“THE MOST VULNERABLE AMERICANS WILL PAY THE PRICE”: Stripping Temporary Protected Status from Immigrant Health Care Workers

Emily K. Abel

The latest assault on immigrant workers in the United States is the Supreme Court decision in Mullin v. Doe on June 25, 2026, removing Temporary Protected Status (TPS) from 350,000 Haitians and 6,000 Syrians. Congress established the TPS program as part of the 1990 Immigration Act signed by President George HW Bush. The program authorizes the Secretary of the Department of Homeland Security (DHS) to apply TPS to individuals in the US who cannot return safely return to their home countries as a result of war, natural disasters, and other crises. Although TPS typically lasts for 18 months, the Secretary can extend the protection to approved individuals from those countries. By March 31, 2025, approximately 1.3 million individuals from 17 countries had received TPS. A disproportionate number worked in health care.

In his first term, Trump attempted to end TPS for people from El Salvador, Honduras, Nepal, Nicaragua, and Sudan. The Biden administration rescinded those terminations. But soon after Trump returned to the White House, Kristi Noem, then DHS Secretary, announced plans to strip TPS from people from thirteen countries, including Venezuela, Haiti, Honduras, Nicaragua, Afghanistan, Cameroon, and Syria.

Civil rights groups filed numerous lawsuits to preserve the legal protections for people from those countries. In addition, on October 2 more than 100 Democratic members of Congress led by Senator Elizabeth Warren sent a letter to Kristi Noem, Health Secretary Robert F Kennedy Jr. and Labor Secretary Lori Chavez-DeRemer, protesting the TPS revocations and warning that “the most vulnerable Americans in need of healthcare will pay the price.” The following day the Supreme Court granted Noem’s request to remove TPS from the 600,000 Venezuelans living in the US.

The DHS first designated Haiti a TPS country in 2010, after a catastrophic earthquake killed hundreds of thousands of people and caused devastating damage. Two years later Syria received the same designation after “a brutal crackdown” by dictator Bashar al-Assad led to “deteriorating conditions.” DHS repeatedly extended both designations until Trump reentered the White House. Soon after his return, Haitian nationals filed suits in Washington, D.C. and New York to stop the terminations. Federal judges in both cities barred the Trump administration from ending legal protections for Haitian immigrants.

Mullin v. Doe overturned those decisions. Writing for the majority (which included Justice Amy Coney Barrett, the mother of two adopted children from Haiti), Justice Samuel A. Alito, Jr. claimed that although virtually all Haitians are Black, the decision did not violate the equal protection clause. He also argued that President Trump’s many statements about Haitians did not influence the Court because they were not “overtly racial.” In her dissent, Justice Elena Kagan expressed incredulity, noting that Trump’s comments were “so repellent and racially inflected that the majority declines to put them in print.” The remarks “fairly shout. . .that race entered into the President’s resolve to remove Haitians from this country,” including the following: Haitians in Ohio were “eating” neighbors’ pets; Haitians “probably have AIDS”; Haiti is a “shithole country,” which is “filthy, dirty, disgusting”; Haitian immigration is “like a death wish for our country; and Haitians are “poisoning the blood of the nation.” Justices Sonia Sotomayor and Ketanji Brown Jackson joined Kagan’s dissent.

The Supreme Court ruling will have a drastic impact on health services, especially in states with high concentrations of Haitians (Florida, New York, and Massachusetts). In 2023, 111,000 health care workers were Haitians. Most worked in elder care. According to Florida’s major health care union, thirty percent of the nursing home workers it represents will now be liable for expulsion.

Abigail Jackson, a White House spokesperson, justifies the TPS terminations this way: “There is no shortage of American minds and hands to grow our labor force. President Trump’s agenda to create jobs for American workers represents this administration’s commitment to capitalizing on that untapped potential while delivering on our mandate to enforce our immigration laws.” Studies by economists report that aggressive campaigns to deport immigrants often result in Americans losing their jobs. As Marcela Escobari, a researcher at the Brookings Institution, writes, “Immigrant and native workers are not simply substitutes for each other. They are complements. When you remove one, you often undermine the other.” American employees lose their jobs when the departure of immigrant workers forces nursing homes to close.

Moreover, Rachel Blumberg, the president and CEO of a senior residence in Boca Raton, Florida, points out that Americans “don’t want” the jobs she offers. “That’s why we’re so dependent on immigrants.” Because the United States tries to provide long-term care services on the cheap, the remuneration is paltry. In 2023 the median hourly wage was $13.50; the median annual income was $25,275. The many workers who can find only part-time employment must piece together several jobs, often working far more than 40 hours a week. Benefits are either inadequate or nonexistent. Since the TPS terminations began, Blumberg has had to dismiss 38 employees representing nine percent of her staff.

