We are running out of health care workers. The Rose Gold Immigration Card can help.
Earlier this fall, President Trump signed an executive order establishing his “Gold Card” program, a $1 million path to legal residency in the United States for the world's wealthy, with the dual goals of increasing investment in U.S. businesses and paying down the national debt.
While the plan may not survive a legal challenge, it highlights something worthy of emulation at the state and federal levels: strategic use of immigrants to address real domestic shortages. States should work with the federal government to create a “Rose Gold Card” aimed at retaining immigrant health care workers in communities where staffing shortages are greatest.
Hospitals are short-staffed and the U.S. health care system is facing pressure from the retirement of baby boomers and an aging population. Staff shortages – exacerbated by delays in the processing of foreign residence visas – are putting further pressure on a system already struggling to keep up with growing demand. By 2036, the United States could face a shortage of 13,500 to 86,000 doctors. That doesn't include another 9 million home health aides, behavioral health providers and support staff, who are also in critical shortage.
These disparities threaten the quality, access, and safety of care, especially in rural and underserved areas, affecting approximately 75 million Americans. Federal and state initiatives are investing in helping U.S.-born citizens fill workforce gaps by expanding access to clinical training and education. Congress has approved new residency quotas. States are developing nursing and allied health community college programs. “Learn while you earn” apprenticeships can help students avoid debt while training in a clinical setting.
These efforts are working, but even under the most optimistic scenarios, they are not scaling fast enough to meet demand. This is where targeted immigration reform can help, and states can take the lead. A parallel track is needed: allowing states to designate high-need areas, streamline licensing, and work with federal programs to quickly and responsibly place qualified professionals.
Foreign-born clinicians already play a vital role in American health care. A quarter of doctors, nearly a third of home care workers and 22% of long-term care nursing assistants are immigrants. But the visa channels they rely on are clogged or outdated. The H-1B cap has been reached every year since 2008, with many nurses failing to meet its academic requirements. The Conrad 30 waiver allows international medical graduates to remain in the United States while serving in underserved areas, but is capped at 30 spots per state. Most recently, the State Department froze nurse visa approvals through 2024, coinciding with record vacancy rates.
Other countries in similar situations are taking urgent action. In 2023, the UK issued 146,000 health and care worker visas. Canada's Economic Mobility Pathways pilot program has welcomed 2,000 skilled refugees and their families, many of whom are training and working in health care roles. There is no reason for the United States to lag behind.
Congress should act to create a targeted visa program to provide skilled clinicians to communities in need. Rose Gold Visa puts this vision into action. It is modeled in part on the Conrad 30 exemption, which places licensed professionals in designated shortage areas with renewable terms based on performance and ongoing demand. It’s a smart, responsive model for high-demand, high-skilled immigrants.
It is also politically feasible, able to gain support from both sides of the political spectrum. Only 32% of Republican-leaning voters initially supported increasing legal immigration in health care — until they learned more. For example, when voters understood the purpose of the Conrad 30 exemption and how it worked, support climbed to 76%. Nearly three-quarters of Americans already support a merit-based approach to skilled immigration. When immigration policy is directly tied to health care, the public becomes involved.
Current systems cannot meet growing demand. The H-1B annual visa cap is capped year-round. Past stopgaps—like the defunct H-1C visa (limited to a few hundred nurses)—were far from enough. Conrad 30 exemptions remain under-resourced, while the 2024 freeze on nurse visas exacerbates shortages rather than mitigating them.
Congress has a unique opportunity to build long-term health care capacity while addressing the immediate personnel crisis. This means expanding domestic training and allowing states to take the lead in deploying skilled immigrant clinicians where they are needed most. Healthcare workforce policies are about more than just staffing levels or shift schedules. This is about public health, economic stability and national resilience.
President Trump has shown a willingness to increase immigration through the Gold Card proposal, which would serve the United States’ tactical advantage. No challenge faces our aging nation more seriously than labor shortages, which limit access to life-saving care.
Americans suffer when hospitals close, nursing homes fall below standards of care, and mental health services are denied access. Immigration should be part of the solution. The Rose Gold Visa and similar reforms offer a strategic path forward – strengthening our healthcare system by opening its doors to those who are ready and willing to serve.
Photo: Evgenia Parajanian, Getty Images
Kristie De Peña is senior vice president for policy and director of immigration policy at the Niskanen Center. DePena has more than a decade of experience leading policy development initiatives at the national level. She is known for her expertise in analyzing complex problems, developing innovative policy solutions, and building coalitions to effect change.
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