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Restrictive immigration policies shape health not only through direct exclusion but also by influencing how immigrant families perceive risk, safety, and institutional trust. In Florida, Senate Bill 1718 requires hospitals to ask about patients’ immigration status, raising concerns about chilling effects on healthcare access. While prior research documents barriers to care, less is known about how families interpret and navigate these conditions in everyday decision-making. This study examines how undocumented and mixed-status immigrant families in South Florida make healthcare decisions under conditions of legal precarity and perceived surveillance.
Methods:
This study used a constructivist grounded theory design. Data came from 52 semi-structured interviews conducted in Spanish with immigrant parents in Homestead and Florida City, Florida. Participants were primarily undocumented mothers living in mixed-status households, often with U.S.-born children. Interviews focused on healthcare access, family health needs, financial barriers, and perceived effects of Florida’s immigration policy climate. Interviews were transcribed, de-identified, and analyzed using iterative initial, focused, and theoretical coding following Charmaz’s approach. Two coders independently coded transcripts and met regularly to compare interpretations, resolve differences, and refine codes and categories through consensus. Constant comparison and analytic memo writing supported theory development.
Results:
Three interrelated categories emerged, shaped by two central constraints: financial precarity and legal status vulnerability. Participants described making healthcare decisions in contexts where care was often unaffordable and insurance access limited by immigration status. Within these constraints, families developed adaptive strategies to manage health needs while minimizing economic and legal risk. First, participants relied on a shadow healthcare system of community clinics, church-affiliated services, informal referrals, and traditional remedies. Second, families engaged in a care threshold calculus, delaying formal care until symptoms became severe enough to justify financial cost and perceived immigration-related risk. Third, decision-making reflected sacrificial parenting, with parents prioritizing children’s care, especially when children had insurance, while postponing their own. Hospitals were often perceived as more uncertain, costly, and potentially risky than trusted community clinics. These patterns support an emerging grounded theory of a deportability-care calculus, in which decisions are continuously negotiated through cost, legal vulnerability, and family responsibility.
Conclusions and Implications:
Immigration policy climates can reshape healthcare behavior even without direct enforcement. Community-based clinics serve as critical safety nets but do not eliminate risks associated with delayed care. Findings highlight the need for policies and interventions that reduce fear, improve trust, and expand equitable access to care for immigrant families.