Science
Migrants Are Skipping Medical Care, Fearing ICE, Doctors Say
A man lay on a New York City sidewalk with a gun shot wound, clutching his side.
Emily Borghard, a social worker who hands out supplies to the homeless through her nonprofit, found him and pulled out her phone, preparing to dial 911. But the man begged her not to make the call, she said.
“No, no, no,” he said, telling her in Spanish that he would be deported.
Ms. Borghard tried to explain that federal law required hospitals to treat him, regardless of his immigration status, but he was terrified.
“He said, ‘If I go to the emergency department, that will put me on their radar,’” she recalled in an interview recounting the incident.
Across the country, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, including injuries, chronic illnesses and high-risk pregnancies, are forgoing medical care out of fear of being apprehended by immigration officials. Since the Trump administration announced plans for mass deportations and rescinded a Biden-era policy that protected spaces like hospitals, medical clinics and churches from immigration enforcement, doctors said they have seen sharp increases in patient anxiety and appointment no-show rates.
If the trend continues, health care officials say, the list of consequences could be long: Infectious diseases circulating unnecessarily; worsening health care costs because of untreated chronic illnesses; and dangerous birth complications for women who wait too long to seek help, among others.
In a survey conducted by KFF, a health policy research organization, 31 percent of immigrants said that worries about immigration status — their own or that of a family member — was negatively affecting their health. About 20 percent of all immigrants surveyed said they were struggling with their eating and sleeping; 31 percent reported worsened stress and anxiety.
A White House spokesman did not respond to messages seeking comment. When the administration announced that it was ending protections at hospitals on Jan. 21, a statement from the Department of Homeland Security said the new policy was intended “to enforce our immigration laws and catch criminal aliens.”
Research has shown that immigration crackdowns are linked with poorer birth outcomes and mental health status, lapses in care, and fewer people accessing the types of public programs that reduce illness and poverty overall.
“We’re really creating not just very serious health risks, but economic risks in the long run for our country,” said Julie Linton, a pediatrician and member of the committee on federal government affairs for the American Academy of Pediatrics. “These policies are creating very real fear and uncertainty for people and have a tremendous impact on their ability to function on a day-to-day level.”
Chronic Conditions
Many immigrant communities suffer from high rates of chronic conditions such as high blood pressure and diabetes, which, if left untreated, can lead to heart attack, stroke and other grave complications.
That is why doctors worry about patients like Maria, a 47-year-old woman with pre-diabetes, who has been going to the same primary care clinic ever since she arrived in the United States from El Salvador 20 years ago. Even during the first Trump administration’s crackdown on immigration, she continued to seek medical care. But when the protections around hospitals and clinics were rescinded earlier this year, Maria canceled her appointment to have her blood sugar checked, a routine and crucial element of diabetes prevention in patients like her.
“We’re very scared of being in the clinic and having ICE arrive while waiting to be called,” she said in Spanish, referring to U.S. Immigration and Customs Enforcement.
Maria, who asked that her last name not be published, said that she is in a state of “constant anguish.” She said she avoids leaving the house and is working on a plan for the care of her children, who are American citizens, in case she and her husband are deported.
One of their daughters, who is 15, is being treated for fatty liver disease and the other, 11, needs therapy for a developmental condition. Their older daughter has another doctor’s appointment in June. Maria and her husband don’t want to interrupt her care, but they are worried about taking her there themselves. “It’s very complicated,” Maria said. “I can put myself at risk for my children. But if it’s for my own health, I prefer to let it go.”
The consequences of abandoning regular medical care can turn serious quickly, however. Jim Mangia, president of St. John’s Community Health Network in Los Angeles described one patient with diabetes who stopped showing up for a weekly diabetes education class. When a clinic staff member called the woman, they discovered she was afraid to even go to the grocery store, and had been subsisting for days on tortillas and coffee, he said.
“Thank God we reached her and she came in,” said Mr. Mangia, whose network serves an estimated 25,000 undocumented patients across more than 20 locations. Tests at the clinic showed that her blood sugar had become dangerously high.
“That’s what we’re going to see more and more of,” Mr. Mangia said. “It kind of breaks my heart to talk about it.”
Acute Care
For doctors working in urgent care settings, a drop-off in immigrants has become apparent through some unusual metrics. For example, Dr. Amy Zeidan, an emergency room physician in Atlanta, said that requests for Spanish-language interpretation in her hospital’s emergency department had fallen more than 60 percent from January to February.
Theresa Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center, said one of her residents had seen an immigrant patient who had suffered multiple facial fractures from an assault, but had not sought care for more than two weeks. “There is tremendous fear,” Dr. Cheng said.
