Hesitation to Seek Healthcare Among Immigrants in a Restrictive State Context

Abstract

This article focuses on how rising nativism, manifested through immigrants’ experiences of everyday discrimination, and Florida’s legal context (ascertained through immigrants’ fears of deportation), are related to immigrants’ hesitation when seeking healthcare services. Hesitation to seek healthcare, or healthcare hesitancy, is examined in the context of Florida’s SB1718, a law passed in 2023 that criminalized many aspects of being an immigrant. Based on a survey of 466 Florida immigrants and U.S. citizen adult children of immigrants, logistic regression analysis reveals that everyday experiences with discrimination are associated with a reluctance to seek healthcare services among this population. In particular, those with insecure legal immigrant status (i.e., undocumented and temporary statuses), those with financial hardship, and women demonstrate reluctance to engage with healthcare systems when controlling for other sociodemographic factors. Findings from this study exemplify how immigration policies that restrict access to healthcare and social services not only create logistical barriers to seeking care but also foster a climate of fear and exclusion that deters even those with legal status from seeking medical attention.

1. Introduction

The United States is home to nearly 46.2 million immigrants, accounting for 13.8 percent of the nation’s total population (Moslimani and Passel 2024). In the state of Florida, they comprise 21.6 percent of the population and 26.6 percent of the labor force (American Immigration Council 2024). Both documented and undocumented immigrants contribute to the U.S. economy and tax base. Collectively, undocumented immigrants generate over USD 375 billion in income annually and contribute approximately USD 96.7 billion in federal, state, and local taxes (Davis et al. 2024; Lisiecki and Apruzzese 2024). Moreover, their labor force participation rate (77.2%) exceeds the national average (63.5%), as they play essential roles in key industries such as construction, agriculture, and hospitality (Lisiecki and Apruzzese 2024).

Despite their significant contributions to the economy and society, in 2023, the Florida state Governor signed SB1718 into law. The bill was meant to discourage undocumented migration to the state. At that time, this law was considered among the harshest in the country. It extended the use of E-Verify to businesses not previously included in existing law and invalidated out-of-state driver’s licenses issued to undocumented immigrants. A particularly controversial provision mandated that hospitals receiving Medicaid funds ask prospective patients about their immigration status. This provision has led critics to argue that both documented and undocumented immigrants would forgo seeking healthcare services for fear that they or their family members may be detained or deported (ACLU of Florida 2023; August 2023).

Anti-immigrant policies can impact immigrants’ health-seeking behaviors if they perceive these laws limit their access to care. In addition, SB1718 has accompanied a rise in anti-immigrant discourse and rhetoric that was fueled by then-presidential candidate Trump’s promises to carry out mass deportations should he be elected in 2024 (Shah 2024). Given this context, our study focuses on how rising nativism, which could manifest itself in immigrants’ experiences of perceived everyday discrimination, and the state’s legal context, which is ascertained through immigrants’ fears of deportation due to SB1718, are related to the likelihood of immigrants hesitating to seek healthcare services (i.e., healthcare hesitancy). Though we focus on immigrants’ hesitancy to seek healthcare, we locate this decision-making within the context of structural forms of violence, including legal violence (Menjívar and Abrego 2012) and systemic racism (Feagin 2006). Using survey data from 466 Florida immigrants and U.S. citizen adult children of immigrants, we assess the association between perceived discrimination and deportation fears and the likelihood of healthcare hesitancy in the context of Florida’s SB 1718, passed in 2023, and the 2024 presidential election campaign season. Our work represents a significant contribution to the literature examining how laws affect healthcare access, given that it is the first to measure the consequences of Florida’s SB1718 regarding immigrants’ health-seeking behaviors.

1.1. Literature Review

Immigrants in the United States face significant barriers to accessing healthcare, leading to lower utilization rates compared to native-born residents (Butkus et al. 2020; KFF 2025; Lindsay et al. 2016). Structural factors such as financial difficulties, language barriers, and discriminatory treatment contribute to healthcare avoidance in this population (Lemon et al. 2023; Lindsay et al. 2016; KFF 2025). These challenges are compounded by immigrants’ varying legal statuses, long recognized as drivers of social exclusion (Asad 2023; De Genova 2002; De Jesus and Castañeda 2025). Moreover, legal status has recently been regarded as an emerging determinant of health disparities (Asad and Clair 2018; Joseph 2025a, 2025b; Menjívar et al. 2018). Immigrants with precarious or temporary legal statuses have historically lacked trust in healthcare facilities and providers, often fearing that utilizing healthcare services may attract the attention of immigration officials to themselves or their families (Friedman and Venkataramani 2021; Joseph 2025b; Rhodes et al. 2015). Their fears are not unfounded, as undocumented immigrants’ risks for detention and/or deportation significantly increase while accessing crucial social services like healthcare (Cervantes and Menjívar 2020; Joseph 2025b). These instances result in immigrants perceiving a palpable connection between deportability and healthcare (Joseph 2025b).

Stringent immigration policies and increased anti-immigrant rhetoric have historically created a “chilling effect” among immigrant communities, regardless of their regularized status (Bao et al. 2024; Held et al. 2020). This manifests as a marked decrease in health service utilization and increased healthcare hesitancy among immigrants and their children (Friedman and Venkataramani 2021; Joseph 2025a, 2025b). Considering that one of SB1718’s provisions requires hospitals receiving Medicaid funds to inquire about incoming patients’ immigration status, moving forward, this could further deepen mistrust and avoidance not just among undocumented populations but also among immigrants with any form of legal status.

Joseph (2025b) posits that public policies produce and reproduce symbolic and social boundaries among immigrants with varying legal statuses by enforcing what she describes as the Documentation Status Continuum (DSC) framework. The DSC challenges binary views of immigration status (i.e., documented vs. undocumented) by delineating a spectrum of rights and privileges differentially afforded to immigrants based on where they fall on this continuum. She argues that public policies create arbitrary distinctions among individuals, which are then institutionalized through the reallocation of resources and opportunities based on their particular legal status within the DSC. While citizens are the most privileged in the continuum, as they have access to the full rights and benefits that citizenship bestows, they are followed by immigrants who have Lawful Permanent Residency, then those with Temporary Protective Status, and finally those who are undocumented, who are ineligible for most public benefits (Joseph 2025b). Extrapolating this framework to understand the consequences of Florida’s policies, laws such as SB1718 may be felt beyond their targeted populations and negatively impact the health and well-being of entire communities depending on where they fall on the DSC (Betancourt et al. 2013; Joseph 2025b; Rhodes et al. 2015; Toomey et al. 2013).

