Tools and tips to deepen care amid a wave of anti-immigrant policies

The months since the second Trump administration began have brought an onslaught of unprecedented federal changes to restrict immigration and increase enforcement in the United States. These changes have caused confusion, isolation, and terror—not only for immigrants, but for their friends, families, and communities. And these new policies are making people sick. Literally.

At the same time, proposed cuts to Medicaid, SNAP, and other critical safety-net services have stoked uncertainty for healthcare and social care leaders who now hesitate to invest in the social-needs programs that vulnerable communities need. The result is an exponential blow to the present and future health of communities we serve. And it presents both an urgent need and an opportunity for healthcare institutions to recommit to supporting patients who, now more than ever, are at risk when advocating for themselves.

Recent immigration policy changes include executive orders that suspended or limited entry for people fleeing violence, persecution, and natural disasters. Other orders have encouraged detaining people as much as possible, including while they wait for hearings. In court challenges, some detained or deported immigrants argue they weren’t given due process. And the Trump administration has rescinded previous protections that made sensitive locations like schools and hospitals safe from U.S. Immigration and Customs Enforcement (ICE) arrests.

These policies have serious consequences for the health of patients, communities, and healthcare staff—and for the work of healthcare institutions that serve and employ them. Many immigrants are skipping healthcare appointments for fear they will be detained by ICE at the hospital or clinic, missing critical treatments that may have lasting consequences. Health Affairs reports that “restrictive immigration enforcement leads to worsened health outcomes,” including poorer birth outcomes.

Beyond immigration policy, funding cuts and executive orders that restrict community-based programs reduce services that help meet immigrants’ social needs, increasing the likelihood of illness at a time when people are more scared to get care.

These changes create health risks not only for individuals but entire communities. A Network for Public Health Law fact sheet highlights some of the public health implications. For example, as immigrants become less likely to visit vaccination and testing sites, communicable diseases will increasingly spread.

Healthcare delivery organizations will undoubtedly feel the effects of these federal actions—and also have a critical role to play in mitigating and changing them. Many healthcare delivery organizations are understandably focused on preparing to navigate potential ICE encounters on their property without compromising patient care—the administrative equivalent of treating the patient in front of you. But this policy won’t be the last danger or disruption to health care for immigrant communities. 

The consequences run deep into the complexities of many healthcare practices and services. The prospect of ICE showing up at hospitals poses an obvious threat to immigrant patients and staff. Yet additional, less conspicuous threats also put these communities at risk. For example, 24 states have extended Medicaid coverage to pregnant people regardless of immigration status. Data on their care, which providers are in many cases required to report to state and federal governments, could put immigrants at further risk of being identified and targeted for deportation. The avoidance of care by fearful communities also will likely result in more acute and costly cases and poorer health outcomes.

The new threats could also affect staffing. An estimated 17% of the healthcare workforce was born outside the United States, while 5% are non-citizens. Many more are likely part of families with mixed immigration status. If immigrant workers or their family members are too afraid to come to work, hospitals and clinics may be unable to meet patients’ needs. 

This moment presents an urgent need to safeguard patients and colleagues against health-harming policies. And it also presents an opportunity for healthcare leaders to harness the national attention focused on immigrant care to build investments, policies, and protections to improve care for these communities long-term.

To make a meaningful and lasting impact, healthcare institutions should create a cohesive portfolio of mutually-reinforcing strategies that drive equity-focused improvement for immigrants across multiple levels of influence. Here are some practices to consider.

Programs and Care Level

Addressing health equity for immigrants at a programs and care level means investing in and improving health and social care integration. It also means mitigating and preventing health inequities caused or widened by how organizations deliver care. Healthcare institutions can:

