Getting Health Care to Undocumented Immigrants in Trump’s America

Immigration enforcement continues to be a top priority for the Trump administration.

Some 60,000 people were being held in immigration detention earlier this month … up from 40,000 when the President took office.

Most people arrested have no criminal convictions.

This week … we’re revisiting an episode from February about how this crackdown is keeping some away from health care.

Stay tuned for an update at the end of the show.

DG: She told herself she wasn’t going to let her kids lose this moment because of her fear.

Maria remains afraid of the sea, and of stepping out into Trump’s America. She feels the fear, feels its impact on her health. But, like that day on the beach, she’s wading in, so that her kids can get the care they need, regardless of who’s president.

Dan Gorenstein (DG): The last thing Maria wants to do these days is leave the house. Rumor has it ICE is around, on the look-out for undocumented immigrants like her.

Maria: El pasar por un proceso de deportación es como una de las cosas más humillantes y más dolorosas que he vivido.

DG: The 47-year-old, who works as a cleaning lady, was deported in 2017. She spent five years back in Mexico separated from her four kids, who today are 15, 16, 23 and 27. She missed out. They missed out.

On the big things, like caring for her oldest when that daughter had surgery to remove a tumor. On little things, like dental checkups. When she came back to the States, Maria says, her kids were different.

Maria: Esos niños que viajaron y disfrutaron del mar y se reían a carcajadas.

DG: She says her kids were travelers. They loved to laugh and play. Now, it’s like they’ve been replaced by other kids. Kids who are quiet…

Maria: Niños callados

DG: Withdrawn.

Maria: Retraídos.

DG: Afraid.

Maria: Temerosos.

DG: That’s why she forces herself to leave the house: her kids. Maria desperately wants for them what’s best. Three weeks ago, she and one of her daughters Uber’d to the dentist knowing the risk she faced.

Maria: Me daría miedo que me arrestaran delante de ella y ella viera todo.

DG: Maria was terrified of being arrested in front of her daughter. She says lots of Latino families go to this dentist — the possibility of ICE showing up felt very real.

Maria: …extremadamente doloroso que mis hijos vieran algo así

DG: The waiting room, normally filled with people, was mostly empty. Maria’s anxiety grew as the dentist treated her daughter. Seeing her daughter finally come out, she breathed a sigh of relief. Until they walked out the door.

Maria: Estaban ahí afuera dos carros encubiertos.

DG: Still in the parking lot, Maria saw what looked like two undercover cop cars.

Maria: Pues en cuantito los vi agarré a mi hija y nos regresamos otra vez al edificio.

DG: She grabbed her daughter’s hand and pulled her back inside.

Maria: Me dijo Mamá, qué pasa si te llevan? Qué voy a hacer yo aquí sola?

DG: Terrified, Maria’s daughter asked her, “What happens if they take you? What am I going to do alone?” Maria told her…

Maria: No pienses eso, vamos a estar bien.

DG: “No, don’t think about that. We’re going to be fine.” But Maria saw the fear on her daughter’s face. Maria started to feel like she couldn’t breathe.  

Maria: Es demasiado doloroso ver que la mirada de tus hijos refleje eso. 

DG: Maria tried to stay calm for her daughter’s sake, but she was terrified.

The fear that Maria and her family are feeling has permeated many immigrant communities since President Trump took office.

Clip: President Trump’s crackdown on undocumented immigrants continues as ICE carries out raids in major cities across the country.

DG: Trump says he wants to deport all undocumented immigrants in the U.S, an estimated 11 million people. He’s revoked temporary legal status for some new arrivals.

Clip: ICE is actually telling its agents that they can put people on the fast-track for deportation.

DG: Rolled back limits on where immigration officials can make arrests.

Clip: The White House says it is allowing ICE agents to enter hospitals, churches and schools…

DG: And he’s directed federal officials to detain up to 30,000 undocumented immigrants at Guantanamo Bay.

Clip: Because we don’t want them coming back, so we’re sending them out to Guantanamo.

DG: This shock and awe campaign has stoked fear among millions of undocumented immigrants, as well as their families, friends and neighbors. Experts say that fear will keep people from going to the doctor, and that it could harm their health.

