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      Trump signs order promising measures, including military, to defend Qatar

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      Donald Trump has signed an executive order vowing to use all measures including US military action to defend the energy-rich nation of Qatar – though it remains unclear just what weight the pledge will carry.The text of the order, available Wednesday on the White House’s website but dated Monday, appears to be another measure by Trump to assure the Qataris following Israel’s surprise attack on the country targeting Hamas leaders as they weighed accepting a ceasefire with Israel over the war in the Gaza Strip.The order cites the two countries’ “close cooperation” and “shared interest”, vowing to “guarantee the security and territorial integrity of the state of Qatar against external attack”.“The United States shall regard any armed attack on the territory, sovereignty or critical infrastructure of the state of Qatar as a threat to the peace and security of the United States,” the order says.“In the event of such an attack, the United States shall take all lawful and appropriate measures – including diplomatic, economic, and, if necessary, military – to defend the interests of the United States and of the state of Qatar and to restore peace and stability.”The order apparently came during a visit to Washington on Monday by Benjamin Netanyahu. Trump organized a call by Netanyahu to Qatar during the visit in which Netanyahu “expressed his deep regret” over the strike that killed six people, including a member of the Qatari security forces, the White House said.Qatar’s foreign ministry described the US pledge as “an important step in strengthening the two countries’ close defense partnership”. The Qatari-funded Al Jazeera satellite news network declared: “New Trump executive order guarantees Qatar security after Israeli attack.”Trump also spoke on the phone later Wednesday to Qatar’s ruling emir, Sheikh Tamim bin Hamad al-Thani, according to a White House official who was not authorized to speak publicly and spoke on condition of anonymity.The White House did not release details about the call, though Qatar later said the two men spoke about Doha’s efforts to reach a ceasefire in the Israel-Gaza war.The true scope of the pledge by the US remains in question. Typically, legally binding agreements, or treaties, need to receive the approval of the US Senate. However, presidents have entered international agreements without the Senate’s approval, as Barack Obama did with Iran’s 2015 nuclear deal with world powers.Ultimately, any decision to take military action rests with the president. That uncertainty has clouded previous US defense agreements in Trump’s second term, such as Nato’s Article 5 guarantees.Qatar, a peninsular nation in the Persian Gulf, became fantastically wealthy through its natural gas reserves. It has been a key partner of the US military, allowing its Central Command to have its forward operating base at its vast Al Udeid airbase.Joe Biden named Qatar as a major non-Nato ally in 2022, in part due to its help during the US’s chaotic withdrawal from Afghanistan. And Qatar has maintained close ties to Trump, from a real estate project with his eponymous Trump Organization to offering him a Boeing 747 to use as Air Force One.In the aftermath of the Israeli attack, Saudi Arabia entered a mutual defense agreement with Pakistan, bringing the kingdom under Islamabad’s nuclear umbrella. It’s unclear whether other Gulf Arab countries, worried about both Israel as well as Iran as it faces reimposed United Nations sanctions over its nuclear program, may seek similar arrangements with the region’s longtime security guarantor.“The Gulf’s centrality in the Middle East and its significance to the United States warrants specific US guarantees beyond President Donald J Trump’s assurances of nonrepetition and dinner meetings,” wrote Bader al-Saif, a history professor at Kuwait University who analyzes Gulf Arab affairs. More

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      Trump FCC chair to reportedly testify to Senate panel after Kimmel suspension