Anderson and Finch (2014) identify access to healthcare and immigration enforcement policies as the main contributors to immigrant health inequities. The potential effects of SB1718 may resemble the outcomes of earlier laws like SB1070 in Arizona or federal enforcement laws such as 287(g) agreements. For instance, Arizona’s SB1070, signed into law in 2010, allowed state and local law enforcement to demand proof of lawful status of any person they suspected may be undocumented during investigatory stops (Martinez et al. 2015). Although several provisions of the law were struck down by the Supreme Court in 2012, SB1070 was linked to adverse mental and physical health outcomes for documented and undocumented immigrants (Ayón and Becerra 2013; Vernice et al. 2020). Immigrants reported higher levels of stress, anxiety, and depression caused by increased uncertainty and fears of deportation (Anderson and Finch 2014; Ayón and Becerra 2013). Toomey et al.’s (2013) study assessing the impact of SB1070 on Latina/x mothers found that the bill’s signing may have resulted in lower birth weights.

Similarly, the U.S. Immigration and Customs Enforcement (ICE)’s Section 287(g) program, enacted in 1996, allows ICE to delegate state and local law enforcement agencies as authorities in identifying, detaining, and serving warrants to undocumented immigrants. At the time of this writing, across 38 states, ICE is partnered with 415 jurisdictions, with 206 of them located in Florida alone, making it the state with the most law enforcement and state agencies working with ICE. Texas (50) and North Carolina (19) rank second and third, respectively, while most other states have significantly fewer, particularly one or two participating agencies (U.S. Immigration and Customs Enforcement 2025). The increase in partnering jurisdictions comes at the heels of Governor Ron DeSantis’ 2025 executive order directing agencies to participate or risk losing state funding (Executive Office of Governor Ron DeSantis 2025; Galo 2025). Prior to his directive, Florida had 53 participating agencies (U.S. Immigration and Customs Enforcement 2025). Although research on the ripple effects of Section 287(g)’s agreements is limited, previous studies have demonstrated that they have adverse mental and physical health effects on local immigrant communities (Rhodes et al. 2015; Lemon et al. 2023; Wang and Kaushal 2018). Section 287(g) has led to immigrant families removing themselves from their established social networks, reducing their physical activity, and altering their food consumption with hopes of reducing their or their loved one’s risk of deportation (Rhodes et al. 2015; Wang and Kaushal 2018). Lemon et al. (2023) found that the impact of such isolation and pervasive fears became internalized by immigrant youth and persisted after the Section 287(g) program came to an end in their area. Additionally, Rhodes et al. (2015) found that North Carolina’s 287(g) program instilled fear among documented and undocumented immigrants, discouraging them from seeking preventative healthcare from public or private entities regardless of their eligibility for services. Their participants further revealed that they worried similar immigration policies increased anti-immigrant rhetoric, resulting in higher incidences of racial profiling and everyday discrimination.

Immigrants’ perceptions linking deportability and healthcare (Joseph 2025b) should not be interpreted to mean that undocumented immigrants are always living in fear or hiding from institutions that have the power to detain or deport them; rather, as Asad’s (2023) work reveals, undocumented immigrants often make calculated decisions about when and how to interact with the institutions that monitor them. Their choices to engage or evade the healthcare system are shaped by the immediate responsibilities and priorities that are most salient to them. For instance, an undocumented mother with a sick child may still seek medical care despite the risks involved. Nonetheless, Lemon et al. (2023) argue that low-income or undocumented immigrants must navigate the healthcare system while dealing with medical mistrust and/or fears of deportation (Coffman et al. 2007; Khullar and Chokshi 2019; Rhodes et al. 2015).

Discrimination also is an established stressor associated with poorer health outcomes and increased rates of healthcare hesitancy among marginalized communities (Benjamins and Whitman 2014; Gazard et al. 2018; Rodriguez et al. 2023; Trivedi and Ayanian 2006). Perceived discrimination both within and outside of healthcare settings can lead individuals to limit their interactions with providers and/or forego medical attention altogether (Alcalá and Cook 2018). Beyond its deterrent effects on care-seeking, discrimination also has been shown to degrade the quality of healthcare interactions. Perceptions of bias in prior clinical experiences are associated with diminished patient–provider communication and lower ratings of respect, warmth, and informativeness, particularly among racially minoritized patients (Hausmann et al. 2011). This erosion of relational trust further discourages future engagement with the healthcare system. At the population level, exposure to racial and ethnic discrimination is linked not only to psychological distress but to broad declines in mental and physical health, including heightened symptoms of depression, anxiety, and poor health in general (Paradies et al. 2015). These effects are not simply interpersonal but accumulate over time as structural and chronic stressors, shaping patterns of care avoidance and exacerbating health inequities across immigrant communities (Williams and Mohammed 2009).

Thus, in conjunction with the decreased utilization of healthcare, racial and ethnic discrimination leads to poorer self-reported health measures (Toomey et al. 2013; Vernice et al. 2020). In combination with fears of deportation, undocumented immigrants and their families report reducing their risk of detection by isolating themselves from their social circles and delaying visits to the hospital, even in times of emergencies (Alcalá and Cook 2018; Rhodes et al. 2015; Lemon et al. 2023; Wang and Kaushal 2018). For immigrants facing punitive immigration policies such as those found in SB1718, deportation fears amplify existing feelings of fear, uncertainty, and hypervigilance (Benjamins and Whitman 2014; Rodriguez et al. 2023).

1.2. State Context

Governor Ron DeSantis’ implementation of SB1718 on 1 July 2023 led to significant unrest and uncertainty regarding detainment, deportation, and accessibility to essential public health services for immigrants across the state of Florida. Some have described the bill as the harshest immigration law to date in Florida’s history (Garcia 2023; The Florida Senate 2023). SB1718 invalidated out-of-state driver’s licenses issued to undocumented immigrants, required hospitals that were recipients of Medicaid funds to inquire about prospective patients’ immigration status, and mandated employers with more than 25 employees to use E-Verify or face state penalties (The Florida Senate 2023), among other provisions. Initially, SB1718 also criminalized traveling across state lines with undocumented friends or family, though the federal courts were quick to block this section of the law (ACLU of Florida 2024). The Florida Policy Institute estimated that the ratification of SB1718 would lead to devastating mass departures across the state, effectively separating mixed-status families and creating profound labor shortages, particularly in the agriculture and construction sectors (Tsoukalas and Santis 2023).

