Healthcare Pitfalls of Trump's Immigration Policies
Our healthcare system relies on noncitizens. This truism has mattered at multiple stages of my own life.
For the seven years that I lived in North Dakota, obtaining healthcare was not easy. Medical professionals weren't and aren't flocking to this state what with its population under 800,000, winter temps below zero, and average snow fall above 30 inches. We North Dakotans owed a great deal to former Senator Kent Conrad who paved the way for noncitizen doctors to serve in rural communities. But Conrad's plan has its failings. Noncitizen doctors still face unacceptably long wait periods for their green cards. These issues prompted my first writing on the issue of medicine and immigration: An Immigration Solution For Improving Rural Healthcare, 124 West Virginia Law Review, 741 (2022).
And then my mom started aging. I entered the world of independent living, assisted living, memory care, hospitals, and rehabilitation facilities. There were nurses, health care aides, sitters, PT, cooks, and cleaners--many of whom were not U.S.-born. Which set me on the path of writing Undocumented Eldercare, LLC
40 Wisconsin Journal of Law, Gender & Society 39 (2025), in an effort to think through ways noncitizen eldercare providers might continue to work in the U.S. after the loss of their immigration status.
Trump's second term has been as bad for rural healthcare and eldercare as I anticipated. News outlets have caught on:
- The New York Times: Trump’s Immigration Policy Sidelines Foreign Doctors Amid Shortage
- The Washington Post: Rural America relies on foreign doctors. Trump’s visa fee shuts them out.
- Marketplace: Retirement communities to lose Haitian staff as TPS expiration looms.
- The New York Times: Haitians Are Vital to U.S. Health Care. Many Are About to Lose Their Right to Work.
I am a bit astounded that Congress has stepped into the breach. ICYMI, the House has passed a bill reauthorizing TPS for Haiti. It's coming to the Senate and I'm getting off my tuchus to call my senators about the issue. The move could be a lifesaver for eldercare. (Other issues remain, of course, but any step is a good step.)
Here is a bit of ammunition for your own call: A recent study by fancy people (Harvard, MIT) called Is Immigration Good for Health? The Effect of Immigration on Older Adult Mortality in the United States. Some highlights:
We find a strong impact of immigration on the size of the immigrant health care workforce: admitting 1,000 new immigrants would lead to 142 new foreign healthcare workers, including 88 new aides, nurses and doctors. Importantly, we find little evidence of a “crowd-out” of domestic
health care workers; indeed, we find crowd-in of domestic physicians, perhaps reflecting the ability to deliver additional care with more lower-skilled foreign workers available. On net, we estimate that 1,000 new immigrants would lead to 173 more healthcare workers of any origin,
including 96 new aides, nurses and doctors.
We then turn to the impact on health. We find a striking and statistically meaningful decline in elderly mortality associated with more immigration: 1,000 additional immigrants result in 9.8 fewer deaths among the elderly annually in the average Metropolitan Statistical Area (MSA). This finding emerges clearly in event studies and, because we examine a static Medicare population and assign treatment status based on one’s geographic location in our study’s baseline year, cannot be driven by older adult migration or changes in the composition of the Medicare population.
We also find that increased immigration leads to a clearly identified reduction in the use of skilled nursing facilities (SNFs), consistent with the earlier studies showing that the availability of immigrant labor reduces the number of older adults residing in an institution (Butcher et al., 2022; Huh et al., 2024; Jung & Mockus, 2025). We improve on this earlier work
using more recent data and confirming results persist when using administrative data to precisely identify new admissions to SNFs. Additionally, we provide evidence that reductions in SNF use are not just allowing older adults to age in their preferred setting (AARP, 2024) but are
intertwined with meaningful improvements in the health of older adults.
We do not find that immigration leads to any other significant reductions in health care use or increases in overall Medicare spending. Taken together, we find that immigration saves elderly lives, and these health improvements may come through protective effects of avoiding the nursing home setting and through better treatment of those who go to nursing homes.
