As Americans gather for holiday celebrations, they will silently thank health care workers who are keeping their families and friends healthy. The ICU nurses who stabilized my grandparents, the doctors who adjusted difficult prescriptions, and the home health aides who made sure our elderly relatives could safely bathe and eat.
Far fewer may realize how many of these professionals are foreign-born or how the immigration policies formed in Washington today determine whether the same families will receive care when they need it in the future.
As an economist who studies how immigration affects the economy, including the health care system, I see a consistent picture. That means immigrants are an important part of the health workforce, especially in roles facing shortages.
However, current immigration policies, including increased visa fees, stricter eligibility requirements, and enforcement actions that affect legally present workers living with undocumented family members, risk eroding this vital workforce and threaten timely care for millions of Americans. The timing couldn’t be worse.
The perfect storm: Rising demand, impending shortages
The U.S. health care system is undergoing unprecedented stress. An aging population and rising rates of chronic disease are pushing the demand for care to new heights.
The workforce is not growing fast enough to meet those needs. The United States is projected to face a shortage of up to 86,000 physicians by 2036. Hospitals, clinics and elderly care services are expected to add approximately 2.1 million jobs from 2022 to 2032. Many will be in front-line care roles such as home health care, personal care, and nursing assistants.
For decades, immigrant health care workers have filled the gap left by U.S.-born workers. They work as doctors in rural clinics, as nurses in understaffed hospitals, and as assistants in nursing homes and home health care settings.
Nationally, immigrants make up about 18% of health care workers, and they are even more concentrated in critical roles. Approximately one in four physicians, one in five registered nurses, and one in three home health aides are foreign-born.
State-level data reveals how deeply immigrants are integrated into the health care system. Consider California. One in three doctors there, 36% of registered nurses and 42% of medical assistants are immigrants. On the other side of the country, immigrants make up 35% of hospital staff in New York state. In New York City, they make up the majority of health care workers, accounting for 57% of health care workers.
Even in states with small immigrant populations, the impact is significant.
In Minnesota, nearly one in three nursing aides in nursing homes and home care agencies are immigrants, even though they make up only 12% of the workforce. Although immigrants make up only 6.3% of the state’s population, Iowa relies on immigrants for a disproportionate share of its rural physician workforce.
These patterns cut across geographic and partisan divides. From urban hospitals to rural clinics, immigrants continue to run facilities. Policies to reduce that number through higher visa fees, stricter eligibility requirements and increased deportations have had the knock-on effect of closing hospital beds.
As medical demand soars, the pipeline of new health care workers may struggle to keep up under current rules. Medical schools and nursing programs are facing capacity constraints, and training new professionals, which often takes doctors 10 years, means there are no quick fixes.
Immigrants have long filled this gap, not only in clinical roles but also in research and innovation. International students pursuing STEM and health-related fields at U.S. universities are an important part of this pipeline. However, recent research from the Council of Graduate Schools shows a significant decline in new international student enrollment for the 2025-26 academic year, due in part to visa uncertainty and global competition for talent.
If this trend holds, the smaller cohorts arriving today will mean fewer doctors, nurses, biostatisticians and medical researchers over the next decade, just when demand is at its peak. No major research institute has yet modeled the full impact that stricter immigration policies could have on health workers, but experts warn that stricter visa rules, higher application fees and increased enforcement are likely to deepen rather than alleviate shortages.
These policies make it difficult to hire foreign-born workers and are already creating insecurity for foreign-born workers. As a result, efforts to staff hospitals, clinics, and long-term care facilities will be complicated at a time when additional strain on the system would be minimal.
The hidden cost: delayed treatment, increased risk
Patients don’t feel the staffing gap as a statistic, they feel it physically.
Delaying seeing a specialist for months can make your pain worse. Older adults without home caregivers are at increased risk of falls, malnutrition, and medication errors. A nursing home that is understaffed turns away patients, and the family is thrown into turmoil. These are not hypotheticals; they are already happening in some parts of the country where shortages are severe.
The costs of restrictive immigration policies will not be reflected in the federal budget, but will be reflected in the human costs of months spent with untreated depression, discomfort while waiting for procedures, and preventable hospitalizations. This will be felt most acutely in rural areas, where immigrant doctors are often in charge, and in urban nursing homes, which rely on immigrant assistants.
Most Americans probably won’t read visa bulletins or labor market forecasts over their holiday dinner. But they will find out when caring for their children, partner or elderly parent becomes difficult.
Aligning immigration policy with the realities of the health care system alone will not solve all of America’s health care problems. But tightening rules in the face of rising demand and known shortages almost guarantees further disruption. If policymakers connect immigration policies to workforce realities and adjust them accordingly, they can ensure that when Americans seek care, someone will answer.