UnidosUS, a non-partisan, nonprofit organization dedicated to promoting Latinos/as/xs’ economic, political, and social rights in the United States, released a 2024 report highlighting the significant economic consequences of SB1718. They report that the bill left employers without essential workers and local businesses without the customers they rely on to stay afloat (Ramón and Oláh 2024). As the law approached its third year of implementation, there remains limited data on its comprehensive effects on immigrant life, particularly regarding its impact on their everyday experiences and immigrants’ access to healthcare services (Colón-Burgos et al. 2023; Lively 2024). This article seeks to fill this gap.

2. Theoretical Frameworks

Our study employs two key theoretical frameworks to explain the mechanisms through which immigration policies, deportation fears, and perceived discrimination are associated with healthcare hesitation among immigrants and their U.S.-born children in Florida. The social determinants of health (SDOH) framework contextualizes healthcare hesitation as a consequence of broader structural inequities, such as socioeconomic disparities, legal status restrictions, and systemic discrimination. Intersectionality theory further expands this perspective by illustrating how multiple, overlapping social identities—such as immigration status, race, gender, and socioeconomic position—intersect to compound health disparities and healthcare access. Below, we outline these frameworks and their relevance to our study.

2.1. Social Determinants of Health

Social determinants of health (SDOHs) refer to the non-medical factors that shape health outcomes. These include the conditions in which individuals are born, live, work, play, worship, and age, as well as the systems and structures influencing these conditions (U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion 2024). SDOHs can be categorized into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion 2024). Moreover, economic policies, social norms, political systems, and development agendas collectively impact these determinants, making them pivotal in understanding health disparities (Centers for Disease Control and Prevention 2024). The importance of SDOHs lies in their significant influence on health and quality of life. For instance, inequities in access to safe housing, nutritious food, transportation, and employment opportunities often result in poorer health outcomes and reduced life expectancy for marginalized populations. Such inequities are deeply embedded in social and economic structures, with systemic factors like racism, discrimination, and violence exacerbating disparities in health outcomes (Centers for Disease Control and Prevention 2024; García et al. 2021; U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion 2024).

Discrimination acts as a chronic stressor that impacts both mental and physical health, creating environments of persistent psychological strain and heightened vulnerability (Castañeda et al. 2015; Wallace et al. 2018). This often manifests in healthcare avoidance, as individuals facing discrimination anticipate or experience unequal treatment within medical systems (Wallace et al. 2018). Similarly, the fear of deportation, pervasive among undocumented individuals and in mixed-status families, exacerbates psychological distress (Castañeda et al. 2015; Wallace et al. 2018). Such fears create an additional barrier to healthcare access, as individuals may prioritize their safety over seeking necessary medical attention.

Immigrants’ legal status is another significant determinant that shapes access to healthcare and social resources. Undocumented individuals, for instance, face systemic exclusion from public health insurance programs and social services (Kolker and Heisler 2024). Even those with temporary or precarious legal statuses often navigate a complex web of exclusions and restrictions, further limiting their access to health-promoting resources (KFF 2025; Kolker and Heisler 2024). These barriers are compounded by socioeconomic constraints, including unstable employment, low wages, and precarious housing conditions (KFF 2025). Together, these factors amplify vulnerabilities and widen health disparities within immigrant communities. Furthermore, immigration policies, such as SB1718, may institutionalize inequities by shaping access to resources, limiting employment opportunities, and fostering environments of exclusion. These policies embody the intersection of structural violence and health inequities, where systemic barriers influence the health outcomes of entire populations (Castañeda et al. 2015; García et al. 2021; Hangartner and Spirig 2024).

Viewing immigration through a social determinant of health lens highlights how migration is both a consequence of structural inequalities—such as economic disparities and legal restrictions in home countries—and a determinant of health in destination contexts, where legal structures, economic policies, and social hierarchies shape health outcomes. This perspective is particularly useful in understanding the health effects of policies like SB1718. By codifying restrictions on employment and access to services for undocumented populations, such policies exacerbate existing socioeconomic and health inequities.

2.2. Intersectionality Theory

Kimberlé Crenshaw’s intersectionality theory emphasizes how various social categories and identities such as race, gender, and class intersect to create unique experiences of disadvantage or privilege (Crenshaw 1991; Menjívar and Salcido 2002). The intersectionality framework reveals how immigrants’ experiences with discrimination are amplified due to their intersecting identities. The challenges stemming from the intersection of gender, race, immigration status, and socioeconomic factors impact immigrants’ experiences with day-to-day discrimination in relation to healthcare access, shaping their overall health outcomes (Viruell-Fuentes et al. 2012).

Gender, for example, plays a crucial role in immigrants’ experiences of discrimination and in assessing the impact of immigration policy on healthcare access (Weber et al. 2018). Immigrant women often face compounded challenges such as limited access to reproductive healthcare (Menjívar and Salcido 2002; Lett et al. 2020). For example, women with low incomes and undocumented status were disproportionately affected by the Hyde Amendment, which restricts federal funding for abortion services (Finer and Zolna 2016; Adashi and Abelman 2017). Moreover, the reluctance among undocumented immigrant families to seek healthcare (even in emergencies) has intensified due to fear of deportation, which serves as a barrier to their access to healthcare resources and opportunities (Hacker et al. 2015). This fear particularly affects more women, who often require specialized services such as prenatal care, mammograms, and contraception (Lett et al. 2020). Consequently, these healthcare disparities have repercussions, including increased maternal mortality rates and poor health outcomes for undocumented women (Menjívar and Salcido 2002). For undocumented immigrants, these intersecting identities compound their vulnerabilities, limiting their access to essential healthcare services, and shaping their overall well-being.

When it comes to racial identities, research has shown that people of color tend to face more discrimination and various forms of mistreatment because of their racial identities (Daftary 2018). Racial biases in the healthcare system have led to discriminatory treatment of immigrants, who may be stereotyped as “undeserving” of care. Lewis et al. (2012) argued that racism in the United States has evolved into more subtle and covert forms. This is also embedded in immigration policies (Aranda and Vaquera 2015) and often operates through structural inequalities and implicit biases. Language barriers further exacerbate these challenges, as many healthcare providers lack the resources or willingness to accommodate non-English-speaking patients (Hacker et al. 2015).

