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President & CEO
The American Healthcare Association (AHCA)
July 26, 2005
President and CEO
American Health Care Association (AHCA) &
National Center For Assisted Living (NCAL)
On Behalf of the Essential Worker
Immigration Coalition (EWIC)
Hearing before the
Senate Judiciary Committee
"Comprehensive Immigration Reform"
Tuesday, July 26, 2005
Thank you, Mr. Chairman, and members of the committee. My name is Hal Daub, and it
is an honor and a privilege to testify before you today on the important, timely topic of
comprehensive immigration reform.
I serve as the President and CEO of the American Health Care Association (AHCA) --
the nation's largest association of long term care providers - and my testimony today is
given on behalf of more than 10,000 members that include not-for-profit and proprietary
skilled nursing facilities, assisted living communities, and facilities for the
developmentally disabled. We represent over 1.5 million nursing staff, and
approximately 1.7 million residents and patients.
I am also here today on behalf of the Essential Worker Immigration Coalition (EWIC), a
broad-based coalition of businesses, trade associations, and other organizations from
across the industry spectrum who are concerned with the shortage of both skilled and
lesser skilled ("essential worker") labor. EWIC supports policies that facilitate the
employment of essential workers by U.S. companies and organizations, and supports
reform of U.S. immigration policy to facilitate a sustainable workforce for the American
economy, while still ensuring our national security and prosperity. EWIC was formed in
July of 1999 with principal leadership from the AHCA.
AHCA/NCAL and EWIC thank you, Senator Specter, for bringing the immigration
reform debate to the forefront, during what is obviously a busy time for the Senate
Judiciary Committee - and we thank Senators McCain, Kyl, Cornyn, and Kennedy for
their commitment to resolving this onerous problem in a manner that advances ideas and
solutions in a straightforward, bi-partisan fashion.
We can all agree America is a stronger and better nation because of the hard work, faith,
and entrepreneurial spirit of the millions of immigrants who have arrived on our shores
for hundreds of years.
Every generation of immigrants has reaffirmed the wisdom behind America remaining
open to the talents and dreams of all seeking a better life, for themselves, and for their
children. Every successive generation of arriving immigrants also has assimilated into our
society, and into our diverse workforce. This has, and always will be, a defining strength
The United States values immigration as an ideal, and depends upon immigration to
bolster a rapidly changing and growing workforce. Ultimately, we must support and
promote public policies that improve our immigration laws in a manner that strengthens
the U.S. economy, improves our security, and maintains the historic principles upon
which our nation was built.
Reform must begin by confronting the fact that many of the jobs being created by
America's growing economy are jobs that American citizens simply are not filling - in
fact, these are jobs no one is filling. Our laws, therefore, should allow willing workers to
enter our country and fill this void.
According to the Bureau of Labor Statistics, about 98 percent of projected employment
growth between 2002 and 2012 will be in the service industries. 80 percent of that
growth is in five service sectors: education and health services, professional and business
services, state and local governments, leisure and hospitality services, and retail trade.
The growth in the education and health services sector accounts for 25 percent of total
2002-2012 projected employment growth. Nearly half (40 percent) of the projected
employment growth in education and health services is in ambulatory health care
services, mostly persons who provide health care and other support to the elderly.
Many of the 58 occupations projected by BLS to have faster than average employment
growth between 2002 and 2012 are in service industries and employ essential workers.
These fast-employment growth industries collectively account for 84 percent of the total
projected employment growth. Employment services, healthcare services, food services,
and construction are projected to account for 5.3 million additional jobs, or one-quarter of
the total expected to be added by 2012. Food services, for example, are projected to have
output growth slightly above average (2.4 percent a year versus 2 percent), and
employment growth of 16 percent, boosting the number of jobs from 8.4 in 2002 to 9.7
million in 2012.
BLS expects employment in all occupations to rise by 21 million jobs between 2002 and
2012 - from 144 million to 165 million - an increase of 16 percent. However, because of
changing demographics and retirements/turnover, BLS projects 56 million job openings
during the decade, or an average 2.6 job openings for each net additional job.
America's health care system, in particular, is straining due to a shortage of key
caregivers necessary to care for a rapidly aging population. From the standpoint of long
term care, Mr. Chairman, we are ready, willing, and able to offer tens of thousands of
good-paying jobs that, if filled, will help boost the quality of seniors' care in nursing
homes across America.