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      Brendan Carr, the pro-Trump chair of the Federal Communications Commission (FCC), has agreed to testify before the Senate commerce committee following Disney’s decision to take talkshow host Jimmy Kimmel off air temporarily, according to multiple reports.Carr agreed to testify after speaking to committee chair Ted Cruz, Reuters reported, citing a source familiar with the matter on Wednesday, adding the date of the hearing has not been set but was expected after November. Semafor was the first to report on the hearing.Carr, Disney, the White House and an FCC spokesperson did not immediately respond to requests for comment.On 17 September, ABC announced it would “indefinitely” suspend Jimmy Kimmel’s show, hours after Carr had appeared on a conservative podcast and appeared to pressure network affiliates to stop airing the show over comments by Kimmel on the death of the far-right pundit Charlie Kirk.“We can do this the easy way or the hard way,” Carr had said, explaining that he wanted broadcasters to “take action” on Kimmel.Nexstar and Sinclair, two major carriers of ABC programming, quickly announced plans to pull Kimmel’s show, seemingly forcing ABC’s hand.Ultimately, ABC decided to bring Kimmel back the following week, and Nexstar and Sinclair followed suit. The network’s decision reportedly followed a wave of cancellations of streaming service Disney+.The show returned on 23 September and hit a 10-year ratings high among adult viewers.Carr’s comments drew criticism from across the aisle. Cruz said some of Carr’s remarks were “dangerous as hell” and compared him to a “mafioso”.During a news conference last week, Carr was asked whether he regrets the phrasing he used when talking about Kimmel, Carr claimed “the full words that I said, the full context of the interview”, were very clear. More

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      Vance uses false claims to pin shutdown blame on Democrats as White House warns of layoffs

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      JD Vance, the US vice-president, used false claims to blame Democrats for the government shutdown as the White House warned that worker layoffs were imminent.Federal departments have been closing since midnight after a deadlocked Congress failed to pass a funding measure. The crisis has higher stakes than previous shutdowns, with Trump racing to slash government departments and threatening to turn furloughs into mass firings.Making a rare appearance in the White House briefing room, Vance told reporters: “We are going to have to lay some people off if the shutdown continues. We don’t like that. We don’t necessarily want to do it, but we’re going to do what we have to do to keep the American people’s essential services continuing to run.”Vance denied workers would be targeted because of their political allegiance but acknowledged there was still uncertainty over who might be laid off or furloughed. “We haven’t made any final decisions about what we’re going to do with certain workers,” he said. “What we’re saying is that we might have to take extraordinary steps, especially the longer this goes on.”About 750,000 federal employees are expected to be placed on furlough, an enforced leave, with pay withheld until they return to work. Essential workers such as military and border agents may be forced to work without pay, and some will likely miss pay cheques next week.At the same briefing, press secretary Karoline Leavitt confirmed that government agencies are already preparing for cuts.