Restrictive state-level immigration policies, such as 91社区's SB 1718, which and criminalizes various aspects of immigrant life, have profound implications beyond legal or economic domains. These policies impose barriers on access to essential services, fostering a climate of fear that deters individuals from engaging with critical systems鈥搃ncluding healthcare鈥攄ue to concerns about deportation and immigration enforcement. Studies have shown that fears related to immigration status can lead to delays in seeking healthcare, particularly for preventive services such as HIV testing 鈥�(). This reluctance not only jeopardizes the health of individuals within immigrant communities but also poses broader public health risks by increasing the likelihood of untreated contagious diseases, reducing immunization rates, straining emergency healthcare services, and impacting workforce productivity due to untreated chronic conditions 鈥�().
The relationship between fear of immigration enforcement and not seeking healthcare services is exacerbated by broader health access barriers that stem from other challenges, such as cultural and linguistic barriers, economic hardship, and systemic discrimination in healthcare settings (). For example, approximately 22% of immigrant adults in the U.S. have reported skipping or postponing necessary healthcare due to concerns about cost or immigration status, with 25% reporting being treated unfairly in healthcare settings ().
SB 1718 exacerbates these challenges by creating a heightened environment of scrutiny and fear. Immigrant communities face compounded stressors as these laws reduce their access to healthcare and discourage engagement with essential public health services. In response to these critical concerns, researchers from the Im/migrant Well-Being Research Center at the 91社区 designed the 91社区 Immigration Policies Project to investigate the impacts of SB 1718 on several dimensions of immigrants鈥� lives. This study surveyed 466 immigrants from 31 countries residing in 91社区 to capture a comprehensive view of how the law has affected the day-to-day realities of immigrant populations across diverse backgrounds. This article explores the implications of SB 1718 on healthcare utilization among immigrants in 91社区, examining how fear of enforcement affects individual health behaviors and identifying the broader public health consequences of this inaccessibility.
Impacts of SB 1718 on Healthcare Utilization Among 91社区鈥檚 Immigrant Populations
The restrictive provisions of SB 1718 have intensified apprehensions among 91社区鈥檚 immigrant communities regarding healthcare access. Findings from our study reveal a widespread reluctance to seek medical care, with 61% of participants indicating concern about their ability to obtain necessary healthcare. This apprehension is particularly acute among non-U.S. citizens, 74% of whom reported fears about accessing medical care due to the policy. Additionally, over half of the respondents (52%) noted that SB 1718 specifically affected their decision to visit a hospital. This reluctance was prevalent among 66% of non-U.S. citizens and 27% of U.S. citizens.
Further illustrating the detrimental impacts of SB 1718, our data show that 77% of participants reported adverse mental health effects鈥攕uch as increased stress and anxiety鈥攕temming from fears of detention or deportation. Additionally, 59% noted that these fears affected their ability to access public services like healthcare. These trends are consistent with the existing body of literature highlighting that restrictive immigration policies contribute to healthcare avoidance among immigrant populations due to heightened fear of legal repercussions (; ; ). This phenomenon, known as the 鈥渃hilling effect,鈥� is particularly pronounced among undocumented immigrants and those with temporary statuses (e.g., TPS, DACA), who often delay or avoid healthcare services due to the perceived risk of exposure to immigration enforcement (). Moreover, the systemic exclusion from public programs further deepens these barriers, as many immigrants鈥攅specially undocumented individuals鈥攍ack access to federally funded health coverage, relying instead on limited and sometimes inaccessible state-funded resources (; ).
Pillai et al. () state that around one in five immigrant adults reports skipping or postponing medical care, with these numbers rising to about a third (36%) among uninsured immigrants. The barriers faced by this population are further compounded by the lack of culturally competent care, as 29% of immigrant adults reported experiencing difficulties in obtaining respectful and culturally competent healthcare, with Black (34%) and Hispanic (33%) immigrants more likely to encounter such challenges (). This reluctance to seek care also impacts immigrants鈥� perceptions of health benefits gained from residing in the U.S. While 43% of our study participants agreed that living in the United States has made them a healthier person, this perception was notably lower among non-U.S. citizens (34%). These data highlight the significant disparities in healthcare access and overall health experiences that non-citizens face under policies like SB 1718. Such conditions not only deter individuals from seeking preventative care but also contribute to worsening health disparities within immigrant communities, as untreated conditions proliferate in the absence of regular healthcare access (; ; ; ).
Policy Recommendations and Community Health Solutions
Addressing healthcare inaccessibility among immigrant populations affected by restrictive policies requires innovative, evidence-based approaches to mitigate these barriers. Implementing healthcare 鈥渟afe zones鈥�, where individuals can access services without fear of immigration enforcement, alongside expanding the availability of 鈥渟afety-net providers鈥� in medically underserved communities, has been suggested as effective approaches (; ;). Healthcare facilities that have adopted policies to mitigate perceived risks among immigrant patients report anecdotal successes, with organizations such as the American Medical Association (AMA) advocating for policies ensuring healthcare access regardless of immigration status ().These options have demonstrated success in increasing healthcare utilization among uninsured individuals and immigrant populations by offering linguistically and culturally competent care tailored to the needs of low-income and marginalized groups ().
In addition, anonymous healthcare access programs could further mitigate fears by offering services without personal identification requirements, which studies suggest helps decrease reluctance to seek care in communities with high numbers of undocumented individuals (). Furthermore, partnerships with local nonprofit organizations have been proven effective in facilitating healthcare access for immigrant communities. Collaborative models, where hospitals and clinics work with community organizations that have built trust among immigrants, can improve access by offering outreach and healthcare resources through familiar, culturally competent intermediaries (; ).
Mental health interventions should be a central focus of these efforts, as policies like SB 1718 exacerbate psychological distress and anxiety among immigrant populations. Programs focusing on community mental health that provide bilingual counseling, mental health education, and support groups could significantly alleviate the mental health burdens faced by these communities. Research has demonstrated that mental health support tailored to immigrant experiences can reduce distress and improve overall well-being (; ). Policy reform that incorporates mental health and well-being into public health considerations is crucial for establishing a healthcare system that addresses the unique challenges faced by immigrant populations.
Toward a Healthier and Inclusive Community
The findings from our study highlight the critical need to view healthcare access for immigrants through a comprehensive public health lens. The restrictive measures of SB 1718 have not only intensified fear within immigrant communities but have also significantly reduced healthcare utilization, creating barriers to timely treatment and prevention services. This reluctance to seek care鈥攅specially among non-U.S. citizens鈥攑laces both immigrant individuals and the wider community at risk, as untreated conditions, including communicable diseases, pose broader health and economic challenges.
Beyond the impacts on non-U.S. citizens, U.S. citizens in mixed-status families also reported hesitancy in accessing healthcare out of concern for their loved ones, creating a ripple effect that influences broader community health dynamics. Our study shows that 38% of U.S. citizens reported being concerned about their ability to access healthcare services due to the law. To address these intersecting health and policy issues, further research is essential to deepen our understanding of how policies like SB 1718 influence immigrant health behaviors over time and to explore the broader implications of healthcare avoidance within immigrant and mixed-status families. Policy reforms that prioritize the integration of healthcare 鈥渟afe zones,鈥� support anonymous healthcare access, and enhance community-based mental health services are pivotal for fostering both individual and community well-being.
Ultimately, ensuring accessible healthcare for immigrant populations benefits public health as a whole, reducing strain on emergency healthcare systems and fostering healthier, more resilient communities. For policymakers, advocates, and public health practitioners, this interconnected approach offers a path toward a more inclusive and effective healthcare system that serves the needs of all community members, regardless of immigration status.