Samantha Artiga (SA): Constant stress which arises from fear, not only has mental health impacts but takes a toll on the body, physically.

DG: Today, how one clinic in Chicago hopes to cut through their undocumented patients’ panic, and how worrying about deportation can literally make people sick.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.

*****

DG: When Steph Willding walked into her waiting room two days after President Trump’s inauguration, her heart sank.

Steph Willding (SW): it was silent, and there was no one in any of the chairs.

DG: Steph is the CEO of CommunityHealth, a free clinic serving more than 4,000 mostly Latino and Polish uninsured immigrants in Chicago. Usually the place is packed, full of people for routine check ups, picking up medications, getting blood work. But not that day. And Steph knew why.

SW: If people go and leave their house to see a doctor, their entire lives could be uprooted, their families destroyed.

DG: In the first two weeks after Trump’s inauguration, Steph says CommunityHealth saw a 10% spike in no-shows and cancellations. In the days after Trump’s border czar joined ICE agents in Chicago to go on highly publicized raids, people picking up prescriptions dropped by 40%.

Nurse practitioner Emily Hendel has seen patients at CommunityHealth for more than two decades. She says even some of the most reliable patients have been staying away. She thinks in particular of a man in his 40’s, who’s Hispanic. 

Emily Hendel (EH): He’s somebody who is really committed to staying on top of his high blood pressure. And it was just really surprising to see him not show up for his visit today.

DG: Emily knows some patients can afford to skip an appointment or two. Others with chronic conditions like this man with his high blood pressure and cholesterol are taking a risk. 

This particular patient was supposed to come in and get a refill on his meds. Emily worries about what could happen if he goes too long without those.

EH: It increases your risk of having a heart attack or stroke, kidney damage. So there are there are a number of consequences to be concerned about.

DG: A few days later, Emily heard from the man. He said car trouble had kept him away, that he’d be in soon.

The empty exam rooms and hollowed out waiting room these last few weeks have left CEO Steph Willding feeling uneasy. 

SW: We provide care to folks who often cannot get care anywhere else. And we are an island of safety for our communities. But in that moment, it felt like it still isn’t enough.

DG: CommunityHealth has started to think of ways to make their clinic feel safe enough for more people to get what they need. They’ve come up with two big ideas.

First, bring care directly to people’s homes.

SW: We have sent out proactive text messages to our patients, giving them the option to select telehealth, either a phone or a video visit.

DG: Steph says telehealth appointments have doubled since the inauguration. CommunityHealth is reminding patients that someone else can pick up their prescriptions, and they’re looking at ways like using Uber Health to bring people to the clinic. 

SW: So we’re going to continue to try to meet our patients closer to where they feel safe. We’re limiting the amount of time they have to be out of the house.

DG: The second big idea: fortify the clinic. Steph has stationed staff at the front door to restrict access. The team has papered the clinic with signage that this is a private facility, which means ICE needs a warrant signed by a judge to enter.

CommunityHealth has also trained staff what to do if ICE shows up. Finally, they’ve rearranged the waiting room furniture so patient chairs are concealed from the outside.

SW: To ensure that our patients know that when they do come on site, it is safe to be here.

DG: Steph says it kinda feels like she’s back in the early days of COVID: empty waiting rooms, big operation changes, trying to convince people that it’s safe to get care. But as the President’s initial “flash bang” of his campaign wears off, Steph has seen the waiting room fill back up, and a few folks who skipped their appointments a few weeks ago are returning.

SW: If you want to meet the moment, doing things in new and different ways is going to be how we can best serve the community.

DG: Steph says it’s too soon to know how well their creative strategies are working. But if they end up falling short, she says they’ll just try something else. 

When we come back, we zoom out to hear how other providers are trying to meet this moment, and what research shows about how increased fears over deportation can harm people’s health.

Midroll

DG: Welcome back.

The Trump administration came into office with a clear mission: deport every undocumented immigrant in the U.S. ICE arrests appear to be up, though experts caution that data from the administration may not be fully reliable. Regardless of the exact numbers, many advocates and immigrants say the fear they feel right now is unprecedented. And that has health care experts worried.

