Nancy Folbre

While awaiting the promised shock and awe of draconian new U.S. immigration policies, I revisited the welcoming poem inscribed on the base of the Statue of Liberty and suddenly imagined a goodbye using similar words:

You gave me your sick, your old, your young,
Your huddled dependents in need of care,
The wretched refuse of your teeming wealth,
You sent these, the helpless, tempest-tossed, to me.
I changed their diapers and wiped their butts,
And hugged them to my ample breast,
And I will lift my lamp to them
As you shove me out the golden door

The new Trump administration claims it will deport 15 to 20 million people and strictly limit legal immigration. Many of President Trump’s supporters believe this will improve their own economic prospects by increasing the bargaining power of U.S.-born workers and reducing social spending on non-citizens.

I think they’re mistaken. Apart from effects on immigrants themselves, the promised pace and process of deportation is likely to disrupt local businesses, escalate inflation, and lead to significant shortages of care services, in particular.

Immigrant workers of every educational level have long bolstered the supply of labor in health care, child care and elder care. In 2023, the President of the American Medical Association reported that more than 83 million people in the U.S. currently live in areas without sufficient access to a primary care physician.

Almost 30% of physicians in the U.S. are immigrants; they typically earn less than their U.S. born counterparts over the course of their careers. The non-profit KFF Foundation estimates that about 17% of all registered nurses in the U.S. are foreign-educated. While the share of hospitals that have hired such nurses nearly doubled between 2010 and 2022, new visa restrictions are now cramping supply. A recent report from the U.S. Chamber of Commerce explains why immigration restrictions exacerbate the nursing shortage and make health care more expensive.

Increases in the average age of U.S. residents—largely the result of declines in birth rates that have reduced the relative size of the younger generation—are projected to sharply increase the demand for elder care workers. Nursing homes in many areas rely heavily on Certified Nursing Assistants (CNAs), but the overall number of U.S.-born CNAs has long been declining and took an especially deep dive during the Covid pandemic. Differences in the relative number of immigrant CNAs across regions of the U.S. make it possible to analyze their impact. Their availability has been shown to increase staffing levels and improve the quality of nursing home care.

Many less-credentialed employees crucial to paid elder care services are undocumented, and particularly likely to help provide the home-based services that allow many elderly to age in place. Research examining the staggered implementation of intensified immigration enforcement by the Secure Communities program between 2008 and 2014 found that it pushed more elderly Americans into nursing homes.

Because it is difficult to identify undocumented workers in survey data—for the obvious reason they are reluctant to reveal their immigration status—they likely represent a significant share of the labor force in both family day care businesses and private household services. They are also prominent in restaurant and food delivery services that make it easier to outsource domestic tasks such as cooking. Considerable evidence suggests that U.S-born college-educated women are particularly likely to benefit. Not surprisingly, another study of Secure Communities enforcement efforts shows that it tended to reduce the employment of highly-educated mothers.

Arnulfo De La Cruz, president of the Service Employees International Union 2015 in California, provides an accurate prediction of the likely blowback from the immigration policies now being put into place: “I think the ultimate cost and impact would be to American citizens who already struggle to find a caregiver.”

The resulting shortfalls and price increases are likely to shift even more of the caregiving burden onto women, who are the primary sources of unpaid care for friends, neighbors, and family members. It seems unlikely that the wealthy white architects of deportation will be bothered in the least. They are well-protected by their personal golden doors.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Image by artist Dorothy Iannone, mural adjacent to the High Line in New York City.