with Paulina Firozi


The country’s already-strained medical system could lose tens of thousands of much-needed workers if the Supreme Court agrees to end the Obama-era program shielding from deportation undocumented immigrants brought to the United States as children. 

Immigrants make up a disproportionate share of nurses, home health aides and health-care facility workers — and they include many of the 700,000 immigrants allowed to stay in the United States under the Deferred Action for Childhood Arrivals program.

About 27,000 of these “dreamers,” as DACA enrollees are known, work in health-care provider and support occupations, according to an analysis of census data by the left-leaning Center for American Progress. Another 200 dreamers are in medical school or participating in residencies. 

These immigrants — and others — play an increasingly important role as the demand for health-care workers skyrockets.

Yet their status has been threatened since Trump in 2017 sought to end the program that allows participants to work legally and renew their two-year protection from deportation. It's open to those who were brought into the country before age 16 and have lived here at least five years. The Trump administration defended its move before the nine justices yesterday in oral arguments, during which the court’s conservative majority appeared sympathetic to the case presented by Solicitor General Noel Francisco, as my Washington Post colleague Robert Barnes reports

Francisco told the court that the administration has decided DACA should end regardless of whether it’s legal. He also disputed lower-court opinions finding Trump’s decision to terminate the program was based on a faulty belief that the program was legally and constitutionally defective and that the administration has failed to provide sufficient justification for ending it.

“The Trump administration, which usually argues for broad executive power, in this case is arguing that the program is flawed and could not be defended against challenges from states that want to end it,” Robert writes.

“The Supreme Court’s somewhat reluctant review of the DACA program — it waited for months before accepting the case — meant that, for the third consecutive year, the high court will pass judgment on a Trump priority that has been stifled by federal judges, this time in a presidential election year and in a case with passionate advocates and huge consequences,” he writes.

“In general, the court’s liberals seemed highly skeptical of the administration’s actions, while the conservatives seemed open to the idea that it had the power to terminate the program,” Robert adds. “The court’s decision is likely to take months.”

Cristian Farias, a writer at the Knight First Amendment Institute at Columbia University:

In the meantime, health-care jobs — particularly those involving elder care — are projected to grow exponentially in coming years as baby boomers grow older. The Institute of Medicine has projected that 3.5 million more health-care workers will be needed by 2030. The country could have a shortage of as many as 122,000 physicians by 2032.

The American Medical Association noted the challenge in a statement yesterday supporting DACA.

“Our health care workforce, including physicians, nurses, physician assistants and home health aides, is bolstered by providers with DACA status,” AMA President Patrice Harris wrote. “During their careers, these providers will care for and improve the lives of millions of Americans.”

The contribution of immigrants is most pronounced in the area of home health care, in which employment of in-home aides and personal care aides is projected to grow 36 percent from 2018 to 2028. Nearly 1 in 3 of these types of workers are immigrants, according to the Paraprofessional Healthcare Institute.

Other medical groups have spoken out as well. David Skorton, president of the Association of American Medical Colleges, wrote in a Post op-ed last week that he is “deeply concerned” about the impact Trump’s decision might have on the country’s health.

Skorton gave two examples of “dreamers” who were able to stay in the United States under DACA who pursued careers in medicine:

  • Jirayut “New” Latthivongskorn, from Thailand, is a first-year resident at Zuckerberg San Francisco General Hospital and Trauma Center. In addition to receiving his medical degree from the University of California at San Francisco, he also received a master’s in public health from Harvard and co-founded Pre-Health Dreamers, which that provides support to undocumented students who are pursuing careers in health care.
  • A co-founder, Denisse Rojas, is pursuing a medical degree at the Icahn School of Medicine at Mount Sinai and is also a candidate for a master’s degree in public policy at the Harvard Kennedy School of Government. Rojas has testified about DACA in Congress.

“Excluding these talented individuals from the workforce would do more than simply thwart their professional aspirations,” Skorton wrote. “It would also deprive a huge number of Americans of accessing quality care. In fact, research indicates that the physicians and trainees who stand to lose their eligibility if DACA is eliminated would, collectively, serve as many as 5.1 million patients over the course of their careers.”


President Trump said his administration is doing a better job than Obama’s at handling an influx of migrants crossing the border. Here’s what you need to know. (The Washington Post)

AHH: Trump administration policies that made it more difficult for adult relatives of unaccompanied migrant minors to claim the children who were in U.S. custody led to a backup of thousands of migrant children at U.S. Border Patrol stations last spring, our Post colleagues Neena Satija, Karoun Demirjian, Abigail Hauslohner and Josh Dawsey report.

“Enhanced vetting of sponsors — including fingerprints and other paperwork — and the sharing of that information between child welfare and immigration authorities slowed down the release of children and exposed the sponsors to deportation,” our colleagues write. “The government knew the moves would strain child shelters, according to documents and current and former officials, but it was aimed at sending a message to Central American migrants: Coming to the United States illegally has consequences.”

In summer 2017, staff at HHS’s Office of Refugee Resettlement argued against the administration’s plans to separate children and to alter the process of passing children to sponsors. Jonathan White, then the deputy director of the ORR’s children’s program, warned in a July 2017 memo that there would be “significant increases” in how long children were kept in custody.

