Supreme Court Ruling Threatens US Healthcare as TPS Workers Face Expulsion

The U.S. healthcare system, already buckling under severe staffing shortages, faces a deepening crisis after the Supreme Court cleared the way for the Trump administration to terminate Temporary Protected Status (TPS) for approximately 350,000 Haitians and 6,000 Syrians. Experts warn the decision will disproportionately impact nursing homes, long-term care facilities, and home health services, where Haitian TPS holders are heavily concentrated.

In a 6-3 ruling on June 25 in Mullin v. Doe, the Supreme Court’s conservative majority held that the Department of Homeland Security has broad discretion to terminate TPS without judicial review. On July 1, DHS announced that existing Employment Authorization Documents for TPS recipients will expire on July 10, according to NPR.

A Healthcare System Already in Crisis

The ruling comes at a precarious moment for American healthcare. Two-thirds of U.S. hospitals report they have had to close beds due to insufficient staff, and roughly half of nursing homes say they cannot take new admissions because of personnel shortages. An estimated 50,000 noncitizen physicians — about 9% of all U.S. doctors — and 145,000 registered nurses work in the country, according to a 2025 report in JAMA.

Roughly 21,000 Haitian TPS holders are employed in hard-to-fill jobs as nursing assistants and caregivers, according to data from FWD.us. The loss of these workers threatens to create a bottleneck across the entire continuum of care.

“It’s going to be a disaster in the Boston area, where a lot of our nursing home and home care aides are Haitian,” said Steffie Woolhandler, a distinguished professor of health policy at CUNY/Hunter College and Harvard Medical School. “If the United States becomes inhospitable to noncitizens, which I think Trump is doing, we’re going to have a lot of problems staffing our entire healthcare system.”

Sector-Specific Devastation

Massachusetts, home to the third-largest population of Haitians with TPS (19,000), is expected to be hit especially hard. Out of 10,000 Haitian workers in the state’s workforce, roughly 1,500 are employed in nursing care facilities alone, as reported by the Boston Globe. Chris White, CEO of the Marshfield-based disability services provider Road to Responsibility, said he expects to lose 28 employees from the ruling, bringing total job losses during Trump’s immigration crackdown to 130 — more than one-eighth of his workforce.

“It’s not like these folks were taking jobs that Americans would be doing,” White told the Globe. “The reality is we don’t have enough people to do the work.”

Katie Smith Sloan, president and CEO of LeadingAge, which represents more than 5,300 aging service providers nationwide, called the ruling a direct threat to care for older adults. “It puts older adults and the providers who care for them in an untenable position,” Sloan said in a statement. “Staff and caregivers who support older adults every day — legal employees who in some of our communities represent 8% or more of the entire workforce — can now lose their jobs overnight.”

Economic and Human Toll

Haitian TPS holders contribute nearly $6 billion to the U.S. economy each year and pay over $1.5 billion in taxes, according to FWD.us. Approximately 200,000 work in industries facing labor shortages, including healthcare, agriculture, and manufacturing. Todd Schulte, president of FWD.us, described the ruling as a “heartbreaking, terrible decision that defies common sense,” as reported by Common Dreams.

“Hundreds of thousands of people who hold legal status, who registered with the government, passed background checks, and paid fees to do so, now face losing their ability to work and being torn from their families and homes,” Schulte said.

An estimated 25,000 U.S. citizen children of Haitian TPS holders will be pushed into poverty when their parents lose work authorization.

Community Devastation

In Springfield, Ohio, where one in four residents is of Haitian descent, panic set in hours after the ruling. Viles Dorsainvil, co-founder and executive director of the Haitian Support Center, told NPR that dozens of TPS holders called seeking advice. “They’re wondering if they can still keep their assets or money at the bank, if they can still go to work because TPS came with the work permit, and with the driver’s license privilege,” he said. “The community is devastated.”

In New York, which is home to an estimated 40,000 Haitian TPS holders, Gov. Kathy Hochul warned the ruling would “cripple” the state’s healthcare system. About 25,000 TPS holders are in the state’s workforce, contributing an estimated $800 million annually to the economy, as reported by Truthdig.

Sandra Britto, a patient care technician at New York-Presbyterian Hospital and member of the 1199SEIU healthcare union, condemned the decision. “This ruling is going to create terrible suffering to my Haitian people, who are only here striving to do better,” she said. “We are not criminals. We are law-abiding human beings.”

Legal and Political Ramifications

Justice Elena Kagan, in her dissenting opinion, noted that the stripping of status for Haitians was likely based in part on “racial animus,” citing Trump’s statements about Haitians that were “so repellent and racially inflected that the majority declines to put them in print.” Justice Samuel Alito, writing for the majority, acknowledged Trump’s comments “would have scandalized the public just a short time ago” but said none were “overtly racial.”

The ruling may set a precedent allowing the administration to terminate TPS for other countries without court oversight. Approximately 605,000 Venezuelans are expected to lose TPS later in 2026, and the administration has also revoked humanitarian parole for Cubans, Haitians, Nicaraguans, and Venezuelans.

In a rare bipartisan move, the House passed an extension of TPS for Haitians until 2029 in April. The Senate has not taken up the measure. Even Rep. Mike Lawler (R-NY), a strong Trump supporter, said he “strongly disagree[d] with ending Haitian TPS at this time,” noting that roughly one-third of Haitian TPS holders work in the healthcare system.

What Comes Next

With work authorizations set to expire on July 10, TPS holders face an immediate crisis. Advocacy groups are urging Congress to pass the American Dream and Promise Act, which would create pathways to permanent legal status. Meanwhile, states like New York and Massachusetts are exploring state-level protections, though the scope of such efforts remains limited.

Woolhandler summed up the stakes bluntly: “The thing that has to be said is that the healthcare of everybody is going to be compromised by this.”