“Unfortunately, because the Democrats shut down the government, the president has directed his cabinet, and the office of management and budget is working with agencies across the board, to identify where cuts can be made – and we believe that layoffs are imminent,” she said.The press secretary acknowledged she could not be precise about timing or identify the percentage of workers likely to be affected.As the messaging war over the shutdown intensifies, Democrats, motivated by grassroots anger over expiring healthcare subsidies, have been withholding Senate votes to fund the government as leverage to try and force negotiations.Vance sought to upbraid Democrats over their demands, targeting Senate minority leader Chuck Schumer and progressive congresswoman Alexandria Ocasio-Cortez, known as AOC.“The Chuck Schumer-AOC wing of the Democratic party shut down the government because they said to us, we will open the government only if you give billions of dollars of funding to healthcare for illegal aliens. That’s a ridiculous proposition.”It is also a false claim. US law bars undocumented immigrants from receiving the health care benefits Democrats are demanding, and the party has not called for a new act of Congress to change that.At a press conference on Capitol Hill on Wednesday, Hakeem Jeffries, the Democratic minority leader in the House of Representatives, said Trump and Republicans shut the government down to deny healthcare to working-class Americans.“The president has been engaging in irresponsible and unserious behaviour, demonstrating that, all along, Republicans wanted to shut the government down,” he said. “That’s no surprise, because for decades, Republicans have consistently shut the government down as part of their efforts to try to extract and jam their extreme rightwing agenda down the throats of the American people.”On another front, the White House began targeting Democratic-leaning states for a pause or cancellation of infrastructure funds.Russ Vought, the OMB director, said on X that roughly $18bn for New York City infrastructure projects had been put on hold to ensure funding is not flowing to “unconstitutional DEI principles”. Later he said nearly $8bn in clean energy funding “to fuel the Left’s climate agenda is being cancelled”.Schumer and Jeffries responded in a joint statement: “Donald Trump is once again treating working people as collateral damage in his endless campaign of chaos and revenge.”Shutdowns are a periodic feature of gridlocked Washington, although this is the first since a record 35-day pause in 2018-19, during Trump’s first term. Talks so far have been unusually bitter, with Trump mocking Schumer and Jeffries on social media.The president’s most recent video showed Jeffries being interviewed on MSNBC with an AI-generated moustache and sombrero, and four depictions of the president playing mariachi music.Vance made light of the tactic. “I think it’s funny. The president’s joking and we’re having a good time. You can negotiate in good faith while also making a little bit of fun at some of the absurdities of the Democrats’ positions, and even poking some fun at the absurdity of the themselves.“I’ll tell Hakeem Jeffries right now, I make the solemn promise to you that if you help us reopen the government, the sombrero memes will stop. I’ve talked to the president of the United States about that.”Jeffries has denounced the memes as racist. Vance retorted: “I honestly don’t even know what that means. Like, is he a Mexican American that is offended by having a sombrero meme?”Efforts to swiftly end the shutdown collapsed on Wednesday as Senate Democrats – who are demanding extended healthcare subsidies for low income families – refused to help the majority Republicans approve a bill passed by the House that would have reopened the government for several weeks.Congress is out on Thursday for the Jewish Yom Kippur holiday but the Senate returns to work on Friday and may be in session through the weekend. The House is not due back until next week.A Marist poll released on Tuesday found that 38% of voters would blame congressional Republicans for a shutdown, 27% would blame the Democrats and 31% both parties. More