“A few months after the policy was implemented, HHS officials determined that it was not improving child safety. They concluded that the added vetting was redundant and needlessly extended the time children remained in custody, according to internal documents that ORR Deputy Director Jallyn Sualog presented to Congress, and to testimony on Capitol Hill.”

OOF: Ex-Food and Drug Administration chief Scott Gottlieb says pod-based e-cigarettes, which he says are fueling youth vaping, should be completely pulled from the market.

Gottlieb called on the agency to implement a full ban in prepared remarks for an address at Harvard University, Stat’s Nicholas Florko reports.

“Unless we’re able to change the current trajectory of tobacco-related disease, almost six million children alive today will die prematurely later in life from tobacco use,” Gottlieb planned to say. “In my view, that requires us to sweep the market of all of the cartridge-based e-cigarette products in their entirety — Juul, Njoy, Blu, Vuse, and the others.”

He said the pod-based products can be banned while open-tank vaping systems “sold in the adult vape shops” can remain on the market. “The kids just don’t like those big open-tank contraptions,” he added.

“His remarks come as the Trump administration continues to weigh a final regulation that could ban most flavored e-cigarettes,” Nicholas writes. “… Gottlieb, who is now a resident fellow at the American Enterprise Institute and a special partner at the venture capital firm New Enterprise Associates, resigned from the FDA early this spring. But since his resignation he has made no bones about advocating for the FDA to pursue certain policies.”

OUCH: Juul Labs is planning to cut $1 billion in costs, an effort that includes cutting 650 jobs — or 16 percent of its workforce of 4,051, CNBC’s Angelica LaVito reports.

K.C. Crosthwaite, the company’s chief executive, called the moves part of a “necessary reset.” It comes as the company grapples with the fallout from a surge in youth vaping.

“As the vapor category undergoes a necessary reset, this reorganization will help JUUL Labs focus on reducing underage use, investing in scientific research, and creating new technologies while earning a license to operate in the U.S. and around the world,” Crosthwaite said.

“He is trying to position Juul as a responsible company. Last week, Juul said it would halt sales of its mint-flavored nicotine pods, which were shown to be the most popular flavor among high school students in two studies,” Angelica writes.


— At least eight Trump allies were hired as outside contractors for the federal health department for work that is usually handled by career civil servants, Politico’s Dan Diamond and Adam Cancryn report.

“They were among at least 40 consultants who worked on a one-year, $2.25 million contract directed by Centers for Medicare and Medicaid Services Administrator Seema Verma,” they write. “The contractors were hired to burnish Verma’s personal brand and provide ‘strategic communications’ support.” The Health and Human Services department ended the contract in April after Politico reported on Verma’s extensive team of private consultants.

In total, the contractors billed the government at least $744,000 from September 2018 to January.

“[U]nder the terms hammered out last year, revealed for the first time, CMS agreed to allow at least four consultants to bill up to $204,000 over the length of the contract. That included one longtime Verma ally — Marcus Barlow, her spokesperson while she was an Indiana-based consultant to then-Gov. Mike Pence — who was greenlighted to bill as much as $425,000 for about a year’s worth of work,” Dan and Adam report. “…Those are far higher rates than for the department's regular communications staff and even the agency’s top political appointees.”

— During remarks before the National Association of Medicaid Directors, Verma defended hiring contractors to build out her communications department.

“When I came to CMS, my vision for the comms department was very different than what we had. I wanted to make sure that we were communicating with our patient population … and the provider community,” Verma told reporters, the Hill’s Nathaniel Weixel reports.

She added that when she began at CMS, such consultants were needed for specific expertise, but that the agency has been since less dependent on contractors. “When I first started at the agency … we did not have that level of expertise,” Verma said.


— National Nurses United, the largest union of registered nurses in the United States, announced its endorsement of Sen. Bernie Sanders (I-Vt.).

The group also supported Sanders during his bid for the Democratic presidential nomination in 2016, the New York Times’s Reid Epstein reports. The group will formally endorse Sanders at a Friday news conference in California.

“We know what we have done and what it takes to bring about fundamental change, and it’s massive organizing and a mass movement,” said Jean Ross, the union’s co-president. “Of all the candidates, Bernie is the one who understands that.”

“After being so tied to Mr. Sanders in 2016, the nurses’ union was unlikely to endorse anyone else in the 2020 race,” Reid reports. “Mr. Sanders, of Vermont, was the only candidate to sit for an in-person interview with the union to seek its endorsement; Senator Elizabeth Warren of Massachusetts called in on a video chat and Mayor Pete Buttigieg of South Bend, Ind., sent a three-minute video. Union officials said they had invited former Vice President Joseph R. Biden Jr. and Senator Kamala Harris of California to interview but each declined to do so.”

— And here are a few more good reads: 








  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the response to lung illnesses and the rise in youth e-cigarette use.
  • HHS Secretary Alex Azar, Sen. Ron Wyden (D-Ore.) and Sen. Mike Braun (R-Ind.) will participate in an Axios event “Health Care in 2020."


The House Intelligence Committee is preparing for three public hearings on Nov. 13 and 15. The Post's Paul Kane explains this phase of the impeachment inquiry. (The Washington Post)