It will not be easy to find replacements. As Katie Smith Sloan, President and CEO of Leading Age, the national association of providers of services for older people, writes, “There is no workforce waiting in the wings capable of replacing the long-standing relations, in some cases built over years and even decades, that are so vital to quality care.” Jill Miller has lived in a Virginia not-for-profit-elder-care facility for eight years with her husband Carl. Asked what she thought about the loss of immigrant workers from TPS-designated countries, she responded, “I just can’t even imagine the impact it would have on those of us that are cared for on a daily basis if we were to suddenly lose them. They’re the backbone.”

Another reason Blumberg may be unable to fill the vacancies left by Haitian workers is that the TPS terminations have aggravated the labor shortage in long-term care. Both nursing homes and home-based services have lengthy waiting lists. The shortage is expected deepen as the population continues to age rapidly. Two prominent policy experts, Andrew R. Olenski and David C. Grabowski, estimate that the US will have a shortage of 2.9 million direct care workers (nursing assistants, home health aides, and personal care aides) by 2040. Mortality rates rise when nursing homes cannot hire sufficient staff and older and disabled people cannot find anyone to assist them at home. The direct-care labor shortage also means more work for family carers, many of them already are overwhelmed by unsustainable responsibilities.

Older Americans and their families are not the only ones who will suffer. People in Haiti who have relied on remittances from the US will lose essential income. And conditions in Haiti are so dangerous that the State Department advises Americans not to travel there. Although DHS Secretary Markwayne Mullin promises to provide air fare for Haitians willing to leave, no commercial airline flies to Port-au-Prince, the capital city. Mike DeWine, the Republican Governor of Ohio, explains why he considers the Supreme Court decision a “mistake”: “The situation in Haiti could hardly be much worse. The violent gangs run most of the country. The government barely functions. And the economy is in shambles.” Haitians who have devoted their lives to caring for older Americans may find no one to care for them when they are in need. According to Doctors without Borders, “Since violence escalated in early 2024, more than 60 percent of medical facilities in Port-au-Prince have been closed or are only partially functioning. Some have been looted, burned, and abandoned, while others face critical shortages of supplies, medicines, or staff. Many people are too afraid to seek health care, even if they are in urgent need.” The conditions elsewhere in the country are no better: “More than 1.4 million people in Haiti are internally displaced by the violence, having fled their homes to other parts of the country. Many are sheltering in areas without adequate medical care or other essential services.”

On January 29, 2025, nine days after President Trump’s second term began, he signed the Laken-Riley Act to facilitate the deportation of immigrants accused of crimes. “It’s a landmark law that we’re doing today,” he remarked. “It’s going to save countless lives.” In fact, his immigration policies have done just the opposite. The recent Supreme Court decision endorsing those policies threatens countless lives, including those of both older Americans in need of health care and Haitian immigrants forced to return home.

Sources:

Council on Foreign Relations, “What Is Temporary Protected Status?” July 9, 2025, https://www.cfr.org/backgrounder/what-temporary-protected-status

Michael Sainato, “Trump Gutting Protected Status for Immigrants Will Strain US Healthcare, Democrats Warn,” Guardian, September 30, 2025.

David M. Cutler, “Trump’s Most Important Health Policy May Be at the Border, JAMA Health Forum, February 27, 2025

Alice Miranda Ollstein, “’They’re the Backbone’: Trump’s Targeting of Legal Immigrants Threatens Health Sector,” Politico, May 31, 2025.

Andrea Hu, “She’s Cared for America’s Elderly for Decades. Trump Wants Her Gone by Sept. 8,” NPR, August 22, 2025.

Madeleine Ngo, “Trump’s Immigration Crackdown Hits Senior Care Work Force,” New York Times, July 18, 2025.

Lenore S. Azaroff, Steffie Woolhandler, and SharonTouw, “Deporting Immigrants May Further Shrink the Health Care Workforce,” JAMA, April 3, 2025.

Leading Age, “Supreme Court Ruling on Haiti, Syria TPS,” press release, June 25, 2026.

Gloria Oladipo, “US Homeland Security Secretary Tells Migrants to Seek Permanent Status or Leave,” Guardian, June 28, 2026.

Adam Liptak, “Justices Clash on Whether Race Played a Role in Trump’s Bid to Deport Haitians,” New York Times, June 25, 2029.

Doctors without Borders, “Haiti Has Become a Far More Dangerous Place to Live or Seek Medical Care,” https://www.doctorswithoutborders.org/latest/haiti-has-become-far-more-dangerous-place-live-or-seek-medical-care.

Andrew R. Olenski and David C. Grabowski, “Caring for an Aging America—The Looming Crisis of the Long-Term-Care Workforce,” New England Journal of Medicine, July 4, 2026.

Marcela Escobari, “ICE Surges Kill Jobs in Red and Blue Cities Alike,” New York Times, June 30, 2026.