Immigration Enforcement’s Twin Threats to Health Care

Dan Gorenstein (DG): Immigration enforcement. That is posing twin threats to healthcare for immigrants. 

One, patients are afraid to show up to medical appointments

Steph Willding (SW):  We had patients call us and say “I’m not going to seek health care ever again.”

DG: The second threat? It’s to healthcare workers themselves. Doctors, nurses, home health aids are being detained, deported or losing their visa status.

Laura Messineo (LM):   It’s not just in rural America. It’s not just in urban cities we really see it nationwide.

DG: Patients, too afraid to get care, certain workers disappearing…

Today, what happens to people’s health and to the health care system when immigrants become federal targets.

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

*****

DG: One month after President Trump took office, we aired a story about how the administration’s amped up immigration enforcement was impacting the health of immigrants and how clinics and providers were responding.

We talked to CommunityHealth, a clinic serving about 5,000 Latino and Polish uninsured and often undocumented immigrants in Chicago.

CEO Steph Willding told us their patients were scared and many were staying away.

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, like many clinics, tried to reassure their patients.

They did more virtual appointments. They added security, trained staff on how to respond if ICE showed up. 

Steph was hopeful, but unsure, if these steps would make a difference.

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: A year later, Steph says despite their efforts, patients are more scared than ever.

SW: While we did our best to meet our patients where they were at, to get them as much care as we could, ultimately there, there’s a limitation to that. 

DG: There’s been a 17% increase in people not showing up to their appointments. That’s hundreds of people skipping check-ups, vaccines and follow-ups.

Most of their appointments are now done via telehealth, which has jumped 733% compared to a year ago.

And Steph says this applies to all of their immigrant patients, regardless of their legal status.

SW:  We’ve seen immigration enforcement is being pretty non-discriminate in terms of whether you have paperwork or not.

DG: The Supreme Court has given ICE the green light to stop and question people just based on their physical appearance and language. 

Steph remembers last October during a major ICE surge in Chicago when a city official got detained at a hospital.

She could hear the helicopters and sirens because it was just down the block from the clinic.

SW: I’m picking up the phone, calling my operations person and saying, we have to lock the doors. We have to lock them right now, because we just didn’t know what else was gonna happen.

DG: The idea of ICE coming into a hospital or clinic used to unthinkable. There was actually a federal rule against it.

But Trump rescinded that rule, moving the front line of the immigration fight inside clinics like CommunityHealth.

SW:  In the month of October alone, nearly every day one of our locations had to go into lockdown, or our staff had to shelter in place due to either ICE activity in the area or ICE clashing with community in the area that made it not safe for them to leave the building.

DG: Steph says they’ve never been inside of one of their clinics, but they’ve had to increase security, trading safety for the sense of welcoming they used to prioritize.

SW:  Now we have to lock our doors? There’s just something that’s not right about it. All we’re trying to do is give healthcare to people.

DG: CommunityHealth is obviously just one clinic in one city.

So we asked Tradeoffs reporter Julie Wernau to talk with other providers and researchers about what we’ve learned after one year of Trump’s increased immigration enforcement policies.

Hi Julie.

Julie Wernau (JW): Hi Dan.

DG: So just to set the stage for everyone, nearly 70,000 people were in immigration detention earlier this month, up from about 40,000 when President Trump took office.

Most have no criminal convictions.

And the administration has sent thousands of ICE agents to major cities including Chicago, Memphis and most recently Minneapolis.

Julie, what do we know about the impact all of this is having on the ability of immigrants to access care?

JW: All across the country, Dan, people are avoiding care.

The New York Times and KFF, the health research group, found that nearly half of undocumented adults they surveyed have skipped out medical care since January 2025 over concerns about their immigration status.

Now, 14% of immigrants with legal status are also not going to the doctor.

Overall, 4 out of 10 immigrants, including naturalized U.S. citizens, say this fear is negatively impacting their health.

DG: Negative impacts, Julie, like what?

JW: Worsening health conditions like diabetes or high blood pressure.

It’s also things like increased stress and anxiety, problems sleeping.

And we know from research that this kind of chronic or “toxic stress” can increase rates of diabetes, heart disease, asthma and cancer.

DG: My guess would be it is too soon to have anything besides survey data about how people’s health is being affected?

JW: That’s right. Researchers told me it will take a while to know exactly how these immigration policies will impact people’s health.

