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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 , Alex feared it would have dire consequences for the patients he served.

Alex is a pseudonym for one of our research subjects.

, 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, , be used for new hires in . 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 and graduate students . We believe SB 1718 has important implications for immigrants, for Floridians and all Americans—particularly as the country faces .

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.

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 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 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 . 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 . They foster an exclusionary policy environment that , restricts access to essential services and exacerbates economic and social vulnerabilities. Moreover, restrictive immigration policies . Immigrants who have been discriminated against in everyday settings may internalize the expectation that seeking care will result in further .

Consequences for public health

U.S. history holds numerous examples of racial and ethnic barriers to health care. Examples include . It also involves systemic restrictions on , including inadequate language assistance services, reliance on untrained interpreters and lack of culturally competent care.

President Donald Trump's signed in January 2025 threaten to further ostracize certain communities. For example, the programs dismantles efforts to address racial disparities in public institutions. could hinder efforts to study and address these disparities.

Civil rights advocates believe these measures represent a that generations fought to secure and could accelerate a based on race under the guise of immigration enforcement.

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 , and among entire communities.

These legal restrictions are likely to increase the and , increasing costs and placing a greater burden on emergency services and public health infrastructure.

This article is republished from under a Creative Commons license. Read the .