Immigration Policy and the Uneven Geography of US Healthcare

The H-1B visa cap has been fixed at 85,000 since 2004 while demand for skilled clinicians has risen, potentially affecting where immigrant clinicians work and patient access to care. This project leverages the cap-exempt status of research-affiliated nonprofit hospitals—institutions that can hire without lottery exposure—to create quasi-experimental variation when the cap binds. Linking hospital cost reports, Medicare claims (1999–2023), and restricted Census data, the study estimates effects of visa rationing on staffing, patient utilization, and spending, and examines whether immigrants complement or substitute for U.S.-born clinicians across markets. A structural model translates estimates into counterfactuals (e.g., cap increases, wage prioritization) to quantify impacts on access to care and welfare across places.