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      Democrats liken Trump to Putin after call to use US cities for military training

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      A leading Democrat has compared Donald Trump to Russian dictator Vladimir Putin after the US president told military leaders on Tuesday that the armed forces should use US cities as “training grounds”.JB Pritzker, the governor of Illinois, which is bracing for Trump to deploy national guard troops to his state, questioned the president’s mental health and accused him of behaving like an autocrat.“It appears that Donald Trump not only has dementia set in but he’s copying tactics of Vladimir Putin,” Pritzker said. “Sending troops into cities, thinking that that’s some sort of proving ground for war, or that indeed there’s some sort of internal war going on in the United States is just, frankly, inane and I’m concerned for his health.”Since returning to office in January, Trump has used crime and illegal immigration as a pretext to expand federal agents and national guard troops into cities led by Democrats, often with large African American populations.The president deployed in Los Angeles in June and Washington DC in August despite the objections of local officials and official figures showing that crime is falling. And over the weekend Trump announced plans to send national guard troops to what he described as “war-ravaged” Portland, though the city and state are seeking a restraining order, claiming that the president has overstepped his legal authority.On Tuesday, the attorney general, Pam Bondi, said a federal taskforce operation in Memphis, Tennessee was under way. Meanwhile, Louisiana’s governor asked for a national guard deployment to New Orleans and other cities.Trump dialled up the pressure further on Tuesday at a rare gathering of more than 800 military leaders in Quantico, Virginia. He said: “Last month I signed an executive order to provide training for quick reaction force that can help quell civil disturbances. This is gonna be a big thing for the people in this room, because it’s the enemy from within, and we have to handle it before it gets out of control.”The phrase “enemy within” was used by Senator Joseph McCarthy in a 1950 speech about threats to democracy. McCarthy is best known for his aggressive campaign against alleged communist infiltration in the US government and society.Addressing an auditorium full of top brass from around the world, Trump said he told Pete Hegseth that “we should use some of these dangerous cities as training grounds for our military.”Trump acknowledged that he had been criticised for deploying the military on US streets but claimed America was in the grips of a battle against immigrants in the country illegally.“America is under invasion from within,” Trump said. “We’re under invasion from within. No different than a foreign enemy, but more difficult in many ways because they don’t wear uniforms. At least when they’re wearing a uniform, you can take them out.”The president encouraged soldiers harassed or assaulted by protesters to “get out of that car and do whatever the hell you want to do”.Democrats condemned the remarks as a dangerous escalation worthy of an authoritarian.Gavin Newsom, the California governor, whose name has been floated as a possible 2028 presidential contender, said the speech should terrify people.“Declaring war on our nation’s cities and using our troops as political pawns is what dictators do. This man cares about nothing but his own ego and power,” Newsom posted on X.Pritzker called for the 25th amendment to the constitution, which deals with the removal of a president incapacitated by a physical or mental illness, to be applied. “There is something genuinely wrong with this man, and the 25th amendment ought to be invoked,” he said.Chuck Schumer, the Democratic minority leader in the Senate, told MSNBC’s Morning Joe: “So, this is totally against the American grain, and it’s one example of many that they’re moving to an autocracy away from a democracy. In dictatorships, the federal military goes into the cities to do bad things.”Civil society groups also condemned the plans. Naureen Shah, director of government affairs of the equality division at the American Civil Liberties Union (ACLU), said: “We don’t need to spell out how dangerous the president’s message is, but here goes: military troops must not police us, let alone be used as a tool to suppress the president’s critics.”The Not Above the Law coalition said in a statement: “Trump’s suggestion that US cities should serve as military ‘training grounds’ represents a fundamental betrayal of American values. Our military exists to defend our nation and protect our freedoms, not to practice combat operations against our neighbors in our communities.”The Posse Comitatus Act of 1878 is supposed to prevent presidents from using the military as a domestic police force. But Trump has exploited a loophole by deploying the national guard, a reserve force often used for natural disasters, and creating a new “quick reaction force” for crushing domestic unrest.At Tuesday’s event in Quantico, the defense secretary vowed the military would abolish “overbearing rules of engagement” and “untie the hands of our warfighters to intimidate, demoralise, hunt and kill the enemies of our country”.There were few visible reactions from the generals and admirals, who sat largely silent and expressionless. Trump, accustomed to roars or laughs at campaign rallies, found his punchlines fell flat. More

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      Federal Reserve governor will keep job for now despite Trump’s bid to remove her