The high demand for long term care workers already is documented by the federal
government as well as by AHCA/NCAL. A recent study by the Department of Health
and Human Services (HHS) and U.S. Department of Labor (DoL) estimates that the U.S.
will need between 5.7 million to 6.5 million nurses, nurse aides, home health and
personal care workers by 2050 to care for the 27 million Americans who will require long
term care - up over 100 percent from the 13 million citizens requiring long term care in
In addition, a recent AHCA study examining staff vacancy rates in our nation's nursing
homes found approximately 52,000 Certified Nursing Assistants (CNAs) are needed
immediately - just to meet existing demand for care. While we are cognizant that the
various legislative proposals on the table do not specifically address the need to fill key
frontline caregiving positions, a comprehensive approach to immigration reform is better
than piecemeal, industry-specific efforts which have not worked in the past.
The current temporary and permanent visa programs are insufficient and inadequate to
accommodate U.S. needs. The H-2B program for seasonal workers is narrowly defined
and has a Congressionally mandated cap that is arbitrarily set at 66,000 per year. The H-
2A visa program for agricultural workers contains no numerical cap, but does not respond
quickly enough to the often rapid fluctuations in agricultural labor demand, and is thus
seldom used by employers. The permanent residence program provides approximately
5,000 slots annually for essential workers. Our current immigration system can not
handle our continuing need for foreign-born workers.
Comprehensive immigration reform should be guided by three basic goals.
First, America must always remain in absolute control of its borders and know who lives
within those borders. On this point, there is no debate.
Second, new immigration laws should serve the needs of the U.S. economy. If an
American employer is offering a job that American citizens are not willing or available to
take, we ought to welcome into our country a person who will fill that job - especially a
job that has the capacity to improve the health and well being of our seniors and people
Third, undocumented workers who pay taxes and contribute to our labor needs should be
given a vehicle to earn legal status. Of course, we should not provide unfair rewards to
illegal immigrants in the citizenship process, or disadvantage those who came here
lawfully; but, we must recognize contributions and provide mechanisms for attaining
The path to permanent status, and eventually U.S. citizenship, is especially important to
the our nation's long-term care profession. With a turnover rate for CNAs and personal
care workers in some of our skilled nursing facilities and assisted living residences close
to 100 percent, we find it illogical that an administrator must send his or her most senior,
qualified aide home after just two or three years simply because they were born in a
That key caregiver should be offered the opportunity to extend his/her stay and continue
to contribute to both the U.S. economy, and the care of our frail, elderly, and disabled.
Moreover, it is time for our nation to acknowledge the enormous and growing importance
of undocumented immigrant workers within our borders who, one way or another, are
integrating into the U.S. economy. The Pew Hispanic Center estimates that in 2004 there
were 10.3 million undocumented immigrants in the United States: 5.9 million from
Mexico; 2.5 million from other Latin American countries; 1 million from Asia; 600,000
from Europe and Canada; and 400,000 from Africa and elsewhere.
Incredibly, 86 percent of undocumented immigrants have arrived since 1990 and 30
percent have arrived just since 2000. Over the past decade, the undocumented population
has grown by 700,000 - 750,000 persons per year.
These statistics highlight the broken immigration system created in 1986 after the passage
of the Immigration Reform and Control Act. We have let our immigration system spin
out of control over the past 2 decades. However daunting the statistics regarding the
undocumented in our country may be, we must keep in mind that these overwhelming
numbers represent mothers and fathers, sons and daughters. Many of these
undocumented workers not only want to help themselves and their families, but have the
capacity to help many of our businesses, and to help care for many of our citizens. That
is why AHCA/NCAL with EWIC helped craft the business communities' basic principles
of what comprehensive immigration reform should include:
· Reform should be comprehensive, addressing both future economic needs for
workers and undocumented workers already in the United States.
· Reform should strengthen national security by providing for the screening of
foreign workers and creating a disincentive for illegal immigration.
· Reform should strengthen the rule of law by establishing clear, sensible
immigration laws that are efficiently and vigorously enforced.
· Reform should create an immigration system that functions efficiently for
employers, workers, and government agencies.
· Reform should create a program that allows hard working, tax paying,
undocumented workers to earn legal status.
· Reform should ensure that U.S. workers are not displaced by foreign workers.
· Reform should ensure that all workers enjoy the same labor law protections
We believe these principles dovetail with the President's principles and some of the
proposed legislation that members of this committee are addressing.
AHCA/NCAL and EWIC want this Committee to know that we are delighted and
encouraged by the fact that the President and key legislative leaders from both sides of
the aisle recognize that vast sectors of the American economy have significant, unfilled
labor needs that require attention and action.
This is the beginning of the process, not the end. We look forward to working with the
Committee in a positive, cooperative manner as comprehensive immigration reform
policy is debated, crafted, and, hopefully, passed into law as soon as possible.
Thank you for the opportunity to testify before you today.