The chilling effect of ICE in hospitals
00:00NPR.This is The Indicated from Planet Money.I'm Adrian Ma.And I'm Waylon Wong.Adrian, do you watch the show The Pits, you know, the medical drama?It's on HBO Max about an emergency room.Do I? I love the PIT.You really?
00:17I'd love to be stressed out.It's very compelling.Well, you probably remember then this episode from March where a couple of ICE agents comeinto the ER with a woman they've detained in a raid.And their presence of the hospital spooks the patients and thestaff, and then the attending physician, played by Noah Wiley, gets really upset about the disruption.I'm already short staffed, and I just lost five nurses and half my environmental services teambecause you walked in. You know, patients come in here for help, right? Because they're either sick
00:48or they're injured and documented or undocumented. They have a right to emergency care.Dr. Robbie. I know. Always care so much. He's under so much pressure all the time. And this episode,it was a real, you know, ripped from the headlines moment because under the second Trump administration,Immigration agents can more easily access so-called sensitive areas, including hospitals.And heightened enforcement has chilled communities across the U.S.A lot of people are missing school, work, and doctor's appointments.So today on the show, we'll look at how both patients and health care workers are bearing the physical and economic costs of the administration's deportation campaigns.Members of the National Nurses United Organization have been protesting ICE and the administration's immigration policy,
01:39across the country.The most recent demonstration was in San Francisco,around 1,000 nurses marched to an ice field office.One of the protesters of the demonstration in San Francisco was Kelly Brennan.She traveled from Portland, Maine, where she works as a neuroscience nurse at Maine Medical Center.Having that many nurses and, you know, sitting down in the streetin front of the detention facilityand really making our voices heard
02:12that's amazing to be a part ofand it fills my cup.Kelly is the co-president of the Nurses Union in Maine.It's an affiliate of National Nurses United.In January, ICE launched an operation in Mainecalled Catch of the Day.I said it was targeting people in the state illegallywho had been charged and convicted with, quote, horrific crimes.
02:32Although later analysis by local news outletsshowed that the vast majority of those targeted had no criminal convictions or pending charges.Kelly said the operation had a chilling effect at her hospital.Staffers and departments like housekeeping and transport services called out of work becausethey were afraid to come in.The void they were leaving directly impacted all of patient care.OARs couldn't be prepped or sterilized timely.Patients were getting delayed, being transported to procedures like x-rays and MRIs.
03:04You know, there was a day where I had to teach an office person how to push a stretcher.That was on the staffing side.Patients also stayed home.Kelly said there was an uptick in missed appointments.Some mothers with high-risk pregnancies avoided prenatal care.And when people delay coming to the hospital, right, that doesn't stop the diseases from continuing to happen.So they're delaying coming in.And by the time they got there, they were sicker than they needed to be.
03:30One recent study in the Journal of the American Medical Association shows that in Los Angeles County,ER visits by foreign-born patients dropped by more than 20 percent in the weeks after enforcement ramped up in June 2025.At the same time, there was an increase in admitting the foreign-born patients that did show up.According to the study, these numbers likely signal that patients delayed care until their conditions were more severe.And it's more costly to treat these patients in the emergency room than if they had seen a doctor.doctor earlier. William Lopez is a professor at the University of Michigan School of PublicHealth. We know in public health and we know in economics that the emergency room is the leastefficient way to treat any kind of illness, because by that point, it's usually escalated to
04:16something fairly catastrophic. William studies how deportation impacts the health of both immigrantcommunities and the ones where people have different legal statuses, like a household where theparents are not citizens, but their children are. He says both on diabetes. He says, both undiagnation.documented and documented people use less health care when there's a fear of immigration enforcement.Those with a skin color that is able to be racially profiled, often Latino immigrants are changing their behaviors to avoid being racially profiled, detained, and deported.And there's just this feeling of fear. There's a spreading of rumor.There's text messages and WhatsApp threads kind of blowing up that leads to a slow shift in behavior.And you will be able to see it.
04:56Researchers have looked at what happened with public health during previous spikes in immigration.enforcement. One study tracked birth outcomes before and after a federal immigration rate in Iowa back in 2008.After the raid, infants born to Latina mothers had a 24% greater risk of low birth weight.These are infants who are ineligible to be deported. Nonetheless, we see the impacts of immigrationenforcement on their bodies prior to birth. And we know that low birth weight is very influential measureof how likely you are to be healthy and have health challenges in that first year of life.One study from the University of Michigan links low birth weight with higher dropout rates in high school,as well as fewer working hours and lower hourly wages at older ages.
05:42Health challenges can add up for children in other ways, too.For example, William says undocumented parents may not apply for SNAP food benefits for their children,even when their kids are U.S.-born citizens and eligible for that assistance.This means that these children may not be getting adequate nutrition.And if they're also staying home from school out of fear, they're not getting school breakfast or lunch either.Another study showed that after Trump was elected to office the first time, there was a decrease in routine checkups for the children of immigrant mothers, compared with the children of U.S.-born mothers.The calculation in many people's minds is that it's healthier to avoid preventative care than it is to risk deportation.The studies we mentioned are some examples of how immigration enforcement or fear of getting deported can affect the health of patients.
06:31And there are also consequences for health care workers.In Maine, where Nurse Kelly Brennan works, ICE detained another nurse from Kelly's hospital over the summer.The Department of Homeland Security told a local news station that the nurse's visa had expired.However, the hospital said it believes she was living and working legally.Kelly's coworker was released after a week and is back at work.when we got her release and the happy tears we cried.And it was like, gosh, when was the last time we cried happy tears?Like, this has just been such a hard year.
07:02We asked the Department of Homeland Security for a response to concerns that heightened immigration enforcementwas leading to staffing issues and negative effects on public health.We received an email back from the press office.It did not address these concerns specifically.Instead, the email said, quote,the assertion that the only way we can support the health care industry is by allowingunvetted illegal aliens to remain in the country is grossly false and lazy.DHS also said that ICE does not target health care facilities. However, the Trump administration
07:32did rescind a Biden-era policy that protected so-called sensitive areas, like hospitals and placesof worship, from the vast majority of immigration enforcement. Without that Biden-era policy,immigration officers can now be in lobbies or waiting rooms without a warrant, although notpatient rooms. Kelly said her hospital designated the parking garage as a patient care area as well.The intent was to make the garage as off limits as an exam room if an officer didn't have a warrant.We wanted to stay ahead of it. We wanted to make sure that our hospital had policies in place thatwould protect our patients and protect us. William Lopez, the public health expert, he says there's abureaucratic and administrative cost for hospitals to respond to the ramped up immigration enforcement.
08:18And that's just part of the picture when it comes to resources that are potentially being diverted away from patient care.You can't do public health work without thinking of the economic costs of health, right?What choices are presented to us?When are we able to access care?What's preventing us from accessing that care?There's also a big question of the money that we spend on immigration enforcement could be spent on health care, right?What do we as a country wish we could do with this money if we weren't spending it on deportation?There's the economic cost and there's the human cost.
08:51And in both cases, patients and providers could be paying for years to come.This episode was produced by Scholar Swenson and Elem Mustafa.It was engineered by Travis Hagan and fact-checked by Sierra Juarez.Kicking Cannon is our show's editor and The Indicator is a production of NPR.
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