Asad and Clair (2018) developed the concept of Racialized Legal Status (RLS) as a critical social determinant of health. Their framework bridges gaps in intersectional scholarship by showing how race and legal classification intersects to produce marginalization for minority groups. They argue that Racialized Legal Status (RLS) produces a cumulative form of social exclusion, inflicting both material and symbolic harms on individuals directly marked by legal and racial stigma. Thus, categories such as “undocumented” and “Blacks” function as both legal and racialized social statuses, disproportionately disadvantaging minority groups’ access to healthcare (Asad and Clair 2018).

In sum, the intersection of immigration status, gender, ethnic and racial identities, and economic status compounds, resulting in discrimination and inequities that impact immigrants’ access to healthcare. Employing an intersectional framework thus gives a better understanding of the unique vulnerabilities of immigrants, which allows for the advocacy of policies that address their unequal access to healthcare.

3. Materials and Methods

3.1. Study Design and Sample

This study employed a cross-sectional survey design to assess associations between experiences with discrimination and fear of deportation and healthcare hesitation among 466 immigrants and U.S.-born adult children of immigrants residing in Florida. We focused on community-based populations1 who are directly affected by policies like SB 1718, as they are more likely to experience barriers to healthcare access due to fear of legal repercussions, economic instability, and structural exclusions (Martinez et al. 2015). Recruitment took place between May and August 2024 in a large metropolitan area in West Central Florida. Key recruitment sites included immigrant-prominent areas such as local plazas, community hubs, and small businesses that cater to immigrant populations. One significant small business was a botánica, a store that sells herbal and traditional remedies, religious items, and spiritual goods, often serving as a cultural hub for immigrants. In addition to providing access to alternative medicine, botánicas function as informal sources of support where immigrants seek advice, share information, and maintain cultural practices from their countries of origin (Viladrich 2017). The botánica provided a familiar and trusted space, and its owner played a pivotal role in helping the research team establish rapport with participants and owners of other local businesses. Other recruitment sites included a local financial services shop where immigrants send remittances, a hair salon, a barbershop, a cafeteria, a Hispanic supermarket, and a community center. These settings were selected for their accessibility and relevance to the daily lives of the target populations.

Recruitment strategies were informed by best practices for engaging hard-to-reach and underserved community-based populations (Garnett and Northwood 2021; Shommu et al. 2016). These strategies emphasized face-to-face engagement and relationship-building over passive strategies, such as flyers or online postings, which have shown limited success in reaching marginalized or geographically dispersed populations (Brand et al. 2014; Riccardi et al. 2023; Garnett and Northwood 2021). The study also employed follow-up calls and texts to individuals who had provided their contact information, offering them the option to complete the survey via phone or a secure online link. Efforts were made to address potential barriers to participation, such as linguistic diversity and mistrust of research institutions. In this study, pre-existing collaborations with nonprofit partners who had worked with members of the research team on prior community-based projects aided in establishing credibility and facilitating introductions to key community leaders and members. Building trust was a critical component of the recruitment process, particularly given the heightened fear and mistrust resulting from the anti-immigrant climate surrounding Florida’s SB 1718. Initial interactions required time and patience to establish credibility, especially in public or semi-public spaces like supermarkets and restaurants. Over time, business owners and community leaders began to vouch for the research team, which significantly improved recruitment rates. Participants were provided with assurances of confidentiality and a clear explanation of the study’s purpose.

The survey was initially developed in English and informed by vetted research instruments, including items adapted from Pew Research Center’s 2013 “A Survey of Hispanics and Asian Americans” on immigration policy (Lopez et al. 2013). To ensure accessibility for the target population, the survey was translated into Spanish and then pilot-tested with Spanish-speaking immigrants from multiple national backgrounds. Based on their feedback, the survey was revised for linguistic clarity and cultural relevance. Participants were eligible for inclusion in the study if they were at least 18 years old, had resided in Florida for a minimum of one year, and were born in another country—regardless of arrival date to the U.S.—or were U.S.-born children of immigrants. The survey typically lasted 20–30 min and participants received a USD 10 gift card as compensation for their time.

The research team included members who represented several ethnic communities, including a Cuban woman who was an immigrant herself, a 1.5 generation Dominican woman, a second-generation Cuban woman, a 1.5 generation Colombian man, and an African woman. Most team members were fluent in Spanish and English. The study, recruitment procedures, and consent process all received Human Subjects approval by the University of South Florida’s Institutional Review Board.

3.2. Measures

A key contribution of this study is its focus on examining the associations among immigrants’ experiences of discrimination and deportation fears and healthcare hesitation, particularly within the context of heightened anti-immigrant rhetoric and state policy changes. Drawing from validated instruments and previous research (e.g., Garnett and Northwood 2021; Rhodes et al. 2015; Benjamins and Whitman 2014; Lopez et al. 2013; Viladrich 2017; Wang and Kaushal 2018; Williams et al. 1997), we operationalized key variables to capture the multifaceted impacts of SB 1718 and related immigration policies. Below, we discuss how we operationalize the key measures employed in this study.

Healthcare Hesitation: The primary outcome variable, healthcare hesitation, was a binary measure (hesitant vs. not hesitant). Participants were asked, “Has the immigration policy [SB1718] made you think twice about going to a hospital if you need medical care?” Responses were coded as 1 for “yes” and 0 for “no.” Important to note is that while this variable focuses on immigrants’ decision-making regarding healthcare hesitation, we understand this decision-making in the larger context of SB1718 as a form of both what Menjívar and Abrego (2012) call legal violence (see also Gómez Cervantes and Menjívar 2020) and what Feagin (2006) identifies as systemic racism (Feagin 2006). Failure to contextualize healthcare hesitancy within these structural frameworks neglects that immigrants’ health-seeking behaviors are responses to structural harm. By highlighting these structural factors as lying at the root of immigrants’ health-seeking decisions, we explicitly draw attention to their roles in creating, reinforcing, and perpetuating structural inequalities.2

Perceived Everyday Discrimination: We employed a modified version of the Everyday Discrimination Scale (EDS), a validated instrument widely used in public health and epidemiological research (Williams et al. 1997). The scale has strong internal consistency and validity across multiple contexts (Kim et al. 2014; Lewis et al. 2012). Responses to 8 questions3 assessing experiences of unfair treatment, social exclusion, and perceived hostility, including being treated with less respect, facing suspicion or dishonesty accusations, and experiencing workplace discrimination, were used to calculate an overall discrimination score for each participant. Participants rated these experiences on a 4-point Likert scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often). Responses were averaged to create a continuous variable ranging from 1 to 4. The inclusion of perceived everyday discrimination as an independent variable is consistent with extensive research indicating its detrimental impact on mental and emotional well-being (Williams et al. 1997; Williams 2025; Joseph 2011).

