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Surely the American national interest, particularly the welfare of the nation's rapidly growing ranks of the elderly, necessitated some sort of rational policy to replace the expired program or at least guide the transition period. And certainly there is a moral dimension to this that the U.S. government could not possibly ignore, namely the abrupt displacement of thousands of productive, loyal, tax-paying professionals who answered its call to service and labored in remote corners of America while many American health-care workers fled for the comforts of the big city.
But that is precisely what happened. Thousands of Filipino and other foreign nurses are literally being put on the street by nursing homes, home health agencies and other health-care facilities, albeit reluctantly, by employers who undoubtedly need and value their services. The system is discarding them like squeezed lemons.
Credit much of this to the swirling winds of election-year politics, which reinforced immigration as a low-risk, high-impact issue. The immigrant voter constituency after all is seen as negligible. Many in government and media advocated informed, sober and well-meaning reservations about the state and direction of U.S. immigration policy. Too many, however, dished out plan political demagoguery, triggering knee-jerk reactions from information laced with fear and cynicism.
Somewhere in this maze of dark scenarios lay legitimate and pressing concerns that affect the daily lives of many Americans; needs that now have been sacrificed at the altar of expediency. The H-1A program and access by the American health-care industry to a limited number of qualified foreign professionals are one such burnt offering.
The vote came without even a cursory examination of the facts and consequences of inaction. Rep. Zoe Lofgren (D-CA) rose to pointedly remind the House that the extension of the H-1A program was unnecessary because foreign nurses can always avail of H-1B visas. It may have sounded reassuring to her colleagues, except that under the current immigration rules H-1B is of extremely limited use to employer-petitioners of registered nurses with its specialty occupation requirement.
One of the most passionate foes of the temporary extension of H-1A was Rep. Howard Berman (D-CA), who forcefully opposed the amendment from a union constituency standpoint. Would Rep. Berman have balanced his position with the fairness issue had he been more sensitive to his Filipino-American constituency in the San Fernando Valley in Southern California? Will Filipino-Americans move to hold him to account for his position on a matter of serious concern to them?
Could the American Nurses Association have used the input of its thousands of dues-paying Filipino-American members as well as the Philippine Nurses Association with its nationwide network of chapters? Has the PNA defined the plight of Filipino H-1A nurses as an area of concern and action?
Foreign-trained registered nurses employed in the U.S. under the H-1A program represent a minuscule number out of the total industry work force (less than one percent). But the approximately 35,000 H-1A nurses are a crucial element in the ability of the health care industry to maintain the quality of care at reasonable costs in areas where nurse shortages exist. Still, that they are economically desirable did not overcome the fact that they are politically dispensable.
The reckless and ill-advised action taken in the House may appear to be the politically correct thing to do. But it could present the U.S. with a health-care emergency in the very near future. In the short term it will disrupt consistency and continuity of care, not to mention the problem of substantially higher costs, triggering a rise in Medicare and Medicaid expenses. And to the extent that it adversely affects the viability of health care facilities in rural, suburban and inner-city areas, it puts American jobs in peril as well.
Then again, it just doesn't make sense, nor is it fair, to displace about 8,000 foreign nurses (the estimated number who have not adjusted to permanent resident status) who are presently performing productive, much-needed services in many remote and under-served areas across America, and turn them into illegal aliens overnight. Consider too, the administrative and financial burden on the health care facilities as a consequence of this policy vacuum.
It is not as if foreign registered nurses are going to innundate Los Angeles, New York and Chicago. Based on Bureau of Labor Statistics data, H-1A nurses constituted a minimal percentage of the increase in employment of registered nurses. The increase in hospital employment accounted for only 20 percent of the rise in registered nurse hires between 1993 and 1994, the period when H-1A nurse recruiting was reaching its peak. The remaining 80 percent of the growth in nurse employment occurred in community health organizations, home healthcare and nursing homes. A large percentage of these health-care providers are located in rural and inner-city areas, which generally see the lowest growth of registered nurses per capita. Indeed, it is not rare for entire rural counties to have only one or two registered nurses.
In the recent Senate debate on the Simpson immigration bill (S.269), Sen. Lauch Faircloth (R-NC) was poised to propose an amendment to fully include registered nurses under the ambit of an expanded H-1B visa program. Aside from the numerical ceiling of 65,000 (total for all professionals including registered nurses), the amendment set up a built-in safeguard: the petitioner must be located within a "health professional shortage area" as determined by the Department of Health and Human Services.
The planned Faircloth amendment unfortunately did not make it to the floor. The North Carolina Republican, who had hoped to present his amendment as a bipartisan initiative, missed the filing deadline after the prospective Democratic co-sponsor, Sen. Carole Mosely-Braun of Illinois wavered on a procedural question.
Would Sen. Mosely-Braun have gathered more conviction had she been reminded that Illinois has the fourth largest concentration of Filipinos in America, and that they strongly care about this issue?
There are barely 30-session days left in the current Congress spread out between June and October. Rep. Burr and Sen. Faircloth, among other congressional advocates, remain willing to pursue a legislative remedy to this grave problem. But as always, voices from other sectors must be heard.
*Gil Roy D. Gorre is assisting the American Business Council for Fair Immigration Reform in its efforts to maintain access to foreign healthcare workers by the U.S. healthcare industry in areas where shortages exist. This article is adapted and reprinted with the permission of the author.
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