Trump deportation pledges raise concerns over U.S. health system

• Registered nurses gap of 78,000
• Immigrants play outsize role in health system
• Immigrants could fear seeking medical care

WASHINGTON - With Donald Trump back in the White House, Dr. Viviana Martinez-Bianchi, a family physician in North Carolina, is worried that the president's promise of a major immigration crackdown could prompt a health care crisis, especially in immigrant communities.

Trump, targeting the estimated 11 million immigrants without legal status, kicked off his new term Monday by declaring a state of emergency at the country’s southern border.

The move allows for use of the military in immigration enforcement, along with orders seeking to end “birthright” citizenship and make changes to the asylum system.

Previous immigration crackdowns have sparked often ignored and invisible impacts, said Martinez-Bianchi, who has practiced in small U.S. rural communities and midsized towns for decades, particularly among Spanish-speaking immigrants.

"Family members or members of the communities would be less likely to go see a doctor," out of fear for themselves or others, said Martinez-Bianchi, who is also health equity director at Duke University's Department of Family Medicine and Community Health.

Impacts would be felt well beyond immigrant communities, too, she said, exacerbating existing health worker shortages, especially in rural areas.

"You would reduce access to essential services because you wouldn’t have enough people doing that kind of work," she told Context.

She said she already is noticing worrying signs in North Carolina.

"I see people right now always carrying their passport with them, even though they're American citizens – just because they're Latino and speak with an accent."

Martinez-Bianchi and others are particularly concerned about lower-level health industry workers – the nurses' aides, community health workers and others who underpin key processes but could be likely to be caught up in an immigration crackdown.

Trump will "institute the largest deportation operation of illegal criminals, drug dealers, and human traffickers in American history while simultaneously lowering costs for families and strengthening our workforce," transition spokeswoman Karoline Leavitt said in an emailed comment.

100,000 workers short

Already communities across the United States are suffering from a significant shortage of health care workers, driven by aging populations, pandemic-era resignations and training gaps.

This year is expected to see a national shortage of more than 78,000 registered nurses, for instance, with some states more than a quarter below their projected need, according to federal statistics.

A report last year projected a shortage of 100,000 critical health care workers and 73,000 nurse assistants by 2028.

Such concerns tend to be most acute in rural areas, in part simply because of their smaller health clinics and centers.

"It's a big problem right now," said Brock Slabach, a former hospital administrator in Mississippi who is now chief operations officer with the National Rural Health Association.

"We have positions unfilled, and it's difficult to recruit and retain qualified personnel in many positions in rural hospitals and clinics," he said.

Rural hospitals are "just one resignation away from closing their obstetrics unit," he said as an example.

"The margins are really thin, so you lose one (worker) and it can be very disruptive to the overall system."

Across the United States, demand for nurses "is as high as we've seen in decades, and anything that threatens the workforce pipeline of nurses is concerning," said Tim Nanof, a vice president with the American Nurses Association, which represents about 5 million registered nurses.

He said shortages are widespread but particularly pronounced in rural communities and urban underserved areas, translating into deferred care by patients, forced overtime for nurses and more.

While most registered nurses are legal residents, some U.S. states allow citizens who came to the country illegally – so-called DACA recipients – to be nurses, and Nanof said these workers could be at risk under an immigration crackdown.

But he raised a particular concern about unlicensed health care aides and assistants.

"The people who nurses count on to be collaborative partners and take direction in the care of patients, I think, will be disproportionately impacted by deportation policy," he said.

Likewise, Martinez-Bianchi said there is concern over community health workers, who serve as key intermediaries between local communities and health services.

"In rural areas, they're very reliant on community health workers to share information and to work directly with those working on farms with temporary-worker visas,” she said.

While they could be vulnerable under a crackdown, at the same time, they can play an important role supporting others in immigrant communities, she added.

"They can help people connect with local resources, help with language barriers, help with understanding the rules," she said.

"They can even help guide them to have a deportation plan in place," she said, noting that mixed-status families need to plan for what children should do in case their parents are deported.

Broken pipeline

As worker shortages have worsened, immigrants have been playing a growing role in the U.S. health system.

The share of hospitals that have hired foreign-educated nurses has doubled in the past decade, said Drishti Pillai, director of immigrant health policy with KFF, a health policy non-profit.

Immigrants often can be found holding certain positions such as in nursing homes or long-term home care, again especially in rural areas.

"So all of these (deportation) policies could impact workforce shortages – not just in the near term but also in the longer-term future," Pillai said.

(Reporting by Carey L. Biron; Editing by Anastasia Moloney and Ellen Wulfhorst)