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      Lisa Cook, the US Federal Reserve governor, will keep her job for now, despite Donald Trump’s extraordinary bid to remove her from the central bank’s board with immediate effect.The US supreme court deferred action on the Department of Justice’s request to allow the president to fire Cook, at least until it hears oral arguments on the case in January.Trump has launched an unprecedented campaign to exert greater control over the Fed, publicly lambasting the US central bank over its decisions, installing a close ally on its board of governors, and attempting to fire Cook.His battle for influence has raised questions over the independence of the Fed, which for decades has steered the US economy without political interference.Trump tried to “immediately” dismiss Cook in August, citing unconfirmed allegations of mortgage fraud dating back to before she joined the Fed in 2022. She has denied wrongdoing, and argued the president has no authority to fire her.On Wednesday morning the supreme court considered his attempt to remove Cook – the first-ever bid by a president to fire a Fed official – and the administration’s complaints about judge’s order which had temporarily blocked Trump from firing her while litigation over the termination continues in a lower court.The justices declined to immediately decide a justice department request to put on hold the judge’s order, enabling Cook to stay in post for now.Abbe Lowell, of Lowell & Associates, and Norm Eisen, of the Democracy Defenders Fund, representing Cook, in a statement said: “The court’s decision rightly allows Governor Cook to continue in her role on the Federal Reserve board, and we look forward to further proceedings consistent with the court’s order.”The justice department was contacted for comment. Karoline Leavitt, the White House press secretary, said the administration was looking forward to oral arguments before the court.Carl Tobias, at the University of Richmond School of Law, suggested that the decision to keep Cook in place, and the court’s announcement that it would hear oral arguments on the merits of the case in January, were “good signs for both sides”.“It does protect the independence of the Fed, at least in the short term,” Tobias told the Guardian. “The one big question is: even if they have arguments in January, when will they issue the ruling? That could come early, because I expect the government will ask them to expedite everything, but it could be as late as June.”The court’s decision to maintain the status quo in the short term should allow markets to “settle down” and mitigate the uncertainty around the Fed, he added.In creating the Federal Reserve in 1913, Congress passed a law called the Federal Reserve Act that included provisions to shield the central bank from political interference, requiring governors to be removed by a president only “for cause”, though the law does not define the term nor establish procedures for removal. The law has never been tested in court.skip past newsletter promotionafter newsletter promotionJia Cobb, a Washington-based US district judge, on 9 September ruled that Trump’s claims that Cook committed mortgage fraud before taking office, which Cook denies, were probably not sufficient grounds for removal under the Federal Reserve Act.Cook, the first Black woman to serve as a Fed governor, sued Trump in August after the president announced he would remove her. Cook has said the claims made by Trump against her did not give the president the legal authority to remove her and were a pretext to fire her because of her monetary policy stance.Trump has made no secret of his plans to influence the Fed, publicly describing plans to swiftly build “a majority” on its interest-rate setting committee of policymakers.He has repeatedly broken with precedent to demand rate cuts, and attack senior Fed officials, including its chair, Jerome Powell, when they repeatedly defied these calls.Powell has repeatedly stressed he is “strongly committed” to maintaining the Fed’s independence. His term as chair is due to end next year. The Trump administration has been drawing up plans to appoint a successor.Reuters contributed reporting More

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      Why healthcare spending was at the center of the US government shutdown battle

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      The federal government shut down on Wednesday in part, due to a battle between Democrats and Republicans over healthcare spending.Democrats had said that they would not vote for legislation to keep the government open unless Donald Trump and Republicans, who hold the majority in Congress, agreed to reverse cuts to Medicaid and extend subsidies for Affordable Care Act plans. That did not respire in either of the votes in the Senate on Tuesday.In June, the US president approved legislation he calls his “big, beautiful bill”, which the Congressional Budget Office estimated would reduce federal Medicaid spending by $793bn and increase the number of uninsured people by 7.8 million.The savings in federal Medicaid spending will largely come from the implementation of the new requirements, which include completing 80 hours of work or community service activities per month, or meeting exemption criteria.The law also means that the premium tax credits implemented during the Covid-19 pandemic for insurance purchased through the Health Insurance Marketplace will expire at the end of 2025. That would make coverage more expensive and lead to 3.1 million more people without health insurance, according to the CBO.skip past newsletter promotionafter newsletter promotion“We are not going to support a partisan Republican spending bill that continues to gut the healthcare of everyday Americans,” Jeffries said following a negotiation with Trump and Republican leaders on Monday.Meanwhile, Trump doubled down during an Oval Office press conference on Tuesday that if the parties can’t reach an agreement, “we can do things during the shutdown that are irreversible, that are bad for them,” Trump said while speaking to reporters in the Oval Office on Tuesday afternoon. “Like cutting vast numbers of people out, cutting things that they like, cutting programs that they like.”He did not mention Medicaid or the Affordable Care Act but said: “We can do things medically and other ways, including benefits.”Still, there could be an opening for negotiation in coming weeks. The Senate majority leader, John Thune, said on the Senate floor on Tuesday that the Democrats should vote to keep the government open until 21 November and that he would be happy to fix the “ACA credit issue” before the credits expire at the end of the year. More

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      Once again, Netanyahu has outplayed Trump | Mohamad Bazzi

