Susan Dentzer: Anti-immigrant policies threaten to hobble U.S. healthcare

As some immigrant healthcare workers were fired from their jobs recently due to loss of Temporary Protected Status (TPS), the U.S. Immigration and Customs Enforcement (ICE) agency began equipping many former TPS recipients with ankle monitors pending their possible deportation. The monitors are a tragic but apt symbol at a time when the U.S. government is slamming the door shut on both undocumented as well as many legal immigrants.

Born of xenophobia as old as the republic — even in a nation created by immigrants — these anti-immigrant policies threaten to impose real costs now, not just in job losses in healthcare but also in poorer outcomes for patients. For all the well-founded concerns about other troubling matters, such as looming Medicaid cuts and health insurance losses, it may yet be that “nonmedical policies” such as clamping down on immigration will have an even greater adverse impact on the system over time, as Harvard health economist David Cutler has observed.^a

The immigrant share of the workforce

Despite more than a century of vacillating policies on immigration, immigrants have long represented an important share of the U.S. healthcare workforce. As of 2021, among the nation’s 15 million healthcare workers, nearly one in five overall (18%) were immigrants. An April 2023 “Spotlight” by the Migration Policy Institute (MPI) reported that the count encompassed about:

• One in four (26.5%) of the nation’s physicians and surgeons
• One in six (16.0%) of nurses
• One in five (21.4%) of nurse assistants
• Two in five (39.8%) of home health aides^b

Among all U.S. healthcare personnel, about 2.3 million are naturalized U.S. citizens, about 700,000 are documented (legal) immigrants and about 367,000 are undocumented.^c The legal immigrants working in healthcare hold a variety of statuses, ranging from legal permanent residency to TPS and the Deferred Action for Childhood Arrivals (DACA) program.

In a field closely related to healthcare, long-term care, immigrants play a major part in providing the hands-on direct care to older adults and people with disabilities to assist with activities of daily living and household matters. Nearly one in three (30%) of the 2.3 million persons in this area of the workforce are immigrants, a July 2026 KFF issue brief noted.^d More than a third of immigrant direct care workers are from Mexico, Dominican Republic, Jamaica, China and Haiti, with smaller shares from Asian and African nations such as India, Vietnam, Nigeria and Ghana.

The clear benefit of immigrant healthcare workers

Economic and health services analyses have demonstrated the value of this overall immigrant work force and undercut predictable criticisms, such as that hiring immigrants steals jobs from native-born workers. By contributing to the supply of healthcare workers, immigrants have clearly mitigated the workforce shortages that are now pervasive across most of the U.S. healthcare system.

About 39% of all U.S. internal medicine physicians in active practice are international medical graduates (IMGs), as are 25% of those in pediatrics.^e  Furthermore, IMGs overall are more likely to be in primary care-oriented specialties and to practice in underserved areas. Various studies have shown that availability of immigrant labor reduces the number of older adults living in institutions, in part because the large share of immigrants performing personal care services enables older adults and disabled individuals to live at home.^f

Moreover, for those Americans who do end up in nursing homes, the improved staffing ratios that result from immigrants in the workforce help to curb mortality in older adults through reduced unnecessary hospitalization, fewer pressure ulcers and less use of restraints, researchers from Harvard University, Massachusetts Institute of Technology and the University of Rochester said in a research paper published last February.^g Most strikingly, they predicted based on their research that a 25% increase in the flow of immigrants to the U.S. would reduce deaths nationwide by 5,000, possibly because the expanded healthcare labor supply would lead to improved access to care.

Although there are legitimate concerns about English proficiency among some immigrant workers, the 2023 MPI Spotlight offered evidence that those employed in healthcare are more likely to speak English fluently than those in other occupations. Many employed as RNs and technicians are also more likely to have received four-year college educations than their U.S.-born counterparts.

And in response to the argument that immigrants “crowd out” and displace native-born workers from jobs, the authors of the recent research paper find contrasting evidence that adding more immigrant healthcare workers actually “crowds in” more U.S. physicians, possibly because they can deliver more care when more, lower-skilled foreign-born workers, such as nursing assistants, are available to support them.

