The COVID-19 pandemic has strained our health care system to the breaking point. Our heroic health care professionals are working tirelessly to provide care on grueling shifts, at great personal risk to themselves and their families, but they need all the help they can get. Additional workers — especially nurses — would be a godsend. 

As it happens, thousands of nurses are waiting in the wings, willing, qualified, and ready to help in the fight against coronavirus in the United States, but are standing by for green cards to be made available to them. The truth is, if employment-based green cards didn’t go unused each year — partially because of bureaucratic errors — then they would already be here.

In the phase-four coronavirus relief bill, Congress should recapture these unused visas by making them available temporarily to emergency nurses and physicians during the coronavirus crisis. 

The urgent need for more nurses

Before anyone had ever heard of COVID-19, the Department of Labor identified nursing as a “Schedule A” occupation, indicating that the United States already faced a nursing shortage. 

The coronavirus pandemic has exacerbated the already-existing shortage and the consequences are all-too-painfully visible: Hospitals are being overrun. Caseloads can be twice the size they are usually or worse. Nurses describe entire staffs “tired and worn out” and some nurses are being asked to work even longer than twelve-hour shifts; 24-hour shifts are not unheard of. Nurses are comparing their work to that in a war zone. Nurses in a Michigan hospital refused to work without getting additional nurses to help. School nurses and retirees are being called in as reinforcements to clinics and hospitals to fight the pandemic. 

In short, we desperately need nurses.

At the same time, thousands of nurses have been waiting to come to the United States to help alleviate the ongoing shortage. As they are not generally eligible for temporary worker visas, they must wait for immigrant visas to become available. Many come from countries subject to annual caps on immigrant visas and have been waiting for years in a growing backlog. This sorry state of affairs was and is avoidable. 

One possible solution would be a temporary change to tap into the pool of unused visas to help alleviate the shortage in this crisis. 

Unused visas

Thousands of visas allocated each year for various immigration categories can go unused, often by accident when U.S. Citizenship and Immigration Services and the Department of State incorrectly estimate the cutoff dates in the visa bulletin. When visas go unused, immigration law generally attempts to “cross-allocate” them, shifting unused employment-based visas into family-based categories for the following year and shifting unused family-based visas into employment-based categories.

However, the unused employment visas do not always get cross-allocated because the family preference category is set to its minimum value whenever the difference between the number of certain immediate relative visas and parolees issued in the previous year and the number of unused visas is greater than 254,000. That condition has held consistently since 2000, meaning that for decades unused employment-based visas haven’t been automatically recaptured. Instead, they have simply vanished. 

Congress has “recaptured” some of these unused visas twice in the past. Between the American Competitiveness in the 21st Century Act in 2000 and the 2005 emergency supplemental appropriations bill, Congress has recaptured nearly 200,000 unused visas. 

Those recaptured by the 2005 bill were exclusively for nurses. Still, through 2009, over 176,000 visas went unused and were never recaptured. While no publicly available data exist since 2009, the years since have doubtlessly seen additional unused visas that never were recaptured. 

Unused and Recaptured Employment-Based Visas, 1992-2009

Total unused employment visas, 1992-2009 506,448
Automatically recaptured by family-based categories 149,578
Recaptured by the American Competitiveness in the 21st century Act and the 2005 supplemental 180,809
Unused and not recaptured176,061

Note: Data only go through 2009, unfortunately. Until 2009, the State Department published an appendix to the visa bulletin which contained more detailed calculations and data, but since 2009 has only published the final topline numbers. The Immigration Statistics Yearbook is incompatible with the numerical limitations so is not useful in reconstructing post-2009 unused visa data.

With this proven tool, Congress can enhance the health care workforce in the midst of the pandemic. Such a change is not permanent but could be written to coincide only with the existence of the current national emergency. Moreover, such a plan does not violate the president’s latest executive order restricting immigration, which exempts health care workers.

There is already bipartisan support for adding nurses and physicians and for recapturing unused visas. The 2000 recapture was signed by President Clinton and the 2005 recapture for nurses was signed by President Bush (with the Heritage Foundation arguing at the time that it didn’t go far enough). 

Republican Sens. Rand Paul of Kentucky and David Perdue of Georgia fought to protect immigrant nurses with changes to the Fairness for High Skilled Immigrants Act. Currently, bipartisan support for international nurses and physicians is apparent in multiple recent letters. Perdue and Republican colleagues, Kelly Loeffler of Georgia and Bill Cassidy of Louisiana, wrote to department heads asking them to prioritize the processing of EB-3 visas for nurses earlier this month. 

A wide-ranging group of Republicans and Democrats from both chambers wrote to Ken Cuccinelli to express concerns over regulations on the H-1B and J-1 visas hampering the strongest possible medical response to COVID-19.

A new effort to recapture stray visas marries smart health care policy to expand the supply of workers with good immigration policy that corrects bureaucratic errors and the unintended consequences of poorly planned immigration laws. Recapturing also respects the numerical limitation on immigration by using visas which Congress has already allocated.  

Our nurses are calling for help. We should listen.

Update 4/30: On April 30th, Senators David Perdue (R-GA), Dick Durbin (D-IL), Todd Young (R-IN), and Chris Coons (D-DE) introduced the Healthcare Workforce Resilience Act which recaptures 25,000 visas for nurses and 15,000 visas for physicians during the COVID-19 crisis. Read Niskanen’s press release on the introduction of this bipartisan legislation here.

Photo Credit: United States Africa Command, Public Domain