Deporting ‘Dreamers’ May Hit Home Health Care Especially Hard

In health care, on the other hand, the economic impact could be significant, depriving patients of help they depend on and driving up costs for families and taxpayers.

Surveys of DACA beneficiaries reveal that roughly one-fifth of them work in the health care and educational sector, suggesting a potential loss of tens of thousands of workers from in-demand job categories like home health aide and nursing assistant.

At the same time, projections by the government and advocacy groups show that the economy will need to add hundreds of thousands of workers in these fields over the next five to 10 years simply to keep up with escalating demand, caused primarily by a rapidly aging population.

“It’s going to have a real impact on consumers,” Paul Osterman, a professor at the Sloan School at MIT and author of a new book on long-term care workers, said of the DACA move.

The DACA program benefits people who entered the country as children and were under age 31 as of June 2012. A 2016 survey by pro-immigration groups and a researcher at the University of California, San Diego, shows that roughly half are still in school, and more than two-thirds have earned less than a bachelor’s degree. That would make fields like home health care aide or nursing and health assistants, which don’t require a college degree, potentially attractive.

Josue De Luna Navarro, a DACA beneficiary, came to the United States from Mexico when he was 9 years old. He became interested in a career in health care after his father nearly died from complications relating to heart disease.

Now a 21-year-old senior at the University of New Mexico, Mr. Navarro works as a health assistant at a clinic in Albuquerque and plans to apply to medical school after he graduates.

He worries that if DACA is revoked, he will not be able to work at all. “Without that work permit, my career in medicine will be very, very difficult,” he said.

Under the Obama-era program, recipients had to apply to renew their status every two years. The Trump administration said on Tuesday that some beneficiaries will be able to renew their status up until Oct. 5. Others could face deportation beginning in March, unless Congress intervenes beforehand.

Experts say the effects of undoing the program could quickly ripple out from DACA beneficiaries to other workers.

“It destabilizes that work force,” said Robert Espinoza, vice president for policy at PHI, a group that advocates on behalf of personal care workers. “If you are seeing family members, children, neighbors being deported, threatened, and so on, the ability to be present on the job is undermined.”

The health care field’s reliance on immigrant labor makes it particularly vulnerable. According to census data Mr. Osterman analyzed, more than one-quarter of home health aides in 2015 were immigrants. The proportion in certain states is far higher, reaching nearly one-half in California and nearly two-thirds in New York.

The undoing of DACA may also herald the undoing of other programs that provide a steady source of immigrant labor in the health care sector. For example, the government can grant people from certain countries that have endured hardship, like natural disasters or civil wars, what it calls temporary protected status.

The overwhelming majority of workers granted that status hail from El Salvador, Honduras and Haiti, and many have flocked to low-paying health care professions as well.

“We know from surveys that T.P.S. recipients are highly represented in the work force in certain areas,” said Tom Jawetz, a vice president of the Center for American Progress, a think tank that favors more liberal immigration policies. “In particular, many — especially Haitians — work in home health care.”

The Trump administration has suggested it may not extend the program for Haitians when its most recent extension expires in January, raising questions about whether it will end the program for Hondurans and Salvadorans as well.

As a basic matter of economics, removing tens of thousands of workers from occupations that already suffer from a serious labor shortage — the Labor Department predicts that country will need more than 1.25 million home health aides by 2024, up from about 900,000 in 2014 — generally has one unambiguous effect: driving up costs.

This may be welcome on some level: The department estimates that the typical home health aide made less than $25,000 in 2016, for a job that can be physically and emotionally grueling.

The economic problem is twofold, however. First, the government, through Medicaid, often pays the salaries of home health workers, meaning that escalating wages could blow a hole in the federal budget. (Medicaid, through the decisions of the state and federal governments, effectively caps compensation for home health workers, but the caps could rise more quickly in a world of plunging labor supply.)

Second, an acute shortage of home health workers could force many older and disabled Americans out of their homes and into care facilities, where costs are roughly two-to-three times the cost of home care for a full year. The government typically picks up that tab as well.

Still, it is the personal toll that may be greatest: A patient’s quality of life tends to be far higher when they can continue living in their own home.

For patients and families who rely on immigrant workers, “if that person is gone, can’t get renewed, it’s not a cute thing,” Professor Osterman said. “A home health aide is what lets you stay at home.”

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