Trump’s deportation plans could hit health care

The U.S. health care workforce could be squeezed even further by President-elect Trump’s plans for mass deportation of undocumented immigrants.

Already the health care sector has shortages across many professions, driving industry groups such as the American Hospital Association and LeadingAge to advocate for changes to the immigration system to bring in more foreign-born workers.

“Unfortunately, this issue really gets tied up with the southern border,” said Nicole Howell, director of workforce policy at LeadingAge, which represents nonprofit aging services. “If we’re going to see reform in the legal immigration system and process, then we’re going to need to likely pair that with reform at the southern border.”

Experts and advocates are anticipating a broad hit to the U.S. workforce if the forthcoming administration follows through on its plan for mass deportations. The American Immigration Council predicts that construction and agriculture would be particularly impacted, with around 13 percent of those workforces being undocumented.

But health care could also be affected, including home health care.

The Migration Policy Institute found that nearly 40 percent of home health aides were immigrants in 2021, with 54 percent of that group being naturalized citizens.

The American Immigration Council found in 2022 that around 4 percent of workers in health care support occupations, roughly 258,000, were undocumented. More than 5 percent of home health care aides, approximately 39,4000, were also undocumented.

Even if the deportations are focused specifically on undocumented immigrants, experts say this disruption could have a massive ripple effect in the workforce and their households.

For long-term care workers, including those providing direct care, the overall demand for their services is projected to grow by 39 percent between 2022 and 2037, according to a report from the National Center for Health Workforce Analysis released this month. The center also projects a nursing-workforce shortage of 10 percent in 2027 and 6 percent in 2037, and an overall physician shortage of 187,130 by 2037.

The American Hospital Association and LeadingAge are pressuring lawmakers to enact legislation by the end of the year to reallocate 40,000 unused visas for physicians and nurses.

LeadingAge also outlined broader immigration reforms for Congress and the White House in a September paper in order to stabilize the workforce and reduce turnover. They recommend increasing the number of employment-based visas, increasing the number of visas available to nurses and direct-care professionals, and creating new visa programs allowing foreign-born workers to fill long-term support and service positions.

Howell said undocumented workers providing direct care often work in the “gray market” off-book, where there aren’t any wage and safety protections. “Families turn to this because there is such a lack of care options and care is so expensive in this country,” she said, adding that families in rural communities are more likely to rely on these workers.

“This really is an issue that will impact the entire care continuum and the entire country regardless of where you live,” she said.

Howell also expressed concern about how households could be disrupted if a resident is deported, suggesting that these households could be “putting together a variety of things to make the bills work” and some individuals may be taking care of children or doing household tasks.

“Individuals working in the care economy may be forced to go find other jobs because for whatever reason this employment no longer works for them,” she said. “They need to make more money; they need different hours; they need more flexibility; it needs to be closer to home. ... So we’re concerned about the ripple effects.”

Many undocumented individuals live in mixed-status households, according to the Center for Migration Studies. Pulling on 2022 data, the center estimated in an October report that 8.5 million undocumented immigrants lived in households with either a U.S. citizen, a resident with a legal status, or both. There are 4.7 million mixed-status households and 1.1 million households with only undocumented residents, according to the group.

“If the undocumented residents of those households were to be deported, what would happen to the citizens that they live with or the people with legal status that they live with is a big question,” said Matthew Lisiecki, senior research and policy analyst at the Center for Migration Studies.

The center's report found that 5.5 million U.S.-born children—so, U.S. citizens by birth—under 18 live with undocumented immigrants and would lose one or more of the adults who are in charge of their upbringing under a policy of mass deportation. There are approximately 1.8 million children with two undocumented parents, the report says.

Lisiecki said families in which one or both parents are deported would face the difficult choice of “deciding whether to have the child stay in the U.S. and have the family be separated in order to stay in the only country they’ve ever known, or leave with their parents.”

Drishti Pillai, director of immigrant-health policy at KFF, said that immigrants and adult children of immigrants “play outsized roles in key areas of the health care workforce,” including practitioners and direct-care workers in long-term care settings.

Pillai pointed to Trump “border czar” Tom Homan’s comments to CBS News in October, in which he suggested families could be deported to avoid separation. She said this could further worsen the health care workforce shortage.

“There’s an increasing reliance on immigrants to fill workforce shortages in health care, and these shortages are also projected to continue over the next few decades,” she said. “As the 65-and-over population in the U.S. grows, these shortages could further be exacerbated.”

Along with the workforce, mass deportations could have impacts on other areas of health care. The American Immigration Council estimates that billions of dollars would be lost in federal, state, and local taxes. Undocumented-immigrant households paid $46.8 billion in federal taxes and $29.3 billion in state and local taxes in 2022, the group says. Additionally, undocumented households contribute to the safety net, paying $22.6 billion to Social Security and $5.7 billion to Medicare in 2022—without receiving any benefits in return.

The council warns that as “the U.S. population ages, the loss of these payments would make it increasingly challenging to keep social safety net programs solvent.”