Tradeoffs producer Ryan Levi has been talking with researchers and providers who work with immigrant communities. Hey, Ryan.

RL: Hey, Dan.

DG: So before the break, we heard from a clinic in Chicago that is seeing many of their immigrant patients avoiding care, and the steps the clinic is taking to make it as safe as possible to return. How are the providers you’ve talked to trying to handle this moment?  

RL: I talked with 10 providers from across the country, Dan, but only the folks in Chicago were willing to talk with me on the record. The rest told me they were afraid of being targeted if they talked about their work with undocumented people given this administration’s willingness to attack projects they disagree with and pull funding. 

DG: Yeah, I saw on social media Elon Musk saying he wanted to shut down federal health funding for religious groups that work with immigrants. Whether he could actually do that, of course, is a different question, but it’s that type of rhetoric that’s got people spooked.

RL: Absolutely. And you talked about this at the top of the show, Dan, but the move that seems to have shaken folks the most is Trump reversing this long-standing policy that kept “sensitive locations” like schools, churches and health care facilities off-limits from immigration officials. 

Now, ICE agents still need a warrant signed by a judge to enter private property. But giving ICE the greenlight to enter these sensitive locations feels like a direct attack on a lot of the providers I talked to. One doctor told me there’s a “pervasive fear,” she said, at her clinic “that ICE is going to walk in any minute.”

DG: So, Ryan, given all that fear, are the folks who were reluctant to talk on-the-record also backing away from providing care? 

RL: Some providers are being cautious, Dan. New York City’s public hospitals and the large private system NYU Langone reportedly told staff not to take any “affirmative steps” to shield someone from ICE.

But those same hospitals, as well as hospitals from California to Texas to Minnesota to Massachusetts, they’re all telling patients and the press that they still treat everyone, regardless of immigration status.

DG: And what does that look like, treating everyone? Are they taking those same “affirmative steps” like Chicago?

RL: Many of the folks I talked to are being more proactive, Dan. They’re offering telehealth, they’re reminding staff not to share patient data, passing out “know your rights” cards, and generally reassuring patients they’ll do what they can to protect people within their four walls.

One person I talked to compared this moment to being a lighthouse: They want to be bright enough so their patients know they can come to them and trust them, but not so bright that they attract unwanted attention from the feds.

DG: And different providers are going to strike that “brightness balance” differently of course.

RL: That’s right.

DG: And did the folks you talk to say they’re seeing a spike in no-shows and cancellations like in Chicago?

RL: A couple said they’d seen a small uptick in no shows and cancellations, but they couldn’t say for sure that it was tied to Trump’s immigration efforts. Or even if the people cancelling were necessarily undocumented because the clinics don’t ask for that info. 

DG: OK, so, let’s just take stock here. As you’ve said, there’s a lot of fear. Providers – some – are seeing this uptick in cancellations or no-shows, and some of the folks that you’ve talked to are trying to be proactive on things like telehealth as a way to deliver care. 

So moving away from anecdotes, let’s focus on data, if there is any. We know President Trump was aggressive during his first term on immigration also.  Ryan, is there any evidence that undocumented folks avoided going to the doctor the last time he was President?

RL: So, I talked to Samantha Artiga about this. Samantha is the director of racial equity and health policy at the nonpartisan health policy research shop KFF.

She said concrete numbers are hard to come by on this. I did come across one study out of Baltimore that found a 34% drop in primary care visits among undocumented adults during Trump 1 and a 43% drop among kids.  And those findings are in-line with a handful of other studies as well as what Samantha heard in interviews she did back during Trump 1 with immigrant families, pediatricians and clinics.

SA: We heard families just overall were so fearful that many were trying to stay inside the home as much as possible and avoid going out, because of the fears and just really trying to minimize any risks.

DG: I mean, depending on those patients, right, a 34 percent drop could be somewhat significant. Is there any fallout from that? Were there any negative health impacts from people avoiding care during Trump 1? Do we know anything there?

RL: I didn’t find any data specifically looking at what happened to undocumented folks’ health if they skipped care during the first Trump administration. What we do know, though, comes from COVID, when obviously a lot of people, Dan, delayed or skipped care.

