Key Healthcare Policy Shifts: Visa Fees, Drug Pricing, and Vaccine Updates with Paige Twenter - Becker’s Healthcare Podcast

Summary4 min read

Becker’s Healthcare Podcast – Episode Summary
Episode Title: Key Healthcare Policy Shifts: Visa Fees, Drug Pricing, and Vaccine Updates with Paige Twenter
Host: Chanel Bunger
Guest: Paige Twenter, Assistant Editor, Becker’s Hospital Review
Date: October 16, 2025
Duration of Content: Approx. 00:00–06:26

Episode Overview

This episode features Chanel Bunger in conversation with Paige Twenter, assistant editor at Becker’s Hospital Review, focusing on three major policy shifts in U.S. healthcare: increased H1B visa fees, landmark drug pricing deals between the government and leading pharmaceutical companies, and evolving national vaccine policies. Paige brings current reporting and expert perspectives, explaining how these changes could impact healthcare professionals, patients, and the broader health system.

Key Discussion Points & Insights

1. New H1B Visa Fees & Their Impact on Healthcare Staffing

[00:19–02:08]

Policy Change: Effective September 2025, the U.S. enacted a $100,000 application fee for H1B work visas, affecting specialty occupations, notably healthcare roles.
Statistical Impact:
- In 2024, about 4% of H1B visas went to healthcare and hospital roles.
- Foreign-born employees make up:
  - 27% of U.S. physicians
  - 16% of registered nurses
  - Nearly 33% of janitorial and maintenance workers in hospitals
Industry Reaction:
- Healthcare leaders warn that the hefty fee could exacerbate workforce shortages and cause a “brain drain” in innovation, particularly health IT.
- The executive order claims the fee aims to combat “systemic abuse,” including wage suppression.
Reporting Note: Paige and colleague Mariah Taylor are seeking input for an in-depth article on these changes' effects on hospital recruitment.

"This fee could exacerbate healthcare shortages...could cause, quote, a brain drain in innovation, primarily in the health IT space. And it could also disrupt clinical workforce pipeline."
— Paige Twenter [01:11]

2. Most Favored Nation Drug Pricing Deals

[02:09–04:00]

Deal Details: Pfizer (US) and AstraZeneca (UK) recently agreed to “most favored nation” pricing contracts with the federal government, pledging to offer most drugs to Medicaid at the lowest price available in any nation.
Upcoming Initiatives:
- The White House plans to launch “TrumpRx.gov” in 2026 for direct-to-consumer transparency.
Patient Impact:
- Currently, Medicaid beneficiaries pay little or nothing for prescriptions (federal cap at $8 for new meds, sometimes $0 in certain states).
- For broader population benefit, these deals would need to extend to employers, private insurers, Medicare, and out-of-pocket payers.
Potential Expansion: The greatest impact would come if these pricing models were expanded beyond Medicaid to include commonly used therapies.

"Really for these to have the biggest impact...these kind of most favored nation deals would need to be expanded to more than just Medicaid."
— Paige Twenter [03:36]

3. National Vaccine Access & Policy Changes

[04:01–06:10]

Florida Developments:
- Florida’s Surgeon General announced intent to eliminate all school-based vaccine mandates.
- Possible removal of school requirements for specific diseases (e.g., chickenpox, hepatitis B) under review.
Professional Response:
- The Florida AAP chapter’s leaders (President and Vice President) report “flooded” phone lines from parents and pediatricians, reflecting widespread confusion and concern.
- AAP asserts that reduced vaccine mandates will jeopardize child and adult health, increasing preventable ER visits, illnesses, and deaths.
CDC Advisory Updates:
- The Advisory Committee on Immunization Practices (ACIP), an independent CDC panel, will review the timing/order of childhood vaccines, safety of vaccine ingredients, and international immunization schedules.
- No specific vaccines or ingredients named, but a significant potential change is the “breakup” of the combined MMR (measles, mumps, rubella) shot into three separate shots.
"AAP leaders told me that a reduction in school based vaccine requirements will not only endanger children, but adults as well. It'll likely also result in avoidable emergency department visits, severe illnesses and deaths."
— Paige Twenter [05:12]

"The administrator of the CDC, the acting director, has indicated the MMR vaccine would be split into three shots. So a potential three way breakup might be on the horizon."
— Paige Twenter [06:00]

Notable Quotes & Memorable Moments

“If any health execs are listening and would like to chime in on the topic, my colleague Mariah Taylor and I are working on an article about how H1 visa fees are changing or could affect hospital recruitment plans.” — Paige Twenter [01:38]
“We’re expecting more of these deals to come through soon. But really for these to have the biggest impact on the average American consumer...the initiative needs to grow.” — Paige Twenter [03:32]
“They said they’re being flooded with calls from parents and pediatricians, many of whom are concerned and confused about the potential change.” — Paige Twenter [04:53]

Important Segment Timestamps

00:19 — Introduction of Topics (visa fees, drug pricing, vaccine updates)
00:32 — Details on H1B visa policy and workforce statistics
01:11 — Anticipated impact of visa fees on healthcare staffing
02:09 — Overview of “most favored nation” drug pricing deals
03:32 — Discussion of limitations and potentials of new drug pricing policy
04:01 — Recent vaccine policy changes in Florida
05:12 — AAP leadership response to vaccine mandate changes
06:00 — Upcoming possible changes to MMR vaccination schedule

Recap

Paige Twenter delivers a concise but insightful overview of pivotal U.S. healthcare policy developments:

The new visa fee may worsen staffing shortages, especially in clinical and IT fields.
Breakthrough federal drug pricing deals might benefit Medicaid patients for now—but broad-based impact remains to be seen.
Vaccine policies are in flux, with Florida rolling back school mandates and the CDC considering substantial changes to recommended childhood immunizations.