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      As a presidential candidate, Donald Trump claimed he would quickly end the war in Gaza. Eight months after taking office, Trump finally decided to exert some US pressure on Benjamin Netanyahu, the Israeli prime minister, announcing a 20-point peace plan at the White House on Monday.But the deal that the US president struck with Netanyahu – after Trump dithered for months, allowing Israel to continue its genocidal war with US weapons and unwavering political support – is less a ceasefire proposal than an ultimatum for Hamas to surrender.After nearly two years of prolonging the war and obstructing ceasefire negotiations, Netanyahu got almost everything he wanted, thanks to Trump. The US plan calls on Hamas to lay down its weapons and release the Israeli hostages remaining in Gaza, but it allows Israeli troops to occupy parts of Gaza for the foreseeable future. It’s close to the “total victory” over Hamas that Netanyahu has consistently promised the Israeli public, but failed to deliver on the battlefield.What if Hamas rejects this deal that was drafted without its input, or that of any other Palestinian faction? Trump made clear he would enable Netanyahu to sow even more death and destruction in Gaza. “Israel would have my full backing to finish the job of destroying the threat of Hamas,” he said at the White House. On Tuesday, Trump added he would give Hamas officials “three or four days” to respond – and warned that the group would “pay in hell” if it turns down the agreement. In past negotiations, Hamas had rejected Israeli proposals that forced the group to disarm and pushed it out of any future role governing Gaza.Once again, Netanyahu has outplayed Trump, who considers himself a master deal-maker. But he’s been regularly outmaneuvered by strongmen like Netanyahu and Vladimir Putin.When Trump took office in January, he had the upper hand over the Israeli leader, having pushed Netanyahu to agree to a ceasefire in Gaza that went into effect a day before the president’s inauguration on 20 January. But Netanyahu, who worried that his rightwing government would collapse if he agreed to a permanent truce with Hamas, imposed a new siege on Gaza in early March. With Trump’s blessing, Israel deprived Palestinians of food, medicine and other necessities. Netanyahu then refused to continue negotiations with Hamas, and broke the ceasefire after two months.Thanks to his unwavering support of Netanyahu, Trump has made the US more deeply complicit in Israel’s war crimes. Since Netanyahu resumed the war in March, civilians made up about 15 of every 16 people that the Israeli military has killed in Gaza, according to the independent violence-tracking group Acled. Israel has also pursued a more severe starvation campaign and instigated a famine in northern Gaza. (In August, the Guardian reported that a classified database maintained by the Israeli military showed that 83% of Palestinians killed in Gaza, between the outbreak of war in October 2023 and May of this year, were civilians.)Along the way, Netanyahu has exploited Trump’s desire for flattery, allowing the Israeli premier to not to draw out the war on Gaza but also to conduct attacks on other countries in the Middle East, including Iran, Lebanon, Syria and Yemen. Starting with billions of dollars in US weapons provided by Joe Biden’s administration and continuing under Trump, Israel has been able to bomb virtually anywhere in the region, with impunity. In June, Israel launched a surprise attack against Iran, killing dozens of top military