Nearly half of likely undocumented adults in the United States have avoided seeking medical care since January 2025. At that time, the Department of Homeland Security rescinded the Sensitive Locations Policy that for over a decade had kept immigration enforcement out of hospitals, as well as schools and churches. 

Today, 14% of immigrants with legal status are also avoiding the doctor. And 8% of naturalized citizens — people who have passed the civics test and sworn the oath — are skipping appointments.

In some clinics nationally, patient no-shows are up 30%. 

Would-be patients tell the story. 

A woman who was supposed to bring her diabetic mother in for a hemoglobin A1c draw called the San Francisco, California clinic where I am a physician at 8:15 on a Tuesday morning in February to cancel. She did not say her mother was feeling better. She said she had seen a white van parked near the corner of 16th Street, and she did not know what it was, and she did not want to find out. 

Foreign-born workers make up an estimated 20% of the American health care workforce. They are the nurses, the home health aides, the medical assistants who draw the blood and take the vitals.

Her mother’s diabetes is uncontrolled. The consequences of an excessively high A1c — dialysis, blindness, foot ulcers, amputation — unfold over years. 

I told her we could reschedule. 

She said she would call back. She has not called back. 

Another story, this one reported in the Oregon Capital Chronicle. On the morning of January 16, 2026, a Venezuelan couple parked their car in the lot of Adventist Health Center in Gresham, Oregon. Their daughter, Diana, was seven. Diana had been bleeding from her nose since the previous night — not a catastrophic bleed, but persistent enough that her parents decided she needed to be seen. They had an active asylum case. Their court hearing was scheduled for 2028. They had recently been approved for work permits, which were in the mail. 

Three trucks surrounded their vehicle. Federal agents forced the parents out and handcuffed them while they pleaded to see a doctor for their daughter. The family was transported to the South Texas Family Residential Center, 2,000 miles from the hospital parking lot where Diana’s nose was still bleeding. 

She received medical care several days later, after developing a fever. The family was released nearly three weeks later.

And in Minneapolis, JAMA Medical News reported that more than half of a pediatrician’s scheduled clinic visits on January 28, 2026 converted to virtual. Patients told Janna Gewirtz O’Brien: “No, we don’t have enough food. Yes, we know people who’ve been detained. Yes, we’re fearful of coming into the hospital.” 

Detained people with chronic conditions — hypertension, diabetes, epilepsy — lost access to the medications and specialist referrals that had been keeping them alive.

O’Brien’s experience speaks to a larger trend: A survey of 691 health care workers across 30 states found that immigration enforcement is keeping children — including U.S. citizens — from health care services. 

Fear also impacts the people who staff clinics and hospitals. 

Foreign-born workers make up an estimated 20% of the American health care workforce. They are the nurses, the home health aides, the medical assistants who draw the blood and take the vitals. They, too, are afraid — for themselves and for their patients.

A chief nursing officer at a health care staffing firm told Tradeoffs that the immigration climate has made it harder to hire and retain the workers the system needs. “Health care’s going to become more reactive and less resilient,” she said.

Rising Mortality Rate in ICE Detention Facilities

The data from inside detention is worse. In a study I co-authored with colleagues at Johns Hopkins and Stanford, we found that the mortality rate in ICE detention facilities during the first 111 days of fiscal year 2026 reached 88.9 per 100,000 person-years — 18 deaths in less than four months. This approaches the worst year on record, fiscal year 2004, when the rate was 127.7. 

The escalation is steep and recent. Since fiscal year 2023, the rate climbed from 13.0 to 31.8 to 47.5. 

When the state turns the clinic into a site of capture, the community builds its own.

In 2025, the administration terminated the Veterans Affairs claims-processing contract that ICE had used to pay for off-site medical care and prescriptions. The system simply ceased to exist. 

Detained people with chronic conditions — hypertension, diabetes, epilepsy — lost access to the medications and specialist referrals that had been keeping them alive. Cardiovascular disease is the leading specific cause of death in custody, accounting for one in five fatalities. The median age at death is 45.

Medical Mistrust

In 1932, the U.S. Public Health Service enrolled 600 Black men in Macon County, Alabama, in what it called the Tuskegee study of untreated syphilis. The men were told they were receiving free treatment for “bad blood.” 