In late January, Dr. Cheng said, she saw a patient who arrived with severely untreated diabetes. The patient, an undocumented woman, said she had waited to receive help because she was scared. She died that day.
Dr. Carolina Miranda, a family physician in the Bronx, spoke of a patient who had been granted asylum but, fearful of ICE, had failed to show up for a doctor’s appointment about a possible brain tumor.
Similar delays or cancellations are arising among pregnant women and new mothers, according to obstetrician-gynecologists around the country. Dr. Caitlin Bernard, an obstetrician in Indiana, said a patient had skipped her postpartum visit, explaining that she would no longer be leaving her house. On an obstetrics floor in a San Diego hospital, multiple staff members said they had seen an overnight drop-off following the inauguration in the number of immigrant women coming in with acute issues during their pregnancies.
“Obviously those women still exist,” said one doctor, who asked not to be identified because her employer forbade her from speaking publicly on the matter. “I fear it’s going to increase maternal mortality over time. ”
Children’s Health
Many of the children of immigrant parents who have skipped appointments or left medications unfilled are American citizens. But in mixed-status families, parents who are at risk of deportation are often unwilling to take the risk of going to the clinic or pharmacy.
A pediatrician at a health center that cares for underserved populations on the central coast of California reported a 30 percent increase in no-shows for pediatric appointments. Many of those who do bring their children, and are referred elsewhere for specialty care, such as speech therapy, or an autism evaluation, refuse, saying they are too frightened, said the pediatrician, who asked to be unidentified because he wasn’t authorized to speak publicly.
Dr. Tania Caballero, a pediatrician at Johns Hopkins who sees patients at a health center for underserved groups called Baltimore Medical System, said she had encountered parents who had not wanted to go with their babies to the emergency room out of fear, and parents of children with chronic conditions like cerebral palsy, asthma, and Type 1 diabetes who had told her they have stopped getting vital care.
“I tell patients, ‘I can’t control what happens outside of my space, and I can’t control if somebody comes into my space, But you know me. I have the tools, and I want to help you navigate this journey and do it together,’” she said.
Some parents of children in other dire situations — such as those receiving cancer treatment — are hoping that their child’s condition might actually protect them. Some have asked pediatricians for letters explaining their child’s medical requirements, in hopes that immigration officials who detain them might be convinced that the child needs to stay in the United States to survive.
Dr. Lisa Gwynn, a pediatrician in South Florida who serves families from across the Caribbean and South America, said that her plummeting patient attendance rate is particularly worrisome because patients are missing out on childhood vaccines necessary for preventing diseases like measles, pneumonia and whooping cough.
Dr. Gwynn also worries that without coming to see her, children who have experienced severe trauma before coming to the United States aren’t being connected to social workers or psychologists who can help.
“Imagine your children living in a home where everyone’s scared, and they’ve come to this country to not feel scared anymore,” she said. “We know that stress does not fare well for health. Period. Kids don’t perform as well in school, they have mental health issues, depression, anxiety. ”
A Dilemma for Hospitals
Some medical facilities have said they will comply with immigration officials. NYU Langone, in New York City, sent a memo to employees warning them not to try to protect illegal migrants. But many other health centers and organizations are finding ways to take a stand, telling staff to display “Know Your Rights” information on the walls and to never record their immigration status in a patient’s medical records. ”
Last week, the New England Journal of Medicine published an article by two doctors and a lawyer detailing how physicians can continue to provide health care and lawfully push back in the face of some ICE requests.
The St. John’s clinic network in Los Angeles recently launched an ambitious home visitation program in which a doctor, nurse and medical assistant visit patients’ where they live to perform exams and deliver medications. They aim to inform all 25,000 of their undocumented patients of this option.
In the New York area, a hospital association suggested designating a “hospital liaison” who can be paged to quickly usher an agent into a private office, and then ask to see a signed warrant, which would then be reviewed by in-house counsel.
At the emergency room of University Hospital, a safety net facility in Newark, staff members hand out cards, in Spanish and other languages, reminding patients of their rights. “You have the right to refuse consent for immigration or the police to search yourself, your car or your home,” the cards state.
But even there, the fear is palpable. Annalee M. Baker, an emergency physician, said she had seen a young woman who said her partner had beaten her until she was unconscious. Covered in welts and bruises, she had waited hours to come in. The reason given: she was terrified that her partner would be deported.
Dr. Baker also treated a minor who had been stabbed; she had needed his parents’ consent to treat him, but the boy had been skittish about providing any details about them, out of fear they might be caught in the immigration dragnet.
Still, it is the people who never come in at all that haunt Dr. Baker the most.
