in the state,” said Jamie White, chief nursing officer at Frederick Health.

> Not only is her hospital one of the busiest in the state, it’s also chronically short-staffed. White said it can’t compete with salaries at hospitals in urban areas or with jobs that allow for more work-life-balance.

Wage suppression? Maybe. But it's not "raise wages" that is an option - its "close the hospital".

The position of "Can we just cancel this program please?" I take to mean all of the H-1B visas. This is a position that I've often seen echoed by people who haven't considered the other positions that use this program and instead see it dominated by technology.

... And it is dominated by technology. And you can see that in the charts and tables of "Top H-1B employers by visa approval" https://en.wikipedia.org/wiki/H-1B_visa#Top_H-1B_employers_b... and how it changed from 2006 to 2017. Everyone I know who is on a H-1B or H-4 visa is affiliated with a technology job.

There's also a loophole that if one's spouse is approved under a H-1B visa and they're under an H-4 visa, they can also work in a H-1B visa field.

https://en.wikipedia.org/wiki/H-1B_visa

    Work Authorization 
    H-1B holder: Allowed to work for sponsoring employer
    H-4 dependents: Eligible if H-1B spouse has approved I-140 immigrant petition or H-1B status beyond 6 years under AC21

So, spitballing the idea... the H-1T visa would be for all STEM positions. This does not extend to a spouse (the spouse would need their own approval). This visa would be for all professions classified as 15-xxxx, 17-xxxx, and 19-xxxx by the BLS ( https://www.bls.gov/oes/2023/may/oes_stru.htm ). That is, if your job is 15-1234 and you are a foreign worker, you must have an H-1T (or O-1) visa. The H-1T visa would have a different cap that is independent from the H-1B visa lottery and instead of a lottery it is done by auction. There is a 10% of salary fee paid with a minimum of $10,000 that is to be paid into the SMART scholarship and S-STEM programs. Applicants under this program may not be paid less than the median wage as determined for that profession ( https://www.bls.gov/oes/2023/may/oes151251.htm ) regardless of skill level for the location where the employee is based. Companies with more than 10% H-1T visa employees may not apply for new H-1T visas if their employees are not compensated for 2000 hours of work or PTO a year (prorated for hire and termination dates - no more than 50 hours a week may be counted for an employee). Positions to be filled by a H-1T visa must first be advertised and open for 30 days on usajobs.gov (expanding the scope of the site) before applications from foreign nationals or other H-1T visa holders may apply to it. Random audits may be done for any position listed and filled by a H-1T visa holder to ensure that the position matches the job listing (with punitive fines per infraction).

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My goal with those spitballs is do decouple the H-1T and H-1B visas which largely work outside of tech. It clearly establishes who can work in that field. It tries to close loopholes (though I'm sure that there are some in there that I've missed) and tries to make sure that consultancies aren't trying to make a deep bench of people they pay part time or not at all. It's attempting to make sure that people are being compensated at market rates based on real data rather than more nebulous titles.

Could you elaborate on how wages of native French speaking language teachers are being suppressed? Or that nurses in North Dakota are not getting jobs because the hospital is going through the process of hiring a qualified nurse under the H-1B program?

I'm not saying that the teachers or nurses are not underpaid - they should be paid more, but the ability for the organization to pay them more is often constrained by other factors (teacher salaries for public schools, medicare reimbursement rates for hospitals).

Saying "no, we shouldn't hire them" doesn't mean that a qualified American teacher will show up or new nurses will go to Fargo to get a job. Rather, foreign language programs in schools will be discontinued and hospitals in rural areas will close (being unable to meet the required nurse to patient ratios).

There are problems with the system. People on HN often forget that there are a lot of other professions outside of technology that make use of the H-1B when there is a genuine need.

Unfortunately technology - and especially technology consultancies - have flooded the application process for the H-1B visas to the point where H-1B has become synonymous with Indian programmer working at a WITCH company.

> Public Law 114–113, part of the Consolidated Appropriations Act, 2016, imposed a fee of $4,000 on H-1B petitions [edit: for H-1B dependent employers] and $4,500 on L-1A and L-1B petitions. The additional H-1B fees would apply to all petitions postmarked on or after December 18, 2015, and until September 30, 2025.

This apparently has expired. The proclamation "Restriction on Entry of Certain Nonimmigrant Workers" is of dubious footing.

You know what would have been good with the budget bill (the previous Consolidated Appropriations Act was a budget bill signed by Obama)? Quadrupling the application fee for H-1B dependent employers and hiring auditors to make sure that the applicants are properly qualified, that there is a position open (not just a position on the bench at a consultancy) for the applicant to fill, that the position to be filled was attempted to be filled by a and that the employer is making full use of their existing employees (e.g. no one on the bench).

This is something that is (was) there and can be regulated and audited and catch the problematic employers - not French teachers and nurses.