The increase in federal immigration enforcement and anti-immigration rhetoric during the first several months of the second Trump administration coincided with fewer emergency department visits and increased hospital admissions among foreign-born patients at Los Angeles County hospitals, according to research published this week in JAMA Network Open.
The findings are evidence of public health warnings that the policies would push immigrants to avoid or delay needed care, leading to worsened outcomes, affordability barriers and higher costs to the health system.
The reduction in ED visits following a June federal enforcement operation in Los Angeles was greatest among Mexican-born patients and other Central or South American-born patients, but was also seen among those born in Asia. Researchers noted the reductions were greatest (exceeding 20%) during the first four weeks after enforcement increased and then roughly halved (to about 10%) by the study’s Oct. 15 endpoint.
Meanwhile, inpatient admission increases among Mexican-born patients (4.8 percentage points), Central or South American-born patients (5.1 percentage points) and Asian-born patients (2.5 percentage points) ran through the end of the study period, researchers found.
The study reviewed electronic health record data for three Los Angeles safety-net hospitals’ emergency and inpatient departments, which rely on self-reported country of birth. It did not measure or account for the acuity of patients’ encounters—though researchers wrote that the trends they observed “likely signal that patients who presented to the ED had higher acuity, consistent with delayed care-seeking or fewer nonurgent ED visits, bolstering inpatient admissions rates to reflect a higher number of acute visits.”
A concurrent study, also published this week in the journal, that surveyed ED patients in the back half of 2025 found that Latinos were highly aware of the policy and rhetoric shift.
Among 345 participants surveyed at three hospitals—two in San Francisco, one in Houston—researchers found Spanish-speaking (but not English-speaking) Latino survey respondents were much more concerned about seeking care than non-Latino respondents. Nearly half of respondents who said they were afraid to seek care at the emergency department also reported delaying emergency treatment, according to the survey.
“Ensuring that EDs are perceived as safe and accessible may reduce fear-driven avoidance of care among Spanish-speaking Latino populations. Future studies should evaluate interventions to improve ED access,” the authors of the ED survey study wrote.
Nearly 52 million people living in the U.S., or about 15.4% of the population, were born outside the country as of June 2025. Just over a quarter of those are undocumented, per a Pew Research Center analysis of Census Bureau data.
Neither study identified participants' immigration status. The emergency department survey used indicators such as preferred spoken language as a proxy measure. Collecting such sensitive information would open the door to privacy, confidentiality and ethics concerns, which researchers studying immigration and healthcare access must be wary of, noted Esmeralda Melgoza, Ph.D., of Stanford University’s Department of Emergency Medicine, in an invited commentary on the research.
From a business perspective, hospital industry leaders operating in areas with large immigrant populations have said changes in care-seeking behaviors have impacted their volumes. Community Health Systems’ Kevin Hammons, in an earnings call last summer, said the company’s patient traffic slowed in Arizona, Texas and “possibly” Florida due to "well-documented instances of individuals in the immigrant community not participating in some everyday things.
“I know hospitals are no longer considered a sanctuary location, and there is concern even among immigrants with legal status—there's some fear in that community that's likely caused, at least in some of our markets, some softness in the volume," he told analysts at the time.