Changes to H-1B visas could strain healthcare industry

Last week, President Donald Trump issued an executive order implementing a $100,000 fee for any new H-1B visa petitions. According to the administration, the fee is designed to help combat "systemic abuse" in the H-1B visa program. The new fee will be implemented during the next lottery cycle in 2026 and does not apply to current H-1B visa holders.

According to Becker's Hospital Review, healthcare employers often use H-1B visas to sponsor medical residents and physicians. Currently, immigrants account for 27% of physicians and surgeons, 22% of nursing assistants, and 16% of RNs in the United States.

However, the new fee would make it harder for these workers to train and practice. Paying the new fee could also add millions of dollars in labor costs for health systems that sponsor many H-1B visa holders.

The new fee "risks shutting off the pipeline of highly trained physicians that patients depend on, especially in rural and underserved communities," said Bobby Mukkamala, president of the American Medical Association.

Similarly, Jonathan Jaffrey, chief healthcare officer at the Association of American Medical Colleges, said the organization "is concerned that the recent proclamation on H-1B visas will worsen the nation's existing physician shortage and jeopardize patient access to care."

Following concerns from large medical associations, the White House on Monday suggested that doctors could be exempt from the new H-1B visa fee. "The Proclamation allows for potential exemptions, which can include physicians and medical residents," said Taylor Rodgers, a White House spokesperson.

(Taylor, Becker's Hospital Review, 9/22; DeSilva, et al., Modern Healthcare, 9/23; Zhang, et al., Bloomberg/Modern Healthcare, 9/22)

Trump, federal health officials link Tylenol use to autism

On Monday, President Donald Trump, along with several top health officials, issued a warning against the use of Tylenol, or acetaminophen, during pregnancy and claimed that it could cause autism. Previously, it was reported that HHS Secretary Robert F. Kennedy planned to link Tylenol use during pregnancy to rising autism rates.

During the briefing, Trump said FDA would issue a notice to physicians about the risk of acetaminophen during pregnancy and would start the process of updating the drug's safety label. He also said federal health officials would instruct clinicians to exercise their best judgment to prescribe the lowest dose of acetaminophen for the shortest duration.

"If you're pregnant, don't take Tylenol, and don't give it to the baby after the baby is born," Trump said. "There are certain groups of people that don't take vaccines and don't take any pills that have no autism."

Health officials, which included Kennedy and FDA Commissioner Marty Makary, also announced new research into the root causes of autism, committing millions of dollars to studies on environmental factors, including a long-debunked theory linking vaccines to the condition.

So far, research on a potential connection between acetaminophen and autism has been inconclusive. In a recent review of 46 previously published epidemiological studies, researchers found that 27 reported links between the use of Tylenol by pregnant people and an increased risk of autism or ADHD in their children. However, a separate study of over 2.4 million children in Sweden did not find an association between Tylenol taken during pregnancy and risk of autism or ADHD.

According to KFF Health News, autism experts at CDC said they were neither consulted nor asked to review a draft of the government's findings and recommendations for the condition. "Typically, we'd be asked to provide information and review the report for accuracy, but we've had absolutely no contact with anyone," a CDC researcher said. "It is very unusual."

Other researchers have also expressed concerns about how the announcement will impact patients and the scientific community. "I'm really concerned about how this message is going to play out," said Ann Bauer, an epidemiologist at the University of Massachusetts-Lowell who worked on the review of 46 studies on Tylenol and autism. "It's a sound-bite universe, and everyone wants a simple solution."

In a statement, Kenvue, which manufactures Tylenol, said it believes scientific evidence clearly shows that taking the medication does not cause autism. "We strongly disagree with any suggestion otherwise," the company said.

(Bettelheim, Axios, 9/22; Maxmen, KFF Health News, 9/22; Ghorayshi, New York Times, 9/23)

• COVID-19: Vaccines are recommended for children ages 6 to 23 months or ages 2 to 18 years with risk factors; people who are planning pregnancy or are pregnant, postpartum, or lactating; adults who have risk factors or are over the age of 65; and all children and adults who are in close contact with people with risk factors. Any person who wants to be vaccinated, even if they fall outside the previous groups, may also receive the shot.
• Flu: Vaccines are recommended for everyone ages six month and older, including women who are planning pregnancy or are pregnant, postpartum, or lactating.
• Respiratory syncytial virus: Vaccines are recommended for children younger than eight months, children between the ages of eight and 19 months with risk factors, pregnant people who are 32 to 36 weeks gestational age; adults ages 50 to 74 with risk factors; and adults ages 75 and older.

According to the New York Times, the states' guidance generally aligns with those previously made by the federal government and by national medical organizations, such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.

In a statement, Erica Pan, director of the California Department of Public Health, said she wanted "the people who live and work in our states to know that there is a strong public health, health care and scientific community that will continue to stand together" to provide all the necessary data "for you to make healthy choices."

(Nunn, New York Times, 9/17)

Ousted CDC director testifies before Senate

In August, CDC Director Susan Monarez was ousted from the agency just weeks after her confirmation due to alleged disagreements with HHS Secretary Robert F. Kennedy Jr. over vaccine policy changes. In the wake of Monarez's departure, several other senior CDC leaders resigned from the agency.

Last week, Monarez testified before the Senate about her firing. During her three-hour hearing, Monarez testified that she was ousted from CDC because she refused to comply with Kennedy's demands for her to pre-approve vaccine recommendations and fire career scientists.

According to Monarez, Kennedy told her the "childhood vaccine schedule would be changing starting in September" and that she "needed to be on board."

"I had refused to commit to approving vaccine recommendations without evidence, fire career officials without cause, or resign — and I had shared my concerns with this committee," Monarez said. "I told the secretary that if he believed he could not trust me, he could fire me."

Deb Houry, CDC's former CMO who resigned following Monarez's ouster, also testified at the hearing. Houry told senators that she resigned "because Secretary Kennedy's actions repeatedly censored CDC science, politicized our processes, and stripped agency leaders of the ability to protect the health of the American people."

Houry added that she felt CDC leaders "were expected to serve as rubber stamps for the secretary's decisions."

In response to Monarez's testimony, HHS spokesperson Andrew Nixon alleged that Monarez's remarks have "factual inaccuracies" and "leave out important details."

"Here's the reality: Susan Monarez was tasked with returning the CDC to its core mission after decades of bureaucratic inertia, politicized science and mission creep corroded its purpose and squandered public trust," Nixon said. "Instead, she acted maliciously to undermine the President's agenda and was fired as a result."

(Stone/Simmons-Duffin, "Shots," NPR, 9/17; Roubein, et al., Washington Post, 9/17)