For 40 years, researchers observed the progression of the disease — the gummas, the aortic aneurysms, the paralysis, the dementia — while withholding penicillin, which became the standard of care in 1947. 

When the Associated Press exposed the study in 1972, the damage extended far beyond the surviving participants. Economists Marcella Alsan and Marianne Wanamaker demonstrated that the disclosure correlated with increases in medical mistrust and mortality among older Black men — effects that persisted for decades and measurably reduced life expectancy.

In June 2025, officials who appeared to be immigration agents showed up at one of St. John’s clinics. The staff’s response, as reported by CalMatters: “We held our ground.”

Similarly, a researcher at Stanford who studies health care access for underserved populations told the health policy outlet Tradeoffs that the current moment — ICE agents in hospitals, Medicaid data shared with immigration officials — “is going to be difficult to repair.”

When the state turns the clinic into a site of capture, the community builds its own. In April 1970, Black Panther Party Chairman Bobby Seale directed all chapters to open health care facilities. They called them People’s Free Medical Clinics. At their peak, there were clinics in 13 cities — staffed by volunteer doctors, nurses, and community health workers who offered basic medical care, preventive screenings and health education to communities that the formal system had abandoned or actively harmed. In 1971, the Panthers launched a national campaign for sickle cell anemia testing, a disease that disproportionately affected Black communities and received almost no federal research funding. 

The clinics were eventually dismantled — by COINTELPRO, by funding shortfalls, by the slow erosion of volunteer labor. The community health center model that now serves more than 32 million Americans traces a line back to those storefront operations in Oakland and Chicago and Seattle.

The parallel institution today is the promotora — the community health worker, often an immigrant herself, who navigates the space between the formal health system and the neighborhood. In Los Angeles, St. John’s Community Health — a network of federally qualified health centers serving at least 25,000 undocumented patients — launched a program in March 2025 called Health Care Without Fear. 

When a segment of the population is too afraid to seek testing or vaccination for communicable diseases, the entire community’s herd immunity is compromised.

The program responded to the fact that hundreds of patients had canceled appointments solely because of enforcement fears. A third of those patients had chronic conditions — diabetes, hypertension — and were forgoing blood sugar tests, blood pressure checks, prescription refills. The consequences of those missed refills are predictable and slow: the retina bleeds, the kidney scars, the nerve dies back from the toes. 

St. John’s response was to send teams of three or four staff members into homes. They draw blood in living rooms. They check blood pressure at kitchen tables. They deliver medications by hand. In June 2025, officials who appeared to be immigration agents showed up at one of St. John’s clinics. The staff’s response, as reported by CalMatters: “We held our ground.”

The Cost of Exclusion

There are those who argue that this system is working exactly as intended — that undocumented immigrants should be denied access to U.S. health care to deter migration and save taxpayer money. But the economics of exclusion tell a different story. When people avoid routine primary care out of fear, their chronic conditions do not disappear; they simply worsen until they become emergencies. 

Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to stabilize anyone who arrives in an emergency department, regardless of immigration status or ability to pay. The result is that the cost of care is not eliminated, but shifted and multiplied. 

Denying care does not protect the health system; it merely ensures that the care delivered is the most expensive, least effective and most desperate kind.

A patient who could have been managed with a $20 monthly supply of metformin instead arrives in diabetic ketoacidosis, requiring a $20,000 ICU stay. These uncompensated care costs are ultimately absorbed by hospitals, passed on to insured patients through higher premiums and subsidized by local taxpayers. 

Furthermore, from a public health perspective, infectious diseases do not check passports. When a segment of the population is too afraid to seek testing or vaccination for communicable diseases, the entire community’s herd immunity is compromised. 

Denying care does not protect the health system; it merely ensures that the care delivered is the most expensive, least effective and most desperate kind.

Back in San Francisco, the woman who called about her mother still has not rescheduled. I do not know her mother’s hemoglobin A1c. I do not know whether the retinopathy has progressed, whether the numbness in her feet has spread, whether the kidneys are holding. 

On the day she called, the white van outside the clinic turned out to belong to a plumber. After idling for a while, it pulled away from the curb. But the waiting room stayed quiet through the morning. By noon, three more patients had not appeared. Their charts remained open on my screen — the labs undrawn, the medications unrefilled, the questions unasked. Harm accumulated in rooms I could not see.