“The tragic message to these people is: Be a shadow and hope that you do not die.”
Sarah Kliffcontributed reporting.
Science
See How Home Insurance Premiums Are Changing Near You
Insurance premiums are rising fast in the parts of the United States most exposed to climate-related disasters like wildfires and hurricanes.
New research shows that, as insurance has sharply pushed up the cost of owning a home, the price shock is starting to reverberate through the broader real estate market.
Rising insurance costs are eating into household budgets.
In some areas of the country that are exposed to disasters, homes are not selling because prospective buyers can’t afford both the mortgage and the insurance.
In parts of the hail-prone Midwestern states, insurance now eats up more than one-fifth of the average homeowner’s total housing payments, including mortgage costs and property taxes. In Orleans Parish, La., that number is nearly 30 percent.
Home insurance costs have soared where climate hazards are highest.
Nationally, insurance rates have risen by an average of 58 percent since 2018, outpacing inflation by a substantial margin. But that growth has been highly uneven across the United States.
Places that are most vulnerable to climate-related disasters like hurricanes, fires and hail are seeing some of the largest premium increases. It’s not always the case that the highest climate risk translates into the highest insurance costs. Local policies and regulations have helped keep prices lower in high-risk places, like parts of California. Other factors, like a homeowner’s credit score, can affect premiums, too.
What’s driving up insurance prices?
Since 2017, an obscure part of the insurance market, known as reinsurance, has helped push up premiums. Insurance companies buy reinsurance to help limit their exposure when a catastrophe hits. Over the past several years, reinsurance companies have experienced what Benjamin Keys and Philip Mulder, the researchers who led the new study, call a “climate epiphany.” As a result, the rates they charge to protect home insurance companies against catastrophic losses have roughly doubled.
Insurance providers have, in turn, passed these costs on to homeowners. The rapid repricing of climate risk is responsible for about 20 percent of home insurance premium increases since 2017, according to Dr. Keys and Dr. Mulder.
What else is contributing to high rates? Rebuilding costs are responsible for about 35 percent of the recent changes, the research found. Population shifts and inflation are factors, too.
High insurance prices are weighing down home values.
Since 2018, a financial shock in the home insurance market has meant that homes in the ZIP codes most exposed to hurricanes and wildfires sell for an average of $43,900 less than they otherwise would have, the research found.
In many places, insurance has been a relatively small part of the homebuying equation. Now, for many, it’s a major consideration.
For several homeowners we interviewed in Louisiana, monthly insurance costs are now higher than their home loan payments.
The research shows buyers may be factoring rising insurance costs into the prices they’re willing to pay for homes. As a result, homes in some areas are selling for less.
Methodology
Benjamin Keys and Philip Mulder calculated annual homeowners’ insurance costs by separating mortgage and tax payments from loan-level escrow data obtained from CoreLogic, a property and risk analytics firm. Households whose payments were captured by CoreLogic were not necessarily present in all years of data from 2014 to 2024.
The home insurance share of total home payments is based on mean values. Total home payments include insurance, property tax and mortgage principal and interest costs. Escrow payments typically do not include utilities, homeowners’ association fees.
Science
L.A. County’s first flu death confirmed in a season that could be harsh
L.A. County has had its first flu death in a season that health officials have warned could be severe.
The county Department of Public Health confirmed the influenza-associated fatality on Wednesday.
The death occurred in an elderly individual with underlying health conditions who had not received a flu vaccination this season, according to the Department of Public Health.
“We send our condolences to the family and loved ones of the person we lost. This tragic death reminds us how serious influenza can be,” Dr. Muntu Davis, Los Angeles County health officer, said in a news release.
Flu activity is low at the moment, though it is likely to increase with Thanksgiving next week and the holiday season, which typically involves more plane travel and indoor gatherings.
Last year’s flu season was the worst California had seen in years — and state health officials have already warned that this year could be just as bad.
Health experts, including the Centers for Disease Control and Prevention, recommend an annual flu vaccination for everyone older than 6 months.
Nationwide, the number of children who died from flu last season — 280 — was the highest in about 15 years, according to one report. About 9 in 10 of those children were not vaccinated, officials said.
The flu vaccine can be administered at the same time as the COVID-19 vaccine and takes two weeks for protection to develop.
“You can also reduce your risk by taking simple but powerful steps,” Davis said. “[W]ash your hands frequently, stay home and away from others when you feel sick, and wear a well-fitting mask in crowded indoor spaces, around people at higher risk, or whenever you have symptoms.”
As respiratory virus activity increases in L.A. County, the Department of Public Health also recommends that everyone 6 months and older receive an updated COVID-19 vaccine. RSV immunization is also recommended for older adults, pregnant people and infants.