• Double down on programs that meet people where they are. This means increasing the availability of telehealth appointments for patients who don’t feel safe coming to the clinic and investing in more community health workers who have community ties and can go to patients. 
• Offer robust language services. Culturally competent language services empower the patients who use them and help them adhere to medical treatment. Beyond interpreter services during medical appointments, it is also important to translate materials—about health education, outreach, and community supports—into multiple languages and tailor them to specific cultural contexts. 
• Cultivate alternate funding streams that do not ask institutions to report patients’ immigration data. Healthcare institutions can’t predict what specific additional steps might be taken to restrict immigrants’ access to health care or use their healthcare data for ICE enforcement. What they can anticipate is that any obligation to report data on individuals without a legal status poses risks. Historically, healthcare institutions have used grant funding or other sources to provide care for this population and have only collected limited information necessary to the provision of care. 
• Invest in medical-legal partnerships (MLP) to support immigrant patients. MLP lawyers can help patients understand their rights not only about their immigration status, but about how their housing, health insurance, education, and public benefits may be affected by it. In some cases, lawyers can help immigrant patients resolve health-harming legal issues. They are also a resource for healthcare teams questioning how best to support their patients.

System Level

The system level encompasses institutional culture and policies and practices that influence the experience of both patients and staff. To create a more effective, just, equitable, and inclusive institution for immigrants and employees, healthcare institutions can:

• Provide staff from “mixed status” families access to legal support. Patients are not the only ones in healthcare institutions facing stress and anxiety in the new political environment. Providing legal resources to non-citizen employees and those with non-citizen family members is one way to support staff and create a more inclusive institution. 
• Require staff to participate in bias training. Explicit and implicit ethnic and racial bias within the healthcare system are widespread and negatively affect patient-clinician communication, clinical decision making, and institutionalized practices, all of which lead to poorer care and outcomes. With additional executive orders targeting diversity, equity, and inclusion (DEI) initiatives across sectors, it can be a scary time to explicitly draw focus to racial and gender equity initiatives. However, it is especially vital amid anti-immigrant rhetoric to provide education and resources to reduce provider and staff bias that can lead to harmful interactions with or provide poorer care to immigrant patients. It can be helpful to situate some of this training within efforts to strengthen trauma-informed care.

Ecosystem Level

Many different sectors—including government, public health, health care, nonprofit, and legal—contribute to the ecosystem for individual and community health. How well sectors work together advances or hinders health equity for immigrants. To strengthen the ecosystem, healthcare institutions can:

• Support dissemination of accurate information about individuals’ rights. In every community, there are organizers, community-based organizations, and legal aid organizations developing “know your rights” materials to help immigrants navigate changing policies. “Red Cards” are a commonly used tool to inform immigrants of their rights if ICE comes to their home or work. And there are resources that help immigrants make emergency plans. Healthcare institutions can partner with these groups to help disseminate accurate information. This is especially important as there are an increasing number of scams that contact immigrants either posing as ICE or offering false assistance in exchange for payment.
• Capture and elevate the fears and lived experiences of people impacted by immigration policies. The stories healthcare providers and staff hear from immigrant communities are important data points. The more healthcare can track this information and share it with partners—taking care to do so in ways that don’t put patients at additional risk—the better health care can craft a comprehensive narrative that illustrates the harm being done. This will help partners both mitigate harm and better understand how to allocate resources to those affected by harmful policies.
• Convene other health care, public health, and social service organizations to share resources and risks. More than ever, protecting and strengthening the response to social needs and health equity requires better resourced institutions sharing tools with under-resourced institutions. It demands stronger collaborative approaches to governance, community engagement, and data sharing. This is also a vital opportunity to bring organizations with deeper community relationships into conversations with healthcare delivery organizations.

Societal Level

Promoting health equity for immigrants at the societal level is about replacing social policies and structures that cause ongoing harms and supporting policies that promote healing and justice. Healthcare institutions can:

• Advocate for policy change around immigration. Healthcare organizations should leverage their power and privilege to advocate for policies that make their community safer and more welcoming for immigrants and that make it easier and safer for immigrants to access health care. At the same time, it is critically important for healthcare organizations to work with local and national immigrant organizing groups and learn from their perspective on what policies to prioritize and what approach to take.
• Monitor how potential Medicaid cuts could affect immigrant communities. For example, 14 states and Washington D.C. use their own funds to provide Medicaid coverage to children regardless of their immigration status. The current budget bill passed in the House would penalize those states by cutting billions of dollars in federal funds, likely leaving millions of people, including non-immigrants, uninsured. This is another area where healthcare institutions should connect with community groups to coordinate advocacy efforts.