This Bill Could Wreck Rural Health Care. Here's How to Fix It


Speaker of the House Paul Ryan, R-Wis., strides to the chamber for votes on an immigration bill crafted by GOP conservatives, at the Capitol in Washington, Thursday, June 21, 2018. The bill was defeated and Republican leaders delayed a planned vote on a compromise GOP package with the party’s lawmakers fiercely divided over an issue that has long confounded the party. (AP Photo/J. Scott Applewhite)

Easy access to medical care is growing dangerously distant in rural communities across the United States, a collision of the economics of health care and a decades-long clinician shortage across the country.

Increasingly, the reimagining of the delivery of rural health care is relying on nurses. But because the country suffers a critical shortage of trained nurses, hospitals and other health networks have begun recruiting and hiring foreign-educated nurses.

A popular immigration bill under consideration by the House of Representatives would catastrophically, if unintentionally, limit the ability of American medical facilities to hire foreign nurses.

The Fairness for High-Skilled Immigrants Act, which aspires to more equitable immigration system by eliminating per-country caps for employment-based visas, would prioritize Indian nationals above all other green card applicants. The move represents a dramatic boon for Indian immigrants, especially technology workers, who’ve been pinched by bureaucratic inertia.

But because so few Indians are nurses, the legislation would result in an immediate decrease in the availability of clinicians from the countries that provide most of the United States nurses. Many U.S. nurses hail from the Philippines, Kenya, Nigeria, Jamaica, and the United Kingdom. Restricting that talent pipeline would take a dangerous toll on the country’s balance of health care, as one hundred-year-old Montana hospital warned lawmakers in a letter shared with RedState:


Rapidly phasing out the per-country limits would negatively impact the health care delivery services in my hospital and across the U.S. Any disruption in health care staffing could have catastrophic consequences for patient care. …

We believe that the Emergency Nursing Supply Relief Act … , which sets aside a small number of immigrant visas for international nurses, physical therapists, and other healthcare professionals, would mitigate the problem … by avoiding a disruption in those critical occupations. And the immigrant visas set aside … have all been deemed so-called shortage occupations by the Department of Labor, so there will be no adverse impact on US workers.

Within the space of just four years, the Bureau of Labor estimates there will be more than one million nursing positions open across the country. If current graduation and immigration trends hold, more than one-third of those jobs would stay vacant. And if this immigration rewrite advances, that gap will only widen–and families and patients will suffer for it.

As the hospital’s letter notes, a minor amendment to specially apportion visas for nurses–who, unlike many technology workers, are not currently in the United States–and other health care professionals could prevent the bill’s unintentional hollowing out of America’s hospitals.


There exists no substantive or procedural reason why an amendment could not be included, and a vehicle already exists that could be seamlessly woven together. Wisconsin’s Republican Sen. Jim Sensenbrenner has introduced legislation (The Emergency Nursing Supply Relief Act) that would specially apportion up to 8,000 employment-based immigrant visas for nurses and other clinicians. If this fix is woven into the Fairness for High-Skilled Immigrants Act, it would solve the problem and help to eliminate some of the country’s nursing shortage.

Here’s the list of legislation’s cosponsors, which includes some friends of RedState. Call your member and warn them of the unintended consequences of this otherwise well-intentioned bill.


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