The Coalition urges passage of immigration policy reforms to improve the quality of healthcare in New Jersey

February 15, 2024:  Immigrants are vital to New Jersey’s healthcare system. They make up 32% of all healthcare positions in the state, including 37% of physicians and surgeons, 32% of registered nurses, and on the lower end of the occupational spectrum, a majority (54%) of home healthcare workers. Without the supply of immigrants, workforce shortages in the healthcare sector would be much more severe.

But even with such high representation, the outlook for the future is not good. Not only is the domestic birth rate below replacement level, the average age of the workforce is rising, and the elderly population is soaring. By 2030, 70 million people will be 65 or older. By 2034, the older population will outnumber the under-18 population for the first time in American history. As most of the older population will prefer to spend their final years at home, the demand for home health care workers will continue to grow.

Although important efforts are being taken to increase the healthcare workforce, these efforts aren’t sufficient. Between 2012 and 2022, over 1 million jobs were added nationally to the healthcare sector. By 2032, there will be another 1 million new jobs. The State of New Jersey is still suffering from the loss of nurses and other healthcare workers during the “great resignation” following the COVID-19 health crisis. In order to maintain the quality of care that New Jersey residents deserve, we need to find new ways to draw in talent and qualified labor from around the world. We also need to create pathways for immigrants already residing in the country to enter the healthcare profession.

Unfortunately, our antiquated immigration system does not recognize the importance of this stream of talent. Few visa programs exist that give priority to foreign-trained health care professionals. Those that do exist are woefully inadequate in that they either do not provide a sufficient number of visas or present obstacles that prevent or deter foreign nationals from entering the healthcare sector. Women are most affected by these system limitations, as they represent 80% of all workers in the healthcare sector in the U.S.

The Coalition believes that this is a crisis of serious magnitude. Unless we create new pathways for talented foreign nationals to enter our healthcare workforce, and reduce the obstacles that exist within the current system, the quality of healthcare in New Jersey may decline, care and treatment may be delayed, and mortality rates may rise.

Based on recent research on this topic and the input of our colleagues in the healthcare profession*, the Coalition makes the following recommendations for policy changes to alleviate this problem and prevent a potential crisis.

FEDERAL POLICY INITIATIVES

  1. The number of employment-based immigrant visas should be increased beyond the current 140,000 to make it easier for foreign-trained health professionals to secure permanent status in the United States. Per-country caps should be raised and dependents should have a separate visa category so as not to use up available employment-based visas.
  2. Congress should pass the Healthcare Workforce Resilience Act, which would recapture and reassign unused employment-based immigrant visas to as many as 25,000 nurses with approved immigrant petitions and 15,000 physicians with approved petitions. We also suggest setting aside as many as 25,000 visas to cover direct care workers.
  3. We also urge passage of The Conrad State 30 and Physician Access Reauthorization Act, which allows states to request J-1 visa waivers for foreign physicians to work in federally designated shortage and underserved areas.
  4. Congress should re-authorize the H-1C program allowing a limited number of foreign-trained nurses to work temporarily in the U.S. This program was operational during an earlier nursing shortage from 1999 to 2009.
  5. The State department should expand the J-1 Visa Exchange Visitor Program to include Home Healthcare Aides for older adults. Adding this occupation to the current list, which includes the au pair program, would be consistent with the purpose and current requirements of the J-1 program.
  6. Congress should create a new, four-year nonimmigrant visa classification for low-skilled healthcare workers
  7. Congress should increase the number of H-1B skilled immigrant visas and make them available to nurses and physical therapists
  8. Physical therapists should be added to the list of “STEM” degrees/occupations so that foreign nationals graduating from U.S. degree programs are eligible for 3-year work permits.

STATE POLICY INITIATIVES

  1. A state commission should be established to research and recommend ways that New Jersey can facilitate the training and credentialing of immigrant health care professionals.
  2. The state should implement inclusive pathways for occupational licensing for foreign-trained physicians and other health care professionals by making permanent some of the innovative approaches adopted during the COVID pandemic.
  3. The state should set up programs to educate immigrants without formal healthcare training about the advantages of, and requirements for, working as home health aides.
  4. The state should explore the possibility of using contextualized English Language Learning programs to prepare immigrants for entry into health care occupations. All such programs should build on the educational backgrounds of participants and avoid “brain waste” outcomes. Such programs should be open to people with multiple legal statuses, including refugees, asylees, parolees, TPS recipients, and asylum applicants.

*The Coalition organized a program on the topic of healthcare and immigration in partnership with the NJ Business and Industry Association on December 5, 2023. Most of the recommendations in this statement are based on the insights and suggestions of the presenters and panel members at this event. Here is the link to the video of the program: https://www.youtube.com/watch?v=EIpa6ZU2_Bw