We saw millions of people miss recommended breast, cervical and prostate cancer screenings in 2021, according to one study. And another study suggested 160,000 people who had cancer during the first year of the pandemic may not have known because they skipped care.

Several providers I talked to said one of the biggest physical health threats they’re worried about for undocumented immigrants is missed cancer screenings if they stay away too long.

DG: Final thing here, Ryan. Based on the reporting I’ve done over the years, I’ve learned that when people are stressed — constantly stressed — their levels of cortisol go up. And that can have profound physiological effects on people. Given all of this fear that you’ve been reporting on, did you talk with anybody about how that might be harming people’s health right now?

RL: I did. So there’s a large body of research showing fear of deportation worsens people’s mental health. We’re talking increases in anxiety, depression, post-traumatic stress disorder. Then, as you’re alluding to, there are also health effects of what’s known as “toxic stress,” which is basically continuous, uncontrollable stress.

DG: Like you might feel if you were worried that your mom could be deported at any time.

RL: Exactly. Samantha Artiga told me that there’s a long list of ways that toxic stress makes people, especially kids, sick.

SA: Increased risk and frequency of infections in children due to high levels of stress suppressing the body’s immune system.

RL: Literal damage in the brain that can make it harder for kids to learn, store memories, and deal with new stresses later in life.

SA: It can also increase rates of physical conditions like diabetes, heart disease, asthma and cancer.

RL: The American Academy of Pediatrics put out a statement right after Trump’s inauguration, Dan, citing this research, and warning that the administration’s action would be harmful to kids’ health. Because, remember, while these deportation policies are aimed at undocumented immigrants, many of them have kids, kids who are U.S. citizens.

SA: Many of these children are U.S.-born children, and they are worrying about whether or not their parents are going to be there when they get home from school that day.

RL: If there’s one thing everyone I talked to agreed on, Dan, it’s that they’re terrified of the impact this moment is going to have on millions of kids. And that’s why they’re committed to helping people feel safe enough to get care.

DG: Tradeoffs producer Ryan Levi, thanks so much for your reporting.

RL: You’re welcome, Dan.

DG: This brings us back to Maria, who we heard from at the top of the show. She and her daughter made it home from the dentist that day. But Maria worries constantly about her kids. She says their health took a hit when she was deported.

Maria: Es triste que tus cuatro hijos expresen que se quieren morir. 

DG: Maria says her kids have told her they want to die. Sometimes they tell her that they’re afraid of getting used to her being around because she might get deported again and leave them alone.

Maria: Que me vuelva a ir y se vuelvan a quedar solos.

DG: Right now, Maria is doing the best she can to protect her kids’ health. Everyone in the family has a therapist. And, she says, she’s going to keep taking them to medical appointments.

Maria: No puedo estar cancelando las citas de mis hijos por un lapso de cuatro años. 

DG: She refuses to stop their lives for the next four years.

Maria says in hard moments these last few weeks, she’s thought about when her kids came to visit her in Mexico after she’d been deported. They asked her if they could swim out in the sea, all together. Maria, terrified of open water, wanted to tell them no. But she said yes. 

Maria: Yo dije que no voy a dejar que mis hijos pierdan este momento de su vida por mi miedo. 

DG: She told herself she wasn’t going to let her kids lose this moment because of her fear.

Maria remains afraid of the sea, and of stepping out into Trump’s America. She feels the fear, feels its impact on her health. But, like that day on the beach, she’s wading in, so that her kids can get the care they need, regardless of who’s president.

UPDATE:

Since this episode first aired … the so-called ‘Big Beautiful Bill’ passed by Congress in July makes it harder for immigrants to qualify for Medicaid, Medicare and Obamacare.

And a new Trump administrative rule could soon block undocumented people from accessing federally-funded health services, including community health centers.

As for Maria … her kids are still making it to their appointments. 

She, herself, experienced two weeks of pain and bleeding earlier this summer before going to the ER.

She agreed to get surgery after doctors said she may have cervical cancer. 

As far as her fear goes … Maria says she’s constantly looking for unmarked cars and finds it hard to sleep.

I’m Dan Gorenstein, this is Tradeoffs.