Everyday discrimination, particularly when perceived as a major problem, has been shown to significantly reduce self-reported emotional well-being among immigrants, with studies documenting a 54% lower likelihood of reporting excellent emotional well-being among those experiencing significant differential treatment (Williams et al. 1997; Vaquera and Aranda 2011). Szaflarski and Bauldry (2019) emphasize that discrimination within healthcare settings is associated with poorer physical health, while general discrimination is linked to adverse mental health outcomes. Their findings suggest that experiences of discrimination in multiple domains erode protective resources, such as social support, and exacerbate stress, thereby shaping health behaviors, including healthcare utilization. In this study, perceived EDS was adapted to reflect the sociopolitical context surrounding SB 1718, incorporating language and content more relevant to immigrant populations facing institutional and interpersonal discrimination in Florida (see note 3 for details on how this measure was adapted for the current study).

Fear of Deportation: Participants were asked, “Have you or someone close to you ever felt fear or concern about being detained by immigration or being deported?” Responses were coded in a binary format: 1 for “yes” and 0 for “no.” While the measure was designed to be straightforward and culturally accessible, its focus on participants’ lived experiences of deportation-related fear ensures its relevance to this study’s objectives. Unlike multi-item instruments like the Fear of Deportation Questionnaire developed by Arbona et al. (2010), which assesses behavioral avoidance, our measure emphasizes subjective perceptions and their potential spillover into decision-making around healthcare. The design of the question was informed by the heightened sociopolitical environment following the implementation of SB 1718, a policy that amplified immigration enforcement efforts and increased the risk of detention or deportation for undocumented individuals. Given the pervasive climate of fear, the variable captures an important subjective stressor affecting immigrant populations and their engagement with services, including healthcare, and its relevance was assessed during pilot testing with community members and cultural experts who confirmed its appropriateness for this population.

Control Variables: Drawing on prior research, we recognize that immigrants’ experiences with discrimination are often shaped by other structural and individual-level factors, including socioeconomic deprivation and limited English proficiency, which can amplify their adverse effects on well-being (Vaquera and Aranda 2017). To better isolate the unique relationships among discrimination, fear of deportation, and healthcare hesitation, we included a variety of sociodemographic variables as controls, including legal status, socioeconomic status, English language fluency, educational attainment, age, gender, marital status, parental status, and perceived racial or ethnic categorization (“street race”) (see Appendix A for definitions).

Legal status has been widely recognized as a critical determinant in shaping the experiences and outcomes of immigrants, influencing their access to resources, vulnerability to exploitation, and overall well-being (i.e., Vaquera and Aranda 2011, 2017). Socioeconomic status is important because previous studies have linked financial hardship to health and well-being outcomes among immigrant populations (Iceland 2021; Torlinska et al. 2020). English proficiency is critical to social integration, as lower proficiency often has been linked to barriers in accessing resources and increased experiences of discrimination (Pandey et al. 2021; Pont-Grau et al. 2023). Education often serves as a proxy for human capital, reflecting an individual’s ability to navigate social systems, secure stable employment, and engage with healthcare services (Chetty et al. 2022; Hagan et al. 2011; National Academies of Sciences, Engineering, and Medicine et al. 2017). Moreover, educational attainment is widely recognized as a significant determinant of health, with higher levels of education generally associated with better subjective health outcomes (Castañeda et al. 2015).

We also included age, gender, marital status, parental status (parents of children under age 18), and perceived racial or ethnic categorization (“street race”) to account for potential confounding effects in the association between independent variables and healthcare hesitation. Age was included because healthcare-seeking behaviors and social experiences—such as exposure to discrimination and fear of deportation—can vary across the life course (Thompson et al. 2016). Older individuals may experience greater healthcare needs but also face additional barriers, such as financial constraints, mobility limitations, or mistrust of healthcare systems (Wilson et al. 2021). Gender was incorporated given well-documented disparities in healthcare utilization, with women generally more likely to seek medical care than men, yet also facing structural and interpersonal barriers, including medical dismissal and gendered discrimination in healthcare settings (Elliott et al. 2012; Rapp et al. 2021). Marital status was included due to its potential influence on emotional and economic support networks, which can impact healthcare decisions (Pandey et al. 2019). The presence of children under age 18 in the household can influence economic stability and healthcare access, as parents may prioritize their children’s needs over their own (Rees et al. 2023). Last, street race (how individuals think others perceive their race) was included as a control variable because perceived racial identity can shape experiences of discrimination, healthcare interactions, and broader social inequalities beyond self-identified race (López et al. 2017).4 Research has shown that racialized experiences impact self-reported health outcomes, healthcare access, and treatment disparities (Vaquera and Aranda 2011, 2017).

3.3. Data Preparation and Analyses

Prior to analysis, the data were evaluated for missing values and outliers. Missing data were addressed using multiple imputation techniques to ensure the integrity of the dataset and reduce potential biases.5 Descriptive statistics summarize the demographic and socioeconomic characteristics of the sample, as well as the distribution of healthcare hesitation, discrimination, and other key measures. For logistic regression analyses, reference categories were chosen to facilitate meaningful comparisons.

Comparisons by survey language revealed noteworthy patterns:6 respondents who completed the survey in English were significantly more likely to report healthcare hesitation (68.5%) compared to those who completed it in Spanish (38.8%) (p < 0.0001). English speakers were also more likely to report higher levels of perceived discrimination, with 41.7% reporting moderate discrimination and 23.9% reporting high discrimination levels, compared to 16.5% and 3.2%, respectively, among Spanish-language respondents. Fear of deportation was also more prevalent among English-language respondents (50.5%) than among Spanish-language respondents (32.5%). However, English proficiency alone was not significantly associated with healthcare hesitation in the multivariate analysis, suggesting that the observed differences reflect broader structural or experiential disparities beyond language ability.

Bivariate analyses showed initial associations between healthcare hesitation and the independent and control variables. These analyses included chi-square tests for categorical variables. The results contributed to the selection of covariates and provided a preliminary understanding of how variables such as legal status, discrimination, and socioeconomic status were associated with the outcome. Non-significant variables (e.g., marital status, English proficiency) were retained based on theoretical relevance.