The episode provides stakeholders with a snapshot of policy challenges and opportunities currently shaping American healthcare.

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Transcript4 lines

[00:00]
A
Welcome to the Becker's Healthcare Podcast, and today I'm your host, Chanel Bunger. And right now I am speaking with Paige Twenter, the assistant editor at Becker's Hospital Review, who keeps us updated regularly on healthcare trends. She's keeping an eye on Paige. Thank you as always for joining me today. Why don't you take it away and tell us about some of the things that you're seeing out there.
[00:20]
B
Okay. Thank you so much for having me. As always, there's three topics I'd love to chat about today, including new visa fees, the most favored nation deals the Trump administration has entered into with Pfizer and AstraZeneca, and then also just national vaccine access and updates. So these are the three stories I'm most closely watching and reporting on. To start us off with the visa fees, In September, the US enacted a new $100,000 application fee for H1B visas. These visas are work visas for specialty occupations, including health care. In 2024, about 4% of H1B visas were for health care and hospital roles. Beckers has spoken to a few health system leaders and hospital executives across the US and many of them have said this fee could exacerbate healthcare shortages. The executive order said the fee is intended to clamp down on what it called systemic abuse, including suppressed wages over the past few years. While healthcare leaders told Beckers that this fee could cause, quote, a brain drain in innovation, primarily in the health IT space. And it could also disrupt clinical workforce pipeline. So foreign born employees account for about 27% of physicians working in the U.S. same with about 16% of registered nurses and nearly 1/3 of janitorial and maintenance workers in hospitals. So if any health execs are listening and would like to chime in on the topic, my colleague Mariah Taylor and I are working on an article about how H1 visa fees are changing or could affect hospital recruitment plans. And so another topic I'm closely following is the most favored nation deals. So a few weeks ago, Pfizer, which is based in New York City, and AstraZeneca, which is based in the United Kingdom, they have both struck most favored nation pricing deals with the federal government. These deals are really the both drug makers, they pledge to offer most of their drugs to Medicaid at this, quote, most favored nation price, which is really what they say is going to be the lowest price that's offered in other nations to American consumers. So the White House is also planning to launch a direct to consumer website dubbed TrumpRx.gov in 2026 One thing to note right now is that while these deals are pretty interesting and newsworthy, Medicaid beneficiaries already pay next to nothing for prescriptions. Federally I believe the cap is $8 for new medications. And in some states, some Medicaid beneficiaries, they have no out of pocket costs and go back to those $8 cap. That's for people with the lowest incomes federally. So we're expecting more of these deals to come through soon. But really for these to have the biggest impact on the average American consumer, you know, the average person walking up to the pharmacy counter for medicine for their family, these kind of most favored nation deals would need to be expanded to more than just Medicaid. For example, if the initiative grew to more therapies, those savings could go to employers, private payers, Medicare, the average American. Last thing I would note is national changes to vaccination availability. So a few different things to watch and onenote is In Florida in early September, Water Surgeon General said that the state's health department was moving to scrap all school based vaccine mandates. And then the department later said it was looking into lifting mandates on school based vaccines for specific diseases including chickenpox and hepatitis B. Meanwhile, I spoke with the president and vice president of the Florida chapter of the AAP or the American Academy of Pediatrics recently. They said they're being flooded with calls from parents and pediatricians, many of whom are concerned and confused about the potential change. And the AAP leaders told me that a reduction in school based vaccine requirements will not only endanger children, but adults as well. It'll likely also result in avoidable emergency department visits, severe illnesses and deaths if the vaccination if the state vaccination rate decreases in results. One other thing to keep an eye out for as it comes to vaccines is MMR or measles, mumps and rubella. It indicated or kind of hinted or teased that the Advisory Committee on Immunization Practices, which is an independent CDC panel of advisors who provide vaccine guidance to the cdc. This committee has shared plans to review several aspects of the childhood vaccination schedule that's recommended by the cdc. So in a document posted earlier in October there looking at the timing and order of vaccines, the safety of vaccine ingredients and then the immunization schedules in other countries. They didn't specify which vaccines they're looking at, which vaccine ingredients they're going to be investigating. But one note is that the administrator of the cdc, the acting director, has indicated the MMR vaccine would be split into three shots. So a potential three way breakup might be on the horizon. And that's what I would note as the top three news in the past few weeks.
[06:17]
A
Perfect. Thank you as always, Paige, for keeping us updated on all these important trends and for joining me once again on the Beggars Healthcare podcast. Always a pleasure. Thank you.
[06:26]
B
Thank you. So now.