This Immigration Bill Will Devastate U.S. Health Care

The shortage of working nurses is among the United States’ most intractable health care challenges, but that deficit will reach catastrophic lows if Congressional Republicans advance an ill-considered immigration proposal this fall that would consequently restrict the ability to recruit and hire foreign-educated nurses.

Because nurses are hard to recruit and train and harder still to retain, understaffed American hospitals must leverage foreign-educated nurses to bridge the gap between domestic labor supply and increasing patient demand for care. These nurses are the glue that binds America’s already strained system of care, and any disruption in the ability to hire them would be a literal deathblow to the patients they serve.

The Fairness for High-Skilled Immigrants Act, which would amend the Immigration and Nationality Act by rapidly eliminating per-country caps for employed-based visas, aspires to a more equitable immigration system. In practice, though, it’s neither fair nor functional.

Instead, this proposal would prioritize Indian nationals above all other green card applicants. Indian immigrants are chasing the American dream and have earnestly followed the law, only to fall victim to bureaucratic inertia.

But because so few of the world’s nurses are Indian nationals, the legislation would necessarily result in an immediate retrogression in the availability of health care professionals from nations including the Philippines, Kenya, Nigeria, Jamaica and the United Kingdom, which collectively represent a vital pipeline of medical talent for this country.

Based on current graduation and immigration trends, more than a third of the Bureau of Labor Statistics’ projected 1 million job openings for nurses will go unfilled by the year 2022. If passed, this immigration rewrite would mean tens of thousands more nursing positions would remain vacant.

As a practical matter, already strained hospitals, especially those serving rural and urban communities, would be forced to dramatically increase nurses’ patient load. But countless studies have warned that overloading nurses leads to higher rates of infections, complications and extended stays.

Said another way: Despite its intentions, this bill threatens your family’s health care. As intended, the Fairness for High-Skilled Immigrants Act isn’t about health care or nurses, but the unintended consequences make it one. It’s the patients — your family — who lose here.

If Congress is willing to concede the legislation’s unintended consequences, there is a path forward. It requires specially apportioning a small percentage of employment-based immigration third-preference category (EB-3) visas for nurses and other health care professionals in critical need categories, as the Emergency Nursing Supply Relief Act would.

That’s a lot of technical jargon, but it means that your family will continue to receive the care it deserves because hospitals will be allowed to continue to recruit foreign nurses and other health care professionals. And because the visas set apart by this fix have all been deemed so-called shortage occupations by the Department of Labor — that is, areas in which we can’t even begin to fill the gaps with available American workers — there will be no impact on the U.S. labor force.

American access to quality health care will be significantly restricted unless and until Congress acts. Merging these two proposals would thoughtfully preserve the intellectual framework of both while safeguarding the balance of the country’s health care system. Patients and taxpayers deserve nothing less.


Shari Costantini is a registered nurse who has spent two decades working to address chronic clinician shortages in the United States, and she is the chief executive officer of Avant Healthcare Professionals and serves as president of the American Association of International Healthcare Recruitment.  

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