Logistic regression was used to model the binary outcome variable of healthcare hesitation (hesitant vs. not hesitant). The key independent variables were fear of deportation and perceived everyday discrimination. Interaction terms were tested to examine whether the effects of discrimination or socioeconomic factors on healthcare hesitation were moderated by variables such as legal status, gender, or English proficiency. While no interaction effects reached conventional levels of statistical significance, we examined potential moderators, particularly the intersection of legal vulnerability, financial stability, and linguistic challenges.7

The analyses were conducted in three stages to progressively adjust for covariates and provide a comprehensive understanding of the associations; thus, the variables were introduced in a stepwise manner to isolate the effects of discrimination and deportation fears while accounting for confounders. For Model 1, we tested our two key independent variables—perceived everyday discrimination and fear of deportation—given their central role in shaping healthcare hesitation (Castañeda et al. 2015; Vaquera and Aranda 2011). In Model 2, we introduced demographic controls (age, gender, parental status, marital status, and street race) to adjust for individual differences that might influence healthcare behaviors (López et al. 2017). For Model 3, we incorporated variables related to structural and socioeconomic factors—legal status, financial stability, English proficiency, and education—since these determinants shape access to healthcare, economic security, and systemic barriers to care (KFF 2025; Hagan et al. 2011; Pandey et al. 2021). Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs), and statistical significance was set at p < 0.05 given the sample size.

4. Results

A total of 53% (248 participants) of the sample completed the survey in Spanish, while 47% (218 participants) completed it in English. The final survey sample included 47 U.S.-born children of immigrants (45 born in the continental U.S. and 2 born in Puerto Rico to immigrant parents) and 419 immigrants from 31 countries, with the largest subgroups representing Cuba (88), other Caribbean countries8 (77), and individuals from Central9 (60) and South America10 (56). Among all participants, 36% were U.S. citizens, 15% were lawful permanent residents, 23% were undocumented, and 26% were visa holders or had temporary or other precarious statuses (e.g., DACA, Temporary Protected Status). On average, participants had lived in the United States for 17 years (range: 1–71). This includes both immigrants and U.S.-born children of immigrants, reflecting a diverse range of experiences with migration and integration. The demographic characteristics of the sample and reference categories are detailed in

Table 1. Descriptive statistics (N = 466).

	Percentage (%)	SD
Healthcare Hesitation
Hesitant to go to the hospital	52.6	0.50
Discrimination	2.0 (mean)	0.88
	0.25–4.0 (range)
Fear of Deportation   Ever felt fear of detention/deportation	40.9	0.49
Gender
Female (ref.)	62.7	0.48
Male	36.3	0.48
Age	42.17 (mean)	14.1
	18–87 (range)
Legal Status
U.S. citizen * (ref.)	36.3	0.48
Lawful permanent resident	14.6	0.35
Undocumented	23.2	0.42
Visa or temporary statuses **	26.0	0.44
Race
White (ref.)	8.4	0.28
Black or African American	24.3	0.43
Hispanic or Latino/a/x	53.4	0.50
Asian/Pacific Islander	6.0	0.24
Mixed or Multiracial	6.2	0.24
Marital Status
Single (ref.)	25.5	0.44
In a relationship/married	54.9	0.50
Previously married	18.2	0.39
Has Children Under Age 18	35.9	0.48
Education
Less than High School	14.0	0.35
High School	25.1	0.43
Post-Secondary Non-Bachelor’s	33.7	0.47
College or more (ref.)	26.4	0.44
English Proficiency
Very good (ref.)	28.9	0.45
Good	17.9	0.38
Somewhat good	35.0	0.48
Not good or not at all	18.1	0.39

* Includes US-born and naturalized citizens. ** Includes visa holders, temporary statuses, asylum seekers, and unknown.

.

Table 2. Bivariate associations with healthcare hesitation.

	χ2 (df)	p-Value	Effect Size (Cramer’s V)
Everyday discrimination	205.34 (30)	<0.0001	0.670
Fear of deportation	64.09 (1)	<0.0001	0.379
Legal status	142.83 (3)	<0.0001	0.558
Financial stability	133.62 (3)	<0.0001	0.543
Street race	105.21 (5)	<0.0001	0.479
Education	18.29 (4)	0.0011	0.200
Marital status	4.20 (3)	0.2409	0.096
English proficiency	5.82 (3)	0.1204	0.113

reveals significant associations between healthcare hesitation and several variables, including discrimination, legal status, financial stability, and street race. Chi-square analyses demonstrated significant differences in healthcare hesitation across legal status categories (χ² = 142.83, p < 0.0001) and financial stability, measured through a proxy of socioeconomic status (SES) groups (χ² = 133.62, p < 0.0001). This suggests that legal status is strongly associated with healthcare hesitation. A higher proportion of undocumented individuals (92.52%) and those with visa or temporary statuses (67.50%) reported hesitation compared to citizens (27.27%) and lawful permanent residents (24.24%). The effect size measures, including Cramer’s V (V = 0.558), indicate a strong association between legal status and healthcare hesitation. Similarly, healthcare hesitation varied sharply across SES categories. Those in low-SES groups (“Sometimes have trouble paying for things” and “Always have trouble paying for things”) demonstrated the highest hesitation (79.89% and 71.43%, respectively), while individuals in the highest-SES group showed the lowest hesitation (22.58%). Further, healthcare hesitation differed significantly across racial and ethnic groups (χ² = 105.21, p < 0.0001). Black (88.50%) and Asian (85.71%) respondents reported the highest levels of hesitation, with mixed-race and white respondents showing comparatively lower hesitation rates at 34.48% and 28.95%, respectively. Discrimination scores were also strongly linked to healthcare hesitation (χ² = 205.34, p < 0.001). Participants who reported higher average discrimination scores (3.75–4) exhibited markedly higher hesitation rates compared to those with lower scores. Moreover, concerns about deportation were significantly associated with healthcare hesitation (χ² = 64.09, p < 0.001). Participants worried about deportation were more likely to hesitate to access healthcare (75.82%) compared to those without deportation concerns (37.36%).

While educational attainment was also associated with healthcare hesitation (χ² = 18.29, p = 0.0011), the association was less pronounced compared to legal status and SES. Those with lower educational levels exhibited slightly higher hesitation, particularly individuals with less than a high school education (53.13%) and those with some post-secondary education (65.81%), compared to those with higher education (45.08%). Finally, neither marital status (χ² = 4.20, p = 0.2409) nor English proficiency (χ² = 5.82, p = 0.1204) exhibited significant associations with healthcare hesitation.

Table 3. Logistic regression models for healthcare hesitation.

