BY BRENDAN WILLIAMS
Brendan Williams
In his final speech as president, Ronald Reagan extolled immigration: “Thanks to each wave of new arrivals to this land of opportunity, we’re a nation forever young, forever bursting with energy and new ideas, and always on the cutting edge, always leading the world to the next frontier. This quality is vital to our future as a nation.”
Much has changed since that speech in January 1989. One significant change is that those 65-and-older comprised 17.7% of the U.S. population in 2023 Census data (almost 21% in New Hampshire data), as opposed to 12.6% of the population in the 1990 Census — the year after Reagan’s speech. And that older population has long-term care needs that cannot be met by native-born Americans, especially as our birth rate reaches record lows.
Today, research finds that 32% of home care workers were born outside of the U.S., as were 21% of the nursing assistants working in nursing homes. With the demand for long-term care increasing exponentially, we are going to need more immigrants in our workforce if long-term care is to have a long-term future.
Immigration cannot be reserved for tech moguls through H-1B visas for immigrants of “exceptional merit and ability.” Some in the tech sector arguably use such workers to undercut wages, as there is a robust supply of domestic workers they could otherwise employ. Nor could the H-2B visa program utilized by businesses like Mar-a-Lago based on the attestation that “there are not enough U.S. workers who are able, willing, qualified and available to do the temporary work” fill the needs of long-term care employers. The H-2B program is limited to seasonal employment for as few as 66,000 workers a year.
We need systemic immigration reform, and yet polling suggests many Americans just want deportations. That is economically self-defeating.
As an open letter to Congress from a huge range of business community organizations, including those in the long-term care space, noted, “Companies are experiencing significant workforce short ages despite their sizable investments in expanding U.S. talent pipelines. As a result, companies of all sizes and across a host of industries are wrestling with the myriad problems caused by their inability to adequately tap into global talent to meet their workforce needs.”
Federal data shows that “nursing and residential care facilities” have still not recovered the workforce they had in February 2020 — just before the COVID-19 pandemic spread — let alone acquired the workers necessary to meet the needs created by the growth in the aged population since then. This is so even though the sector’s wages overall, through last November, are up 31% since February 2020, or 33% for “production and nonsupervisory employees.” Those are staggering figures and certainly a show of good-faith efforts to attract workers, unmatched in most states by a corresponding increase in Medicaid reimbursement to cover wage costs.
I have written critically about both parties when it comes to immigration. Our past two administrations used the pretext of contagious disease to thwart it, even though the law known as “Title 42” — enacted during World War II — was aimed at preventing syphilis spread from returning servicemen, not a common respiratory virus like COVID-19 that knows no international boundaries.
Probably the most appalling finding in the polling I referred to was that 10% of Democrats, and 18% of Republicans, would deport even legal immigrants. More than xenophobia, I believe this reflects economic insecurity, a driving force in the 2024 election, despite most objective economic indicators being strong. Yet the sad irony is that such an attitude is a bellwether of economic decline. As Reagan said in his speech, “If we ever closed the door to new Americans, our leadership in the world would soon be lost.”
Instead of insularity, we need innovation.
Even a modest step in the right direction would help, like the bipartisan Healthcare Workforce Resilience Act introduced in both the House and Senate in 2023, which Senator Kevin Cramer (R-N.D.) noted would provide “up to 25,000 immigrant visas for nurses.”
Let’s keep our doors open to those who would come here and bolster our economy, including by serving our aging society’s health care needs.
Brendan Williams is president and CEO of the New Hampshire Health Care Association.