But several also told me that COVID could be a good parallel because so many people avoided care then.

And we saw pretty much every health condition get worse. 

For example, cancer survival rates dropped. Anxiety and depression rose 25% in a year. 

Dan, going into this, I expected there would be a lot of people no longer getting care who needed care.

What I was surprised about was the undocumented people who are getting care and what that looks like.

DG: What are you talking about, Julie?

JW: Well like you said, Dan, there are 70,000 people in ICE detention right now.

Reports of inadequate care in these facilities are rampant and horrific. Measles outbreaks, mistreatment of pregnant women, two nurses to care for 1,500 detainees due to staffing shortages. 

The Department of Homeland Security has vehemently disagreed with these reports.

Their Chief Medical Officer in a press release, said quote, “This is better, more responsive health care than many aliens have ever received in their entire lives.”

I talked with emergency room doctor Hannah Janeway who works at a few hospitals in LA, including one right near a detention facility.

So ICE agents bring detainees in for medical checks.

Hannah Janeway (HJ):  When patients come in ICE custody, a lot of times they’re injured. You know, they’re terrified

They’re brought in usually by officers who  a lot of times are wearing full ski masks

JW: Hannah says doctors are concerned whether patients are getting their meds because the detention facility doesn’t have a contract with a pharmacy.

HJ: I still remember the face of one woman I treated who was pregnant and had a urinary tract infection, and I discharged her back to custody with an antibiotic which I’m now concerned she never got.

JW: These conditions, Dan, make it hard for Hannah and other clinicians to do right by their patients. 

Hannah told me that staff have a moral and legal responsibility here. 

Legal experts told me ICE detainees still have the right to speak with medical providers in private and are supposed to be granted access to inform their family members about their health status.

But Hannah says ICE agents ignore requests to leave the room, so doctors will write on a scrap of paper, “Tell me how to contact a family member,” like when an agent’s back is turned.

HJ:  Whenever I’m standing up to an ice officer, insisting that I talk to the patient in private and they’re physically intimidating me… my heart is beating fast. These are just doctors trying to be doctors and trying to provide the best care for their patients, and I know how difficult that can be.

DG: So, Julie, it sounds like between people avoiding care in the community and immigrants in detention receiving inadequate care. The administration’s immigration policies are having a real negative effect on people’s health. Is that the big takeaway here?

JW: I think that’s one takeaway, for sure, but there’s another one. 

I visited Tuskegee, Alabama during the pandemic. Black men there were told they were being treated for bad blood in the 1930s but in reality they were being allowed to live with syphilis long after there was a treatment.

Nearly 100 years later, the impact of that broken trust still makes people suspicious of public health.

Jordan Herring, a researcher at Stanford who studies health care access for underserved people, said immigrants who’ve seen ICE raids at hospitals, or had their health records shared with the federal government are likely to remember this for years.

JH:   The core of this issue goes to like trust in healthcare providers and trust in public resources. And so that, you know, that’s gonna be difficult to repair.

DG: When we come back, the impact immigration enforcement is having on the health care workforce and what that’s looked like for a group of community health workers in Chicago. 

BREAK

DG: Welcome back. 

In the first half of this episode, we talked at length about the impact all these immigration enforcement actions are having on the health of patients. 

There was this sense that an entire segment of the population is reliving the pandemic.

They’re avoiding health care settings. Virtual visits have risen dramatically. 

Clinics are starting to worry about people with heart conditions and diabetes.

Tradeoffs reporter Julie Wernau is here talking with us about this. So, Julie, now let’s talk about the people who are providing this care. 

The workforce. What’s happening with immigrants who are in health care?

JW: Well, Dan, to put this slice of the workforce into some context, a recent study found nearly 1 in 5 people working in health care are foreign born, including a million who are not U.S. citizens. 

Obviously, the U.S. healthcare system relies on these people. We’re talking about primary care docs, surgeons and dentists…

We both know there are already worker shortages. I mean, there are 193,000 vacant nursing positions.

Stanford researcher Jordan Herring says these immigration crackdowns are exacerbating some of the most acute… 

Jordan Herring (JH): Home healthcare aids, psychiatric aid,, medical assistants. I mean, some places that’s like a fourth, a half, maybe even more than maybe even the majority of those positions are immigrants. 