	Estimate (SE)	Estimate (SE)	Estimate (SE)
	Model 1	Model 2	Model 3
Everyday discrimination	1.81 (0.18) ***	1.63 (0.22) ***	1.33 (0.26) ***
Fear of deportation	0.64 (0.27) *	0.60 (0.29) *	0.37 (0.34)
Gender (ref. female)
Male		−0.58 (0.27) *	−0.58 (0.30) *
Age		−0.01 (0.01)	−0.002 (0.01)
Has children under 18		0.46 (0.29)	0.22 (0.32)
Marital status (ref. single)
In a relationship/married		−0.24 (0.32)	−0.04 (0.35)
Previously married		0.04 (0.42)	0.26 (0.46)
Street race (ref. White)
Black or African American		0.90 (0.58)	0.52 (0.65)
Hispanic or Latino/a/x		0.17 (0.45)	−0.20 (0.48)
Asian/Pacific Islander		1.04 (0.77)	0.97 (0.87)
Mixed or multiracial		−0.35 (0.64)	−0.53 (0.70)
Legal status (ref. U.S. citizens)
Undocumented			1.93 (0.55) **
Visa or temporary statuses			0.86 (0.40) *
Lawful permanent resident			−0.19 (0.43)
Education (ref. college or more)
Less than high school			0.84 (0.50)
High school			0.72 (0.40)
Post-secondary Non-Bachelor’s			0.30 (0.41)
Financial stability (ref. never had trouble paying for things)
Always had trouble			0.73 (0.50)
Sometimes had trouble			0.89 (0.37) *
Rarely had trouble			−0.08 (0.44)
English proficiency (ref. very good)
Not good or not at all			0.44 (0.50)
Somewhat good			0.39 (0.43)
Good			0.22 (0.48)
Intercept	−3.57 (0.34) ***	−3.08 (0.72) ***	−3.93 (0.87) ***

* p < 0.05; ** p < 0.001; ***p < 0.0001.

presents results from the three nested models. Across all models, a strong association remained between perceived everyday discrimination and healthcare hesitation—individuals who reported frequent experiences of discrimination were significantly more likely to avoid seeking medical care. In Model 1, the odds of healthcare hesitation increased by a factor of 6.11 (OR = 6.11, 95% CI: 4.29–8.70) for every unit increase in reported discrimination. This association persisted, albeit with slightly attenuated effect sizes, in Model 2 when sociodemographic controls were added (OR = 5.10, 95% CI: 3.31–7.87) and Model 3 (OR = 3.78, 95% CI: 2.27–6.31). Model 3, which included a comprehensive set of theoretically relevant sociodemographic, legal, and socioeconomic controls, revealed that individuals reporting higher levels of perceived everyday discrimination were nearly four times as likely to hesitate when seeking healthcare compared to those reporting lower levels of discrimination. Notably, even after adjusting for legal status and socioeconomic factors, discrimination remained an independent driver of healthcare avoidance, reinforcing its role as both a psychological stressor and a structural barrier to care (Hacker et al. 2015; Joseph 2011).

Fear of deportation was also associated with healthcare hesitation, though its effects diminished when legal status and socioeconomic controls were introduced. In Model 1, individuals expressing deportation-related fears exhibited 1.90 times higher odds of healthcare hesitation (OR = 1.90, 95% CI: 1.12–3.22). This effect remained significant in Model 2 (OR = 1.82, 95% CI: 1.03–3.22) but was no longer significant in Model 3 (OR = 1.45, 95% CI: 0.74–2.82), indicating that deportation fear is deeply intertwined with broader vulnerabilities such as legal status. Legal status was significantly associated with healthcare hesitation in Model 3. Undocumented immigrants exhibited 6.89 times higher odds of healthcare hesitation compared to U.S. citizens (OR = 6.89, 95% CI: 2.34–20.24). Similarly, individuals with a visa or temporary statuses showed increased hesitation compared to U.S. citizens (OR = 2.36, 95% CI: 1.08–5.18). Men consistently showed lower odds of healthcare hesitation compared to women (Model 2: OR = 0.56, 95% CI: 0.33–0.95; Model 3: OR = 0.56, 95% CI: 0.31–1.01). Additionally, financial instability (“sometimes have trouble paying for things”) was associated with higher odds of healthcare hesitation (Model 3: OR = 2.44, 95% CI: 1.18–5.03).

5. Discussion

The findings of this study reinforce longstanding research on the structural and psychosocial barriers that shape immigrants’ access to healthcare. In the context of heightened immigration enforcement and anti-immigrant rhetoric, our results indicate that perceived everyday discrimination remains a powerful and independent factor associated with healthcare hesitation, even after controlling for legal status, financial instability, and other sociodemographic factors (Williams et al. 1997; Szaflarski and Bauldry 2019). Similarly, the relationship between deportation fears and healthcare hesitation was statistically significant but lost significance when adjusting for broader social and economic vulnerabilities, suggesting that legal and economic precarity may mediate the relationship between deportation fears and healthcare avoidance.

Our results support the growing body of research demonstrating that immigration status operates as a social determinant of health, as it is associated with healthcare access through economic constraints, legal exclusions, and the broader sociopolitical climate (Castañeda et al. 2015; Wallace et al. 2018). Moreover, our findings highlight how the intersection of different social categories and identities compounds healthcare avoidance, emphasizing the cumulative effects of multiple, overlapping social disadvantages (Crenshaw 1991; Menjívar and Salcido 2002; Viruell-Fuentes et al. 2012). Legal status was one of the strongest factors associated with healthcare hesitation in our study. Undocumented immigrants exhibited the highest levels of hesitation, followed by individuals with visas or temporary statuses, whereas lawful permanent residents and U.S. citizens had significantly lower levels of hesitation. Studies have shown that systemic barriers to healthcare, such as exclusion from public health insurance programs, economic precarity, and heightened surveillance, discourage institutional engagement for undocumented individuals (Hacker et al. 2015; Wallace et al. 2018). Moreover, our results regarding legal status confirm Joseph’s (2025b) DSC framework proposing that variability in legal status equates to differential benefits and opportunities. Our results also align with studies documenting that restrictive immigration policies and enforcement programs such as Arizona’s SB 1070 and 287(g) agreements have historically contributed to healthcare avoidance among immigrants, even those with legal protections (Ayón and Becerra 2013; Rhodes et al. 2015; Vernice et al. 2020).

Building on this understanding of systemic barriers and the evidenced impact they have on underserved populations, Florida’s SB 1718 seems to exacerbate healthcare exclusion by explicitly restricting access and heightening the risks associated with seeking medical care. This law, combined with the current federal push toward mass deportations and other harmful 2025 presidential Executive Orders, has intensified fear and mistrust among immigrant communities (ACLU of Florida 2023; American Immigration Council 2025; August 2023). The resurgence of punitive immigration policies, along with the erosion of the civil rights protections achieved in recent decades, has created a chilling effect, compelling many immigrants to withdraw from public life, avoid institutions, and even forgo essential healthcare services (Aranda et al. 2025; De Trinidad Young et al. 2023; Polantz 2025).