L.A. County residents can find a vaccine site near them by visiting the department’s website.
Science
Rising Home Insurance Premiums Are Eating Into Home Values in Disaster-Prone Areas
This Louisiana resident expects to pay 45 percent more for home insurance this year.
Similar increases are hitting homeowners across the state, where insurance costs have exploded over the past four years.
It’s part of a rapid shift that’s sending tremors through real estate markets across the country.
Even after she escaped rising floodwaters by wading away from her home in chest-deep water during Hurricane Rita in 2005, Sandra Rojas, now 69, stayed put. A fifth-generation resident of Lafitte, La., a small coastal community, she raised her home with stilts.
But this year, her annual home insurance premium increased to $8,312, more than doubling over the past four years.
She considered selling, but found herself in a dilemma. As insurance costs have risen, area home values have fallen, dropping by 38 percent since 2020. The roadsides around her house are dotted with for-sale signs.
“They won’t insure you,” Ms. Rojas said. “No one will buy from you. You’re kind of stuck where you are.”
New research shared with The New York Times estimates the extent to which rising home insurance premiums, driven higher by climate change, are cascading into the broader real estate market and eating into home values in the most disaster-prone areas.
The study, which analyzed tens of millions of housing payments through 2024 to understand where insurance costs have risen most, offers first-of-its-kind insight into the way rising insurance rates are affecting home values.
Since 2018, a financial shock in the home insurance market has meant that homes in the ZIP codes most exposed to hurricanes and wildfires would sell for an average of $43,900 less than they would otherwise, the research found. They include coastal towns in Louisiana and low-lying areas in Florida.
Changes in an under-the-radar part of the insurance market, known as reinsurance, have helped to drive this trend. Insurance companies purchase reinsurance to help limit their exposure when a catastrophe hits. Over the past several years, global reinsurance companies have had what the researchers call a “climate epiphany” and have roughly doubled the rates they charge home insurance providers.
Benjamin Keys at the Wharton School of the University of Pennsylvania and Philip Mulder of the University of Wisconsin-Madison, the authors of the study, which was published this week, have called these swift changes “a reinsurance shock.” For some Americans, these changes have made it unaffordable to remain in homes they have lived in for decades.
“Homeowners don’t appreciate or don’t understand that we are living in a much riskier world than we were 25 years ago,” Dr. Keys said. “And that risk? They have to pay for it.”
After analyzing 74 million home payments — which included mortgage, taxes and insurance and were made between 2014 and 2024 — the researchers found that a rapid repricing of disaster risk had been responsible for about a fifth of overall home insurance increases since 2017. Another third could be explained by rising construction costs.
The researchers estimated the effects of the reinsurance shock on home prices in the ZIP codes most vulnerable to catastrophes. They found that rising insurance premiums weighed down home values by about $20,500 in the top 25 percent of homes most exposed to catastrophic hurricanes and wildfires, and by $43,900 in the top 10 percent.
Buying a home has long been seen as a way to lock in predictable housing costs. But the fast-increasing burden of insurance is catching some homeowners by surprise.
Last year, Ms. Rojas’s brother-in-law, who lived down the road in Lafitte, decided to sell his home to escape the area’s rising premiums. It sold for $150,000, which is what it cost him to build it in 1984. He estimated he lost about $75,000 on the sale, after accounting for the cost of renovations.
In parts of the hail-prone Midwestern states, insurance now eats up more than a fifth of the average homeowner’s total housing payments, which include mortgage costs and property taxes. In Orleans Parish, La., that number is nearly 30 percent.
A hundred miles north of Lafitte, the small city of Bogalusa, La., lies further inland. Nevertheless, Cristal Holmes saw her insurance premium more than quadruple in 2022, to $500 per month, on top of her $700 monthly mortgage.
Ms. Holmes, a single mother who was working 56 hours a week at a warehouse, struggled to keep up with the higher bills. She fell behind on mortgage payments after her work hours were reduced to 35 per week. She worried she couldn’t stay in her home.
Similar stories are playing out all over town. Ms. Holmes’s real estate agent, Charlotte Johnson, said her office was getting phone calls every day from people who said they could no longer afford their rising insurance premiums. For many, dropping insurance is not an option, because banks refuse to offer or maintain mortgages for people without coverage.
That means owners are being forced to choose between accepting home insurance policies they can’t afford or risking foreclosure.