officials and nuclear scientists. Netanyahu then convinced Trump to briefly join Israel’s war, when he ordered US planes to bomb three major nuclear facilities in Iran.Two weeks later, in early July, the Israeli premier showed up for dinner at the White House. Trump was eager to build on the momentum of a ceasefire he brokered between Iran and Israel, and was planning to cajole Netanyahu into making a deal with Hamas in Gaza. But Netanyahu avoided being publicly pressured by Trump to end the Gaza war, as Trump had done weeks earlier with the Iran ceasefire. Instead, Netanyahu stroked Trump’s ego by revealing that he had nominated the US president for the Nobel peace prize.Netanyahu managed to both flatter Trump and tap into his sense of grievance over being denied the world’s top peacemaking award. Trump has insisted for years that he deserves the Nobel prize for orchestrating a series of diplomatic agreements between Israel and several Arab countries during his first term. These so-called Abraham Accords were brokered in 2020 by Jared Kushner, Trump’s son-in-law and senior adviser at the time, and they included the United Arab Emirates, Bahrain and Morocco. But Trump couldn’t entice Saudi Arabia, the most important Arab state, and its crown prince, Mohammed bin Salman, to reach a normalization deal with Israel.Like Trump’s current peace plan for Gaza, the Abraham Accords were negotiated directly with Israel and autocratic Arab regimes – and they excluded Palestinians from any discussion of their future or aspirations. These are deals conceived by real estate tycoons like Trump, Kushner and Steve Witkoff, who has served as Middle East envoy and one of Trump’s top diplomats in his second term. Trump and Kushner have always viewed Gaza through the prism of a real estate project, where Palestinians are holdouts refusing to cave into pressure to make way for the renovation of prime beachfront property along the Mediterranean Sea.In one of the few positive developments for Gazans, Trump dropped his widely-derided idea, which he floated during a meeting with Netanyahu in February, for the US to take over Gaza and turn it into a “Riviera of the Middle East”, in effect endorsing the ethnic cleansing of Palestinians.But on Monday, as Trump announced his latest plan, which would establish a temporary governing board for Gaza that he himself would chair, he couldn’t resist ad-libbing a digression about the perceived value of the territory’s waterfront. “As a real estate person, I mean, they gave up the ocean,” Trump said, referring to the Israeli government’s decision in 2005 to withdraw troops occupying Gaza, along with about 8,000 Israeli settlers. He added: “They gave up the ocean. I said: ‘Who would do this deal?’”In reality, even after its withdrawal, Israel maintained control over Gaza’s airspace, borders and shoreline. In 2007, after Hamas took military control of Gaza following its victory in Palestinian legislative elections, Israel imposed a blockade on the territory that continues until today. Israel gave up the beach, but it still controlled the sea.In the days leading up to Monday’s announcement at the White House, Kushner and Witkoff spent hours meeting with Netanyahu, who was able to make last-minute changes to Trump’s plan, including the scope and timing of Israeli troop withdrawals from Gaza. As he has for the past two years, the Israeli prime minister managed to impose his will on a US administration that should have far more leverage over him than the other way around. And that means Netanyahu may well doom Trump’s latest peace deal.