Rather than acting independently, these policies amplify structural determinants of health, disproportionately impacting already vulnerable populations by deepening economic precarity, limiting mobility, and fostering environments of chronic stress and social exclusion (Hacker et al. 2015; Wallace et al. 2018). The financial precarity of immigrants further exacerbates healthcare hesitation. Our study found that individuals with lower socioeconomic stability were significantly more likely to delay or avoid medical care, a finding that aligns with broader research indicating that economic instability amplifies health disparities by increasing cost-related barriers and uncertainty about future expenses (Iceland 2021; Finkelstein et al. 2022; Torlinska et al. 2020). Additionally, the intersection of economic stress and legal insecurity may create compounding layers of vulnerability, making it difficult for individuals to navigate healthcare systems without fear of exposure or financial hardship. Overall, the findings from this study exemplify how immigration policies that restrict access to healthcare and social services not only create logistical barriers but also foster a climate of fear and exclusion that can deter even those with some level of legal protection from seeking medical attention (Hacker et al. 2015; Martinez et al. 2015; De Trinidad Young et al. 2022).

One of the most striking findings of this study is the robust and persistent relationship between perceived everyday discrimination and healthcare avoidance, even after accounting for legal status and socioeconomic controls. Participants who reported higher levels of perceived discrimination were significantly more likely to hesitate when seeking medical care, reinforcing previous research that has documented the detrimental effects of discrimination on health-seeking behaviors, stress levels, and provider trust (Benjamins and Whitman 2014; Rodriguez et al. 2023; Trivedi and Ayanian 2006). This dovetails with structural racism theories, which argue that discriminatory experiences are not isolated incidents but rather embedded within institutional practices, including healthcare delivery systems (Alcalá and Cook 2018; Gazard et al. 2018). Furthermore, our findings highlight how perceived everyday discrimination operates as a social determinant of health beyond individual experiences in clinical settings. Prior studies have documented that perceived discrimination within healthcare environments leads to lower levels of patient–provider trust, increased healthcare avoidance, and poorer health outcomes (Wallace et al. 2018). However, our results suggest that perceived discrimination in everyday life is also associated with healthcare decisions, which is consistent with research showing that perceived hostility, racial profiling, and exclusionary policies reinforce institutional distrust among immigrants (Aranda and Vaquera 2015; Rhodes et al. 2015).

It is possible that immigrants who experience discrimination in other aspects of life may anticipate biased treatment in healthcare environments, leading to avoidance behaviors. Moreover, our results suggest that the association between deportation fear and healthcare behaviors may be largely mediated by broader structural vulnerabilities, such as financial insecurity and precarious legal status. In other words, individuals who fear deportation may also experience economic instability, legal exclusion, and systemic barriers, which collectively are associated with their reluctance to seek care (Castañeda et al. 2015; Wallace et al. 2018). These findings emphasize the importance of examining legal status, economic security, and perceived discrimination as interrelated, rather than independent, determinants of healthcare-seeking behaviors.

Given these findings, this study represents an important contribution to the scholarship on health-seeking behaviors, discrimination, and immigration policy. It is the first empirical study that addresses the outcomes of Florida’s SB1718 on immigrants and their U.S.-born children, based on a survey conducted during Donald Trump’s campaign for a second presidential term.

5.1. Limitations

This study’s cross-sectional design prevents causal inference and limits our ability to track changes over time. All data were self-reported and may be subject to recall or social desirability bias, especially given the sensitive nature of immigration status and perceived discrimination experiences. Although we drew from multiple recruitment sites and established community partnerships, the non-probability sampling strategy limits generalizability beyond the study population. Moreover, the study did not assess healthcare access or utilization outcomes directly.

5.2. Future Directions

Future research should further explore the longitudinal impacts of restrictive policies on healthcare-seeking behaviors, particularly as anti-immigrant rhetoric and exclusionary laws continue to expand. In particular, more research is needed on the mechanisms that fuel the relationship between restrictive policies and their effects on increasing the incidence of discriminatory experiences in all aspects of social life, such as the workplace, in public settings, and in interactions with others. Such experiences may be instilling mistrust in those negatively affected by perceived everyday discrimination, spilling over into decision-making on whether to seek healthcare and mistrust of social institutions generally. Future research should also further explore how immigration enforcement climates interact with financial and legal stressors to shape long-term healthcare trajectories. In particular, qualitative research is needed to capture the nuance of immigrants’ decision-making in a hostile enforcement climate to ascertain to what extent and under what conditions prior discrimination experiences and immigration policies affect their health-seeking behaviors.

6. Conclusions

This study demonstrates how legal precarity, economic hardship, and perceived everyday discrimination contribute to healthcare hesitation among immigrants in Florida. Even after accounting for sociodemographic and structural variables, perceived discrimination emerged as a distinct and robust barrier. While deportation fears initially were associated with healthcare avoidance, these effects appear to be driven by broader structural vulnerabilities, including financial and legal insecurity. Gender also played a role, with women being more hesitant to seek healthcare, further shaping disparities in healthcare access.

There are several policy implications that emerge from this study. Our results reinforce the urgent need for policies that reduce institutional barriers to healthcare, address discrimination within healthcare and other settings, and mitigate the chilling effects of immigration enforcement on healthcare utilization. Lawmakers should seriously consider revamping policies that mandate the reporting of immigration status in healthcare settings. In addition, hospitals should be designated as sensitive locations that bar immigration enforcement actions on their premises. Lawmakers should restore the sensitive locations policy that was in place until recently, when the Trump Administration rescinded it in early 2025. Overall, these policies discourage immigrants from seeking healthcare as they further reinforce mistrust of social institutions and generate fears associated with the threat of immigration enforcement. Moreover, policymakers should re-evaluate the trend of rolling back diversity, equity, inclusion, and accessibility practices, given that the persistence of discrimination experiences in everyday life may be spilling over into people’s decision-making regarding whether to seek healthcare. The practical implications of forgoing healthcare may harm public health, as healthcare avoidance could increase the spread of communicable diseases while straining healthcare systems because of undiagnosed conditions and delayed treatment, which can lead to worsening health disparities in communities at large. These community-level effects will not just harm immigrants, but U.S. citizens as well.