The New Barrier of Fear: The Impact of Immigration Enforcement on Healthcare Utilization Among Immigrant Populations in the United States

Abstract

Fear of deportation has emerged as a significant barrier to healthcare access among undocumented immigrants in the United States, particularly as federal immigration enforcement policies have shifted toward increased deterrence and criminalization. This literature review examines how changes in immigration enforcement practices between 2008 and 2020 influenced healthcare attendance among immigrant populations, comparing the enforcement climates of the Obama and Trump administrations. Under the Obama administration, enforcement prioritized individuals with serious criminal convictions while programs like Deferred Action for Childhood Arrivals (DACA) fostered trust in public institutions, leading to increased health service utilization. In contrast, the Trump administration's expansive enforcement measures, including the public charge rule, increased ICE raids, and workplace operations, corresponded with measurable declines in health service attendance. Studies documented a 28% reduction in health center utilization among adult immigrant patients, increased missed appointments among non-English speakers, and significant avoidance of prenatal and preventive care in general. These patterns resulted in vaccination gaps, delayed cancer screenings, and increased mental health burdens. As stricter immigration enforcement policies intensify in 2026, this review underscores the urgent need for policy reforms that decouple healthcare access from immigration enforcement, including healthcare-immigration firewalls, safe access zones, and community-based trust-building initiatives to protect both immigrant health and broader public health outcomes.