      Mohamad Bazzi is director of the Hagop Kevorkian Center for Near Eastern Studies, and a journalism professor, at New York University More

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      Trump’s H-1B visa fee is a death sentence for US healthcare | Eram Alam

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      The Trump administration announced last week that every new H-1B visa will now cost $100,000. Framed as a crackdown on Silicon Valley, the policy will devastate American hospitals. Its real casualties will be poor and rural Americans in need of medical care, but with no one left to provide it.One in four US physicians is foreign-trained. Many enter through the H-1B program, disproportionately staffing rural and underserved hospitals where American graduates rarely go. In some facilities, every single doctor is an immigrant. These are the physicians who deliver babies in Mississippi Delta towns, staff emergency rooms in the Dakotas, and run primary care clinics in the Bronx. By raising visa costs from a few thousand dollars to $100,000, the administration is functionally cutting off their pipeline.The consequences will be immediate and severe. In this year’s residency match, international graduates filled more than 6,600 positions, with the vast majority in internal medicine and family medicine – the unglamorous workhorses of primary care. American graduates consistently avoid these specialties, preferring higher-paying and more prestigious fields. Without immigrant physicians, safety-net hospitals will be unable to fill residency slots, rural areas will lose their only steady doctors, and wait times for basic care will stretch our even further than they already are. The result will not be new jobs for Americans; it will be shuttered clinics and lives lost.The administration claims that cutting off immigrant doctors will catalyze domestic production of physicians. But training a doctor takes at least a decade, and requires investments in medical education that both major US political parties have consistently refused to make. Since the 1960s, Congress has chosen not to expand medical school and residency capacity in line with population growth, instead treating immigrant doctors as a convenient – and far cheaper – stopgap.When Medicare was created in 1965, lawmakers agreed to fund graduate medical education precisely because hospitals argued they could not sustain the high cost of residency training on their own. But funding was capped in the 1990s, and despite repeated warnings about looming shortages, Congress has failed to lift those limits. Today, the Association of American Medical Colleges projects a shortfall of up to 86,000 physicians by 2036. That crisis is not the product of immigration policy. It is the predictable result of decades of underinvestment in training the workforce Americans need.As I show in my forthcoming book, the Care of Foreigners: How Immigrant Physicians Changed US Healthcare, the US has always yoked the fate of immigrant physicians to the health of American patients. After the second world war, when new public insurance programs like Medicare and Medicaid expanded access to care, lawmakers turned to foreign doctors to fill the gaps. The 1965 Hart-Celler Act, passed the same year as Medicare, was explicitly designed to recruit highly trained professionals from abroad. Within a decade, tens of thousands of physicians – overwhelmingly from India and other postcolonial nations – were staffing hospitals across the United States.This arrangement was hailed as mutually beneficial: the US got the doctors it needed, and immigrant physicians got training and opportunity. But the costs were exported. Countries like India, with far fewer doctors per capita and vastly greater health burdens, lost tens of thousands of their best-trained clinicians. American lawmakers knew it. In 1967, Senator Walter Mondale called it a “national disgrace” that the US was siphoning lifesaving workers from countries “where thousands die daily of disease” in order to staff American hospitals. Yet the practice persisted, institutionalized as a structural feature of US healthcare.What Donald Trump’s new policy does is break even with this pragmatic, longstanding “America-first” tradition with which the country has long prioritized its own convenience over an honest accounting of its effects on the poorer nations from which it continually extracts value. Instead of using immigration policy to stabilize the system, it weaponizes it for exclusion. The $100,000 fee is not simply a labor market reform. It is a political message: immigrant doctors are expendable, and so are the patients they serve.The American Medical Association, the American Hospital Association, and 53 leading medical societies have already urged the administration to exempt physicians from the new fee. But carving out exceptions misses the point. Relying on temporary waivers and emergency visas has always been a precarious way to run a healthcare system. Immigrant physicians are not a contingency plan. They are the backbone of American medicine – and they deserve stability, not discretionary exemptions subject to the whims of Kristi Noem, the homeland security secretary.The deeper crisis at play is not immigration at all. It is America’s refusal to build a sustainable pipeline with which to ensure care for its citizens. For 60 years, policymakers have papered over severe underinvestment in medical education and poor rural and urban communities by exploiting immigrant labor. Now, instead of repairing that rotten foundation, the administration is simply dynamiting the patchwork that has kept the system functional. Wealthy hospitals in big cities may find ways to absorb the costs. Rural and safety-net hospitals cannot. Patients in those communities – disproportionately poor, rural, and minority – will be the ones left sacrificed in service of Trump’s indulgence for dramatic, nonsensical proclamations without accounting for their very real consequences for American communities.The lesson of this moment should not be that immigrant doctors need another exception. It is that Americans cannot afford to keep treating healthcare labor as a disposable commodity, imported when convenient and scapegoated when politically expedient. What we need is structural reform: expanding medical school and residency capacity, investing in primary care, and ensuring that immigrant doctors who already sustain the system have a predictable, efficient and permanent route to practice.Immigrant physicians have long been America’s safety net. To slam the door on them now, without fixing the underlying shortages, is more than shortsighted. It is a policy of exclusion disguised as reform – and it will cost lives. America first, in this case, will make Americans die.

      Eram Alam is a historian of medicine and migration in the department of the history of science at Harvard University. She is the author of the Care of Foreigners: How Immigrant Physicians Changed US Healthcare, forthcoming from Johns Hopkins University Press in October 2025 More