By Catherine Wu, Global Health Communications Assistant

In a new JAMA Open Network invited commentary, CIGH postdoctoral affiliate Esmeralda Melgoza, PhD, MPH, CHES weighs in on how recent immigration policies and actions are impacting immigrants’ ability and willingness to seek medical care.

Melgoza, a postdoctoral researcher based in the Department of Emergency Medicine at Stanford University’s School of Medicine, examines inequities in the healthcare system, with a focus on underserved populations and emergency medical services provided in the prehospital setting and the emergency department. 

Her commentary responds to two studies published in JAMA Network Open. The first, drawing on three Los Angeles County hospitals, found that after immigration enforcement intensified in June 2025, emergency visits by foreign-born patients fell by more than 20% relative to US-born patients in the first month, and were still about 10% lower by mid-October. In addition, the foreign-born patients who did come in were often sicker when they arrived. The second, a survey of emergency patients in San Francisco and Houston, quantified how changes in the immigration landscape amounted to a delay in care, finding that 34% of Spanish-speaking Latino patients said anti-immigrant rhetoric and policies made them afraid to come to the emergency department, and that translated to delaying their own care.

Melgoza argues that the political and social conditions shaping whether immigrants feel safe seeking care matter just as much as whether services are available. Since January 2025, she writes, immigration policy changes, enforcement, and “exclusionary rhetoric” have “exacerbated barriers to health care access and utilization” among foreign-born residents.

“Understanding how political, economic, and social conditions in the US influence health care-seeking behaviors and utilization is the first step to inform efforts that advance health for all,” Melgoza added.

Melgoza also pointed out an ethical dilemma from both cited studies: neither measured patients’ immigration status directly; one used preferred language and the other used country of birth as an operationalization of immigration status. Disclosing a patient’s immigration status could have serious consequences for them and their family, Melgoza wrote. Facial and voice recognition, among other identification technologies, pose a possibility of sensitive data being linked across US health care systems without consent. Strong data security helps, she notes, but it cannot remove every risk.

Seeking emergency care in the context of a changing immigration landscape is close to Melgoza’s own work: her research follows patients through every phase of an emergency — from the 911 call to the EMTs to the emergency department —  with a focus on language access and underserved communities. This year, she is co-principal investigator on a Stanford Global Health Seed Grant project, “Borderline Care: Advancing Emergency Medical Services in Northern Mexico.”

“The imperative is 2-fold: to strengthen the evidence on how a changing immigration landscape influences emergency care–seeking and utilization while ensuring that the pursuit of this knowledge does not create additional risks for the individuals being studied,” Melgoza wrote.

Read the full JAMA Network Open commentary: “Emergency Care Seeking and Utilization in a Changing Immigration Landscape—Balancing the Need for Evidence With Potential Risks.