In the next installment of the Health Equity Series, Eva Clark, MD, PhD, CTropMed, reflects on the health care dilemmas that many U.S. immigrants are facing, what these experiences reveal and how to address this crisis.
Fear. It’s palpable — I can feel it even through the telephone intermediary of the Dari interpreter’s flat, impersonal voice. My patient is explaining that his health care coverage ended. Because he was resettled in Texas — a state that excludes lawfully present adult male immigrants from Medicaid — his refugee medical assistance stopped after 12 months. (1-3) Even Catholic Charities has exhausted its resources for him. (4)
My patient’s symptoms of chest pain and shortness of breath were recently found to be caused by a pulmonary embolism, a consequence of a large echinococcal cyst complex. We have been discussing his urgent need for surgery. I emphasize that he is fortunate to live near the Texas Medical Center, one of the world’s largest medical campuses. But he has just endured a frustrating and expensive hospital stay and is not eager to repeat the experience. He insists that he feels better and prefers outpatient management … but he cannot afford the fee that my safety-net health system will charge for his infectious diseases appointment.
“Do you understand?” I ask desperately. One or more cysts could rupture at any time — and this could be devastating.
I listen to a pregnant silence as he weighs his response. He feels fine. He needs time to look for work — he was a plumber in Kabul but has been unable to find a job here. His daughter has congenital heart disease and is hospitalized. He just can’t. He hangs up.
A nation of immigrants
An estimated 97% of the U.S. population are immigrants or their descendants, primarily European, Mexican and African diaspora. (5, 6) Some have lived here for a few weeks; others for decades. Those who are not immigrants or related to recent immigrants often “look” like immigrants — in Houston you’ll hear people say, “My family has lived in Texas since Texas was Mexico!” (7, 8)
While many of us cheerfully learned in elementary school that the U.S. is a “melting pot,” historians and journalists have documented waves of anti-immigrant sentiment since the nation’s founding. Even so, the current atmosphere feels different, unprecedented — at its most benign, it feels ominous and fragile. For many, it is outright hateful and dangerous.
Another patient, a U.S. permanent resident with advanced breast cancer whom I treat for neurocysticercosis, recently told me that she only came to her appointment to bid me farewell. She migrated to the U.S. during the El Salvador’s civil war in the 1980s to escape political instability, economic hardship and widespread violence — violence that persisted into postwar years. After more than 40 years in the U.S., she has decided to return to El Salvador because she fears forcible removal; she wants to leave on her own terms.
When I asked her if she could continue cancer treatment there, she said no. Infectious diseases care? “Tampoco” (which translates to “neither” or “not that either” in Spanish). How does she feel about her choice to leave her friends and family in Houston? “I love my country. But I am scared.”
A perfect storm
The facts supporting my patients’ decisions are disheartening. U.S. Immigration and Customs Enforcement has more than doubled its daily arrest rate since January 2025, averaging more than 930 arrests per day in June 2025, of which 42% had no criminal history. (9) Health care providers nationwide report that immigrant patients — even citizens and legal visa holders — are cancelling appointments, arriving sicker when they do seek care and avoiding preventive services entirely due to fear of racial profiling making them victims of police action now that immigration enforcement is permitted in health care facilities. (10, 11)
Health care accessibility will worsen. The recently passed “One Big Beautiful Bill” Act imposes new limitations on immigrants’ eligibility for major programs like Medicaid, the Supplemental Nutrition Assistance Program and Affordable Care Act premium tax credits, impacting even lawful categories of immigrants like refugees, asylum seekers and temporary protected status holders. (12) This perfect storm of enforcement terror and systematic exclusion is rapidly escalating a public health crisis, turning treatable conditions into life-threatening emergencies.
These stories reveal more than individual tragedies — they expose a moral crisis at the heart of U.S. health care and present us with a choice about who we want to be as a nation.
Paths forward
Fortunately, proven pathways exist to address this crisis. Congress could pass the HEAL Act and the LIFT the BAR Act to eliminate the five-year waiting period for lawfully present immigrants and allow undocumented immigrants to purchase ACA coverage. (13, 14) Legislators could increase funding for federally qualified health centers and protect their mission to provide care based on medical need, not documentation status. The seven states that still exclude legal immigrants from Medicaid should expand coverage. (15)
Health care institutions should establish immigrant-friendly policies, provide cultural competency training, develop protocols for ICE encounters and partner with legal aid organizations to help patients navigate eligibility. (11) Professional medical associations should advocate aggressively for health care as a human right.
Most importantly, we must rebuild trust by creating truly safe spaces for healing — places where a patient's first concern is their symptoms, not their status, and where the only documentation required is a willingness to be well.
Learn more about the Health Equity Series on Science Speaks and read other posts in the series.
References
- Coverage for lawfully present immigrants. HealthCare.gov. 2025.
- Medical Assistance Programs for Immigrants in Various States. National Immigration Law Center. 2025.
- Reduction of the Refugee Cash Assistance and Refugee Medical Assistance Eligibility Period. Administration for Children and Families. Updated March 28, 2025. 2025.
- Supporting Refugees & Immigrants. Catholic Charities. 2025.
- Top Diaspora Groups in the United States, 2023. Migration Policy Institute. 2025.
- Passel JS, Krogstad JM, Moslimani M. How the origins of America’s immigrants have changed since 1850. Pew Research. 2025.
- De León A. Handbook of Texas Online: Mexican Texas. Texas State Historical Association. 2025.
- Alonzo AC. Tejano Legacy: Rancheros and Settlers in South Texas, 1734-1900. University of New Mexico Press; 1998.
- Fitzpatrick A, Beheraj K. Noncriminal ICE arrests spiked in June. Axios. 2025.
- Nicolaus T. Immigrants bypassing care in wake of deportation fears. American Public Health Association. 2025.
- Immigration Enforcement-Guidance for Health Centers. American Civil Liberties Union. 2025.
- H.R.1 - One Big Beautiful Bill Act. 2025.
- S.2149 - Health Equity and Access under the Law for Immigrant Families Act of 2025. 2025.
- S.2038 - LIFT the BAR Act of 2023. 2025.
- Kaushal N, Muchomba FM. Cost of Public Health Insurance for US-Born and Immigrant Adults. JAMA Netw Open. Sep 5 2023;6(9):e2334008. doi:10.1001/jamanetworkopen.2023.34008