Since arriving in the United States four years ago, Alex has worked at a primary care office. He has witnessed firsthand how difficult it was for immigrants to access preventive care.
When he heard of the implementation of Florida’s Senate Bill 1718, Alex feared it would have dire consequences for the patients he served.
Alex is a pseudonym for one of our research subjects.
SB 1718, signed into law by Gov. Ron DeSantis in May 2023, imposed sweeping restrictions aimed at discouraging unauthorized immigration. Among its provisions, it requires hospitals that accept Medicaid funds to question patients about their immigration status and share data about how many immigrants they are serving within the state.
The law had several more provisions. It mandated E-Verify, a system to check employment eligibility, be used for new hires in businesses employing more than 25 employees. It also criminalized driving into Florida with an unauthorized immigrant, and restricted community organizations from issuing IDs.
After the law passed, Alex told his patients that they could refuse to divulge their legal status when asked on hospital forms. But he says his reassurances didn’t work. He watched as many immigrant patients hesitated to access necessary medical care for themselves and their children – or even left the state.
Alex had legal documentation to be in the country, but as his immigrant community shrank, he wondered if he, too, should leave Florida.
We are a group of social science professors and graduate students studying immigrant communities in Florida. We believe SB 1718 has important implications for immigrants, for Floridians and all Americans – particularly as the country faces surges in outbreaks of communicable diseases like measles and the flu.
An environment of fear
These concerns are based on our survey of 466 immigrants to Florida and adult U.S.-born children of immigrants between May and July of 2024.
Nearly two-thirds of non-U.S. citizens and one-third of U.S. citizens who responded to our survey said they hesitated to seek medical care in the year after SB 1718 passed.
“I was very sick recently and needed medical care, but I was scared,” one survey participant told us.
While hospitals cannot deny care based on a patient’s immigration status, our data shows that anticipating they would be asked deterred not only immigrants lacking permanent legal status but also those with legal status, including U.S. citizens, from seeking care.
We believe U.S. citizens are affected by spillover effects because they are members of mixed-status families.
Our survey took place during the intense 2024 presidential election season when anti-immigrant rhetoric was prevalent. The immigrants we surveyed also reported experiencing discrimination in their everyday lives, and these experiences were also associated with a reluctance to access health care.
Laws like SB 1718 amplify preexisting racial and structural inequities. Structural inequities are systemic barriers within institutions — such as health care and employment — that restrict access to essential resources based on one’s race, legal or economic status.
These kinds of laws discourage immigrants from utilizing health resources. They foster an exclusionary policy environment that heightens fears of enforcement, restricts access to essential services and exacerbates economic and social vulnerabilities. Moreover, restrictive immigration policies exclude people from accessing services based on their race. Immigrants who have been discriminated against in everyday settings may internalize the expectation that seeking care will result in further hostility – or even danger.
Consequences for public health
U.S. history holds numerous examples of racial and ethnic barriers to health care. Examples include segregation-era hospitals turning away Black patients . It also involves systemic restrictions on health care access for non-English speakers, including inadequate language assistance services, reliance on untrained interpreters and lack of culturally competent care.
President Donald Trump’s new executive orders signed in January 2025 threaten to further ostracize certain communities. For example, the order terminating federal diversity, equity and inclusion programs dismantles efforts to address racial disparities in public institutions. New restrictions on federally funded research on race and equity could hinder efforts to study and address these disparities.
Civil rights advocates believe these measures represent a systemic rollback of rights and diversity practices that generations fought to secure and could accelerate a national shift toward exclusion based on race under the guise of immigration enforcement.
Joe Raedle via Getty Images
The results of our survey in Florida may be a warning sign for the rest of the country. Health care hesitancy like we documented could increase the likelihood of delayed treatment, undiagnosed conditions and worsening health disparities among entire communities.
These legal restrictions are likely to increase the spread of communicable diseases and strain health care systems, increasing costs and placing a greater burden on emergency services and public health infrastructure.