DG: So what are we talking about here? We’re a year into these immigration enforcement efforts.

Do we have any idea how many foreign-born health care workers have stopped coming to work? 

JW: The truth is – it’s very hard to keep track.

By one tally, President Trump took more than 500 actions on immigration in his first 12 months. 

We’re talking about mass deportations, suspending refugee admissions, travel bans.

A lot of this is getting challenged in court. People are told to leave  – then suddenly the courts say they can stay. It’s totally a moving target. 

Nobody I talked to had specific numbers on people dropping out of the workforce. What is clear is there’s a lot of chaos out there, particularly for people trying to fill open jobs.

LM:  It is literally all hands on deck. 

JW: To get a better handle on this, I called Laura Messineo. 

Laura is the chief nursing officer for Worldwide Health Staff Solutions, a staffing firm for international health care workers. 

She told me even in the best of times hiring immigrant health workers and relocating them can take over two years. 

So when these bans come down, it upends tons of planning. 

She told me this crazy story about this Nigerian nurse that was approved to move to Iowa. 

Then the President added Nigeria to his banned list. They had two days to get her stateside. 

LM: Quickly packing, quickly, getting on a plane. I mean, saying goodbye to everyone, not an ideal situation

JW: Laura got that nurse to Iowa, Dan, but Laura’s struggles are just one example of how these immigration policies are having an impact on the workforce.

For clinicians who serve immigrant communities, the job has gotten harder.

There’s one clinic in Minnesota that captures what I heard. 

Patient no shows there are up 30%, which is pretty demoralizing for the staff. And the people who do come in have some intense trauma.

There are a lot more telehealth visits now so doctors and nurses are stuck on screens for hours at a time.

The burnout is real. 

DG: Julie, talking to the folks in Minnesota, or wherever, what stood out?

JW: People are really scared. I heard from healthcare workers in 10 states. Most were too afraid to speak with their names or use their voices, even anonymously.

That clinic in Minnesota? Workers are walking around with photo copies of their passports because they’re afraid they’ll get stopped by ICE agents.

DG: And that fear, Julie, is another hidden way the workforce is taking a hit? 

JW: Yeah, some people have stopped going to work, or at least stopped going into the office. 

In Chicago, I talked with a woman who supervises four promotoras – community health workers – for the organization Enlace, which is in the neighborhood Little Village. We conducted most of the interview in Spanish.

Sahida Martinez (SM): Hi. My name is Sahida Martinez.

JW: Little Village is a low-income neighborhood. It’s got the highest rate of uninsured residents in the city. 

25% of people here  – one out of every four – are undocumented. 

Before ICE showed up last fall, Sahida and her promotoras would fan out across the largely Mexican-American community to encourage people to take care of their health, like get free check-ups and attend mental health support groups.

She told me that she and her team have spent several months grappling with whether or not to go back to work in person, meaning both at the clinic and just walking around the neighborhood. 

DG: Why did they stop working in person? 

JW: Sahida said she and her coworkers all are immigrants – some documented, some not. Regardless of their status, they’re worried about getting hurt or being deported.

But they’re also worried that, in hiding from ICE, they are invisible for the people they are trying to help.

SM: Teníamos que buscar el equilibrio. Porque también la comunidad también nos necesitaba.

JW: She said their community needs them and they didn’t want to let them down by shutting themselves away.

SM: Levantarnos y que no queríamos escondernos.

DG: So it sounds like they are trying to figure out what to prioritize. Their own personal needs or the needs of their patients. 

JW: I think that’s right. And after talking to Sahida, I really understand why she and her team are so afraid. 

Sahida gave me this great description of her neighborhood. She said it’s usually a place where the bells of street vendor carts jingle, cars cruise by slowly, you’ll hear music as you walk down the sidewalk. 

That all changed last September.

SM: Era un silencio.

JW: She said there was just silence. 

SM: Un silencio que lastimaba.

JW: She described it as a silence that felt like missiles, sent to shut them up.

SM: Como si fuera misiles contra ti y contra tu comunidad. 

JW: With ICE agents all over the neighborhood, Sahida tells me living in Little Village these past few months felt like being in a movie. 

SM: Como una película de ladrones.

JW: Like a heist movie, where she and her neighbors are the villains, being hunted by big men with angry faces.

Sahida: Nos sentíamos así. Que estaban persiguiéndonos a todos.

