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Immigration Enforcement as a Public Health Crisis: Spillover Effects Across Health Systems and Communities

Friday, November 6, 8:30 to 10:00am, Property: Boston Marriott Copley Place, Floor: 3rd Floor, Room: Simmons

Session Submission Type: Panel

Abstract

The intensification of federal immigration enforcement since 2025 has generated urgent questions about its effects beyond the individuals directly targeted. This panel brings together four complementary studies that collectively examine how aggressive Immigration and Customs Enforcement (ICE) activity reverberates across distinct sectors of the U.S. health system and communities — health insurance, emergency medicine, nursing homes, workplaces and education facilities, and across both immigrant and non-immigrant communities.

The first paper, "Massachusetts' Health Reform at 20: State-Level Variation, Immigrant Exclusion, and Lessons for a Fractured Federal Landscape," situates current enforcement dynamics within a longer arc of exclusionary health policy design. Based on qualitative interviews with 209 participants in Greater Boston, the study documents how documentation status, language barriers, and racialized enforcement have persistently stratified health access and what state-level systems can and cannot do to buffer federal failures.

The second paper, "The Public Health Implications of Aggressive Immigration Enforcement," examines whether local ICE enforcement activity in greater Los Angeles is associated with increases or decreases in emergency department utilization. Drawing on hospital-level ED admissions data across five counties and crowd-sourced incident-level reports of enforcement activity, the study applies a difference-in-differences design to test whether anticipatory stress and system avoidance behaviors — documented mechanisms linking law enforcement exposure to health — translate into ethnically disparate declines in healthcare utilization, or to elevated and costly healthcare utilization.

The third paper, "Rising Immigration Enforcement Intensity and Nursing Home Care Quality in the US, 2023-2026," provides evidence that heightened ICE arrest intensity is associated with meaningful deterioration in nursing home quality. Using a facility-month panel of 14,455 nursing homes, the study finds that each additional ICE arrest per 100,000 residents is associated with a 1.2% higher total health deficiency citation rate, equivalent to an 11.1% higher total health deficiency citation rate at the 90th vs the 10th percentile of state arrest intensity. Findings imply that a disruption to the immigrant direct care workforce is a plausible mechanism and suggest that immigration enforcement spill over into essential care industries that depend on immigrant workers.

The fourth paper, "The Social Costs of ICE Enforcement," examines the broader community-wide consequences of immigration enforcement. Combining geocoded ICE operations with mobility data, it provides causal evidence that enforcement disrupts economic and social activity beyond directly targeted individuals, affecting White and Hispanic neighborhoods alike. The study identifies two spatial channels: reduced travel from exposed residential areas and declining visits to nearby establishments. A spatial model attributes roughly 80% of the aggregate activity decline to home-based exposure and 20% to diminished destination attractiveness. The resulting community-wide costs exceed ten times the Department of Homeland Security's benchmark per-removal cost.

Together, these papers span diverse methodologies and shed light on how enforcement-oriented federal policy generates inequitable costs for minority communities that also spill overs to the broader population.

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