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June 28, 2018

SCOTUS upheld Trump's travel ban. Here's what it means for health care

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    A Supreme Court ruling to uphold President Trump's so-called travel ban "could have far-reaching effects on" U.S. health care, as foreigners—including those from countries affected by the ban—make up a sizeable share of the health care workforce, Julia Belluz and Sarah Frostenson report for Vox.

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    Details on ban

    President Trump in January 2017 issued an executive order that blocked many individuals from seven countries from entering the United States. Amid the legal challenges, Trump later signed a new executive order to replace the January order, which has since been updated. The current version of Trump's travel restrictions apply to individuals from:

    • Iran;
    • Libya;
    • North Korea;
    • Somalia;
    • Syria;
    • Venezuela; and
    • Yemen.

    The restrictions vary by country. For instance, the measure completely bars travelers—including health care providers and potential medical students—from North Korea and Syria, but the restrictions for individuals from Venezuela apply only to certain government officials and their families. The White House said the restrictions take into account the "unique conditions and deficiencies" in the affected countries' vetting processes and "tailor[s]" the restrictions accordingly.

    The restrictions last indefinitely. Individuals from the affected countries who already have visas or who are lawful permanent residents of the United States are exempted from the restrictions. A list of potential case-by-case exceptions include instances when an individual is in need of "urgent medical care."

    Several states challenged the ban in court, and the 9th U.S. Circuit Court sought to put the ban on hold. However, the federal government appealed the ruling to the Supreme Court.

    SCOTUS' ruling

    The Supreme Court ruled 5-4 on Tuesday to uphold the ban.

    Chief Justice John Roberts, writing for the court's majority, in the ruling said the Trump administration "has set forth a sufficient national security justification" for the travel restrictions. Roberts in the ruling said Trump's restrictions were "well within executive authority and could have been taken by any other president," but noted that the court "express[es] no view on the soundness of the policy." Roberts added that those challenging the travel restrictions failed to demonstrate that the travel limits violated the U.S. Constitution's First Amendment restrictions on the federal government favoring a specific religion or that it violated U.S. immigration law.

    But Justice Sonia Sotomayor in a sharply dissenting opinion said the majority's ruling "leaves undisturbed a policy first advertised openly and unequivocally as a 'total and complete shutdown of Muslims entering the United States' because the policy now masquerades behind a façade of national-security concerns." She added, "But this repackaging does little to cleanse Presidential Proclamation No. 9645 of the appearance of discrimination that the president's words have created."

    The Supreme Court decision sends the case back to the 9th U.S. Circuit Court of Appeals, which previously ruled against the ban, to rule on the ban's merits. According to Vox, the Supreme Court's ruling makes it highly unlikely the ban will be struck down by the lower court.

    Health care implications

    The travel restrictions are expected to exacerbate the nation's shortage of health care professionals, Vox reports.

    The health care industry has the highest share of foreign-born and foreign-trained workers of any industry, according to Vox.  Recent data from the Migration Policy Institute (MPI) showed 30% of active physicians and surgeons are immigrants. Other research has shown that, as of 2015, 20% of health care support staff—such as nurses—were immigrants.

    Further, some of the countries included in the ban are among the leading contributors of foreign-born and foreign-trained physicians and surgeons, Vox reports. Iran and Syria are the sixth and 10th largest contributors, respectively, according to Jeanne Batalova, a senior policy analyst and demographer at MPI.

    Overall, 5.7% of international medical graduates in 2015 were residents of the seven countries affected by the ban, according to a data analysis by the Robert Graham Center. Stan Kozakowski, director of medical education for the American Academy of Family Physicians, said the number is not huge but is noteworthy, Vox reports.

    In addition, foreign-trained doctors are more likely to practice in areas affected by doctor shortages, Vox reports. And CDC data show they are more likely to treat patients with Medicaid coverage.

    The Association of American Medical Colleges (AAMC) has spoken out against the ban. AAMC President and CEO Darrell Kirch in a statement said, "As we expressed in our amicus briefs challenging the various executive actions over the past year and a half, nationality-based exclusions will worsen the nation's health professions shortage and impair our ability to advance medicine and protect public health"  (Belluz/Frostenson, Vox, 6/26; Finnegan, FierceHealthcare, 6/26; Hurley, Reuters, 6/26; Gerstein/Hesson, Politico, 6/26; Lind, Vox, 6/26).

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