JW: I also talked to Jadhira Sanchez, Enlace’s community health director. 

She says one day shortly before the New Year, ICE agents arrived at the clinic’s door.

Jadhira Sanchez (JS): It was like seven vehicles all tinted out all officials all scary men and we had staff arriving staff was caught outside in the streets. They tried to check them and pull them out of the vehicles. They started taunting our staff.They tried to open our building doors.

SM: I feel like I was in a time of war. 

DG: That’s Sahida saying it felt like she was living in a time of war? 

JW: It is. ICE ended up leaving before they got inside, but the incident deeply affected Sahida and her staff.

One coworker started to have panic attacks and dreams that ICE agents had taken her. 

She’s a widow with two young kids. 

SM: Lo que más me dolió de esta promotora fue cuando una vez.

JW: Another coworker with three kids kept saying how she’d never forgive herself if her kids got deported because she was responsible for bringing them to the United States. 

SM: Dijo Por qué? Mi hijo era pequeño cuando yo lo traje y mi hijo no tiene por qué pagar mis errores.

DG: Julie given these risks, why did these community health workers think it was so important to be meeting with people in person? 

JW: Honestly, it’s because they all remembered how badly things went during the pandemic.

Sahida told me a lot of people died. And that maybe fewer would have died, she thought, if Sahida and the team could have met with people face-to-face. 

Instead the promotoras were working from home, trying to do these wellness checks on people virtually. 

Basically, Dan, the pandemic taught them they have a lot more impact when they meet in person compared to over a screen. 

And that’s just as true now with the ICE actions as it was during the pandemic.

DG: Did the promotora’s work suffer when they went virtual this past fall?

JW: Yes, because people weren’t reaching out for virtual support. They were afraid that the government might be listening. 

SM: No noise, no nothing, no calls in my, in our telephones. 

JW: Sahida and her coworkers understood they were helping a lot less than they wanted during this moment of profound need. 

DG: Julie, this feels like an impossible choice. I get that they want to do more, but given the stakes for people … potentially breaking up families … what did Sahida and her team do?

JW: She put the question to her coworkers. 

SM: Yo pensé que ellas me iban a decir otra vez que no.

JW: Going into the meeting, she was worried some would want to keep working from home and others would want to come back. 

She was shocked when they all said they wanted to come back. 

SM: Wow. Vamos a regresar.

DG: Why did they want to come back?

JW: For one, they felt like being home alone increased their own fears. 

Being around each other they would feel more supported. More grounded. 

Being in person would feel like they were fulfilling their mission. 

SM:Tengo que hacer mi trabajo. Quiero seguir haciendo mi trabajo. La gente me necesita.

JW: Dan, her coworkers just sat down and started filling out the schedule. 

SM:  Nadie se quejó. Al contrario, ellas mismas empezaron a decir yo voy tal y tal día y yo tal y tal día.

DG: I’m thinking about this small team of health care workers in Chicago, Julie, and wondering what this looks like more broadly. 

Julie, you said that about one in five people who work in healthcare are immigrants. 

If a chunk of people stop coming to work, what’s the spillover to the larger health care system. 

JW: Well, if there are fewer healthcare workers coming in to fill the gaps, it’s going to be a thing.

One study found that when immigration enforcement increased during the Obama administration, a bunch of foreign-born home health aids stopped working and that made it harder for people on Medicare to get long-term care.

So we could be talking about less support for our aging parents and grandparents.

And Laura Messineo who works at the international health care staffing agency … says fewer nurses and doctors will mean longer wait times and less personalized care.

LM: Someone who wants to have a primary care visit with a physician, you may have to wait for a new patient appointment for nine months. That’s today. I think it’s gonna, you know, it’s gonna get worse by threefold.

DG: Sahida and her coworkers have been back outside, working, since…?

JW: January. 

DG: January. What did she tell you about how things have been going?

JW: I actually got a text message from her a few days ago. Let me pull it up.

DG: Okay great. 

JW: She told me people are slowly coming back outside, they’re getting food, they’re returning to their support groups. 

She said, QUOTE “I think the community is tired of being afraid, and “We no longer want to live locked up like during the pandemic.” 

DG: Julie, thanks so much for your reporting on this story. 

JW: Thanks, Dan. 

DW: I’m DG. This is Tradeoffs.