The current climate surrounding immigration enforcement and deportation has created widespread fear that, according to health care providers, is directly reducing health care utilization. This avoidance extends beyond those that are undocumented to visa-holding immigrants, mixed-status families, and even U.S. citizens. Telehealth has emerged as a vital tool for maintaining access to care while minimizing perceived risks of immigration enforcement encounters, reflecting both patient preference and provider adaptation. However, telehealth has limitations: many health conditions require in-person care, not just as a preference but as a necessity, which restricts the extent to which telehealth can be relied upon as a meaningful mitigation tool.
Providers report that fear is already contributing to negative health outcomes among individuals of a broad range of immigration status, including delayed care, missed preventive services, and treatment interruptions. Many note that patients are arriving sicker, with some anticipating more advanced disease presentations, such as late-stage cancers. Children in mixed-status families are especially vulnerable, with parents in some cases refusing essential services like post-surgical rehabilitation due to immigration-related concerns, indicating a broader, long-term public health impact that extends beyond individual patients.
At the institutional level, responses to immigration enforcement pressures vary widely. While some health care systems have implemented clear protocols and staff training, others offer little guidance or have removed patient-facing materials altogether. This moment presents an opportunity for institutions to lead with clarity by establishing standardized best practices that protect both patients and providers, and by reinforcing the health system’s role as a trusted space for all.
Many health care workers described experiencing situations consistent with “dual loyalty,” whereby they navigate conflicting demands between their professional obligations and institutional or perceived legal constraints. In the absence of consistent institutional support and to respond to their dilemma, some health care providers have developed informal strategies to protect their patients, including modifying documentation practices, adjusting referral patterns, and expanding telehealth services – efforts that highlight both the resilience of providers and the pressing need for systemic solutions.
Are you a health care professional based in the United States? If so, you have unique insights into how federal policy changes, including President Trump’s Executive Orders (EOs), initiated on or after January 20th, 2025, affect both health care access and delivery.
This confidential survey, which takes no more than 15 minutes to complete, seeks to understand how Trump-era policies have directly or indirectly affected your patients who are undocumented or have insecure immigration status, as well as the ethical and institutional challenges faced by healthcare providers. Findings from this research will inform policy recommendations to safeguard healthcare access and ethical medical practice for all.