The unfathomable current immigration policy

Amid these clear benefits of immigrants in the healthcare workforce, many aspects of current U.S. immigration policy appear inexplicable — especially the Trump administration’s efforts to restrict all categories of legal immigration. Since taking office in January 2025, the Trump administration has moved to cancel TPS for immigrants from 13 out of 17 nations — moves that have inevitably hit healthcare and direct care workers, including many of the estimated 348,187 TPS holders from Haiti.^h

What’s more, a recently adopted federal rule will now impose restrictions that will affect the up to 80% of IMGs – who constitute approximately 16,000 residents and fellows – entering the United States for graduate medical training annually under so-called J-1 exchange visitor visas.ⁱ These visa holders will now be able to remain in the U.S. legally for no more than four years, even though many medical residency, doctoral and postdoctoral programs often take longer than four years to complete.

Many such individuals may ultimately be able to apply to extend their status, but in a recent statement, the American Academy of Medical Colleges (AAMC) expressed its concerns about the rule, saying, “it is inadvisable to actively reduce our capacity to effectively train the health care workers … that Americans
rely on.”^j

Remedial actions by states

Despite the Trump administration’s relentless anti-immigrant stance, some states — even those led by Republican governors — have sought other approaches to attract immigrant healthcare workers and address critical shortages. At least 26 states and territories have loosened longstanding requirements that IMGs obtain U.S. residency training to obtain state licenses to practice; they can now qualify if they have obtained training abroad that is “substantially equivalent” to accredited U.S. programs.^k

Noting that many Haitians in his state with expired TPS status have been working in nursing homes and other elder care activities, Ohio Gov. Mike DeWine, a Republican, has called on President Trump and Congress to “start a discussion about legal immigration and what is in the best interest of the nation.”^l

Undoing the self-defeating shackles of xenophobia on a nation that desperately needs greater healthcare access would seem the right place for another national attempt at a major immigration reform to start. 

Footnotes

a. Cutler, D.M., “Trump’s most important health policy may be at the border,”  JAMA Health Forum, Feb. 27, 2025.
b. Batalova, J., “Immigrant health-care workers in the United States,”  Migration Policy Institute, April 7, 2023.
c. Azaroff, L.S., et al., “Deporting immigrants may further shrink the health care workforce,” JAMA, April 3, 2025.
d. Chidambaram, P., Pillai, D., and Burns, A., “Who are direct care workers and how might federal policy changes impact the workforce?” KFF issue brief, July 9, 2026.
e. Ahmed, A.A., et al., “International medical graduates in the U.S. physician workforce and graduate medical education: current and historical trends,” Journal of Graduate Medical Education, April 1, 2018.
f. Harris, B.H., and Marshall, L., “Immigration to address the caregiving shortfall,” Brookings, April 2, 2024.
g. Grabowski, D.C., Gruber, J., and McGarry, B.E., “Is immigration good for health? The effect of immigration on older adult mortality in the United States,” working paper 34791, National Bureau of Economic Research, February 2026.
h. Forumtogether.com, “Temporary protected status (TPS): fact sheet,” updated Aug. 13, 2026; number of TPS holders was listed as of June 2025).
i. Department of Homeland Security, “Establishing a fixed time period of admission and an extension of stay procedure for nonimmigrant academic students, exchange visitors, and representatives of foreign information media,” Federal Register, July 17, 2026.
j. AAMC, “AAMC statement on duration of status final rule,”  press release, July 17, 2026.
k. Chaudhry, H.J., Johnson, D.A., and Abraham, G.M., “International medical graduates in America: Navigating a winding history of immigration laws and licensure requirements,” Annals of Internal Medicine, July 28, 2026.
l. Trau, M., “Ohio GOP Gov. DeWine makes plea to Trump: Let us keep immigrants,” Ohio Capital Journal, Aug. 14, 2026.