Buyers face their own obstacles. High insurance prices and interest rates are making it harder than ever for first-time buyers to purchase homes, said Nancy Galofaro-Cruse, a senior loan officer with CMG Home Loans who works with many of Ms. Johnson’s clients. She estimated that more than a third of would-be buyers in the area backed out of the market this year after insurance and interest rates pushed their total monthly housing costs out of reach.
It’s not just the hurricane-prone coasts that have been affected by the reinsurance shock. In Colorado, where wildfires and hail pose the biggest threats to homes, the average homeowner’s premium has more than doubled in the last decade and median premiums have increased 74 percent since 2020.
Steve Hakes, an insurance broker with Rocky Mountain Insurance Center in Lafayette, Colo., has seen clients consider homes in wildfire-prone areas, only to back out when they can’t find affordable insurance. High prices and limited availability have pushed him to advise buyers to look for insurance early in the homebuying process.
And in California, 13 percent of real estate agents surveyed by an industry trade association said they’d had deals fall through in 2024 after buyers couldn’t find affordable insurance coverage.
Colorado regulators are aware of the threats these dynamics pose to the real estate market and are exploring a wide range of fixes, said Michael Conway, the Colorado insurance commissioner.
“We don’t want a situation where the insurance market is effectively decimating the real estate market,” he said.
As insurance becomes more expensive, home values will need to adjust for potential buyers to afford their monthly costs, industry analysts say. And if home values fall, lower property tax revenue could mean less money for local governments to pay for essential services or affect the ability of those governments to borrow money.
Clarence Guidry reached a breaking point this year when he got a quote to insure his home in Lafitte, La. He’d pay a $20,000 annual premium but if a hurricane struck, he’d be on the hook for the first $50,000 in damage before the insurance company would pay out.
His lender wouldn’t let Mr. Guidry, who goes by Rosco, keep his mortgage without home insurance. But keeping his home insured against damage from hurricanes would mean stomaching monthly payments that are at least 40 percent higher than the rest of his monthly mortgage and property taxes combined.
Over the last decade, as the number of wildfires and storms has mounted, losses have exceeded the revenue insurance companies receive from home insurance policies across the United States. In Louisiana, 12 companies, including Mr. Guidry’s insurer, became insolvent after a wave of hurricanes between 2021 and 2023. (Most private insurers do not cover flood damage, which is handled separately under a federal program.)
Insurance companies’ own costs have climbed in recent years for a variety of reasons, including higher construction costs, higher interest rates and President Trump’s tariff policies.
But the changes in the insurance market have begun to put a higher price on risk. Reinsurers have been driving these effects, Dr. Mulder said.
“These reinsurers are looking at a lot of the same data as insurers, but at a much bigger scale and with more sophistication,” he said.
Politicians, homeowners, economists, state insurance commissioners and real estate agents have long worried that insurance costs will rise so much that they will begin to pull down home values.
According to the study by Dr. Keys and Dr. Mulder, which was published as a working paper in the National Bureau of Economic Research, this is already happening in some areas.
Jesse Keenan, an associate professor of sustainable real estate and urban planning at Tulane University, said the direct evidence of this phenomenon remained limited and there were factors beyond insurance that affected local home prices.
But there are increasingly troubling signs in some markets, he said.
“The New Orleans housing market is exhibiting signs of failure that are imposing stress on the financial system around it,” he said.
Overall, U.S. home prices have risen about 55 percent since 2018, but New Orleans prices have increased by only 14 percent, less than the rate of inflation over the same time period.
Even in states where heavy regulations have kept costs down, there are signs that home insurers will continue to raise premiums to align more closely with disaster risk. New rules in California allow insurance companies to pass rising reinsurance costs on to consumers. One consumer advocacy group, citing the effects of similar changes in other states, has estimated this provision could raise net premiums significantly for homeowners.
Back in Lafitte, Mr. Guidry was running the numbers for his own budget. Against the advice of his financial adviser, he took money out of his retirement account to pay off his home loan. The plan now is to self-insure for wind and hail damage. That means he and his wife will have to pay out of pocket to repair their home if another severe storm hits.
In forgoing coverage, the Guidrys join some 13 percent of U.S. homeowners who are uninsured, according to Census Bureau data. Insurers continue to drop people in many areas.
“Now, we’ve got to take the gamble,” Mr. Guidry said.
Methodology
Benjamin Keys and Philip Mulder calculated annual homeowners’ insurance costs by separating mortgage and tax payments from loan-level escrow data obtained from CoreLogic, a property and risk analytics firm. Households whose payments were captured by CoreLogic were not necessarily present in all years of data from 2014 to 2024.
The home insurance share of total home payments are based on mean values. Total home payments include insurance, property tax and mortgage principal and interest costs. Escrow payments typically do not include utilities, homeowners’ association fees.
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