Impact of Federal Anti-Immigrant Rhetoric and Policies on Emergency Department Visits

Undocumented immigrants face substantial healthcare barriers. Federal policy changes and anti-immigrant rhetoric under the 2025 presidential administration, such as the removal of hospitals as protected spaces and increased Immigration and Customs Enforcement (ICE) presence, may have worsened these barriers. Emergency departments serve as critical safety nets for vulnerable populations, including undocumented immigrants, making it essential to understand how such policies affect ED use.

We conducted an interrupted time series analysis of all adult and pediatric ED visits at a San Francisco safety-net hospital, comparing January 1-June 30, 2024 (pre-administration) and January 1-June 30, 2025 (post-administration). Guided by expert consensus and prior research, we proxied legal status using two groups: (1) non-English primary language with no Social Security number (NEPLw/oSSN), and (2) English primary language with a Social Security number (EPLwSSN). All other patient encounters not meeting these criteria were excluded. Our primary outcome was the percentage of total ED visits attributable to each group. Monthly ED visit counts were modeled using Poisson regression, with legal status and year as covariates. Because California expanded Medicaid to all income-eligible individuals regardless of legal status, analyses were repeated among Medicaid patients - a subsample likely enriched in patients without legal status.

We analyzed 58,052 ED visits. The median patient age was 43 years; 36.7% were female; 33.7% were Hispanic/Latino; 24.8% were Black/African American; and 24.5% were Non-Hispanic White. ED visits among EPLwSSN increased monthly in 2025 (+0.35% to +2.15%), while visits among NEPLw/oSSN decreased monthly (-0.35% to -2.15%). NEPLw/oSSN had a 6% (95% CI 3–10%) lower ED visit rate compared to EPLwSSN from 2024 to 2025. Among Medicaid patients, NEPLw/oSSN had an 8% (95% CI 6-10%) lower ED visit rate.

At a safety-net hospital in a sanctuary city, 2025 federal anti-immigrant policies were associated with decreased ED visits among undocumented immigrants, suggesting a chilling effect of these policies on immigrant healthcare access. This new barrier could lead to delayed presentations, higher acuity, avoidable deaths, and ultimately, higher downstream costs.