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On a rainy Friday afternoon, I walked into the Manitowoc County Jail. I asked tentatively into the metal box at the door: “I’m here to see Randy Curtis?”

I was there to deliver a simple message. What I stumbled into was something much larger, a reality I had not previously fully understood.

Randy had missed a few shifts without calling in. His supervisor looked for him where we sometimes do when an employee disappears without a word: the inmate list at the county jail. Sure enough, there was his name.

Randy is a knockout pourer at Wisconsin Aluminum Foundry, doing hard physical work for $27.53 an hour – good money, the kind that, if you’re careful and nothing goes wrong, can be the beginning of something. He had spent years rebuilding his life in Manitowoc after a troubled young adulthood in Milwaukee. He had a girlfriend. He was saving for a car. Then an old legal matter surfaced, along with a small claims debt.

It is not uncommon for our employees to find themselves in jail. Often it’s a DUI, delinquent child support or drugs. The ones who don’t have money for bail spend weeks or months awaiting resolution. Usually in these situations we let the employment relationship expire.

But Randy’s supervisor called me: “We have to keep his job for him.” Of course we would. But how would we let him know? I pictured him in that cell, cut off from the outside world, assuming he had lost his job and maybe his apartment and girlfriend too, watching his precarious new life crash down.

I went to tell him myself.

The corrections officer was polite but matter-of-fact. I could not see the inmate in person. To speak with him, I would need to create an account on a third-party video service, deposit money, schedule a window and wait.

I am a CEO. I work on computers all day. It still took me the better part of an hour to figure it all out.

The service was called CIDNET, operated by Encartele, a corporation in Nebraska. The site defaulted to a purchase of 150 megabytes at 30 cents per megabyte. That’s $45, before a “Data Security Token” fee and a 5% merchant surcharge on top. I put $10 on the account, enough for a few minutes. On Sunday evening I logged on, saw Randy on a small screen and quickly told him his job was waiting. He looked relieved.

I want to be fair. Someone has to pay for that infrastructure. The same logic applies to bank overdraft fees and payday loan rates. Even the $2.59 Snickers bar in our plant vending machine, nearly four times what my family pays at Costco, is bought by a worker without the time or transportation to shop elsewhere. Each of these charges is, on its own terms, defensible. Together they amount to something else: a compounding tax on not having enough.

Being poor, it turns out, is expensive.

Randy made it through. Another of our employees didn’t fare as well.

I’ll call him Michael. He had spent his entire life in America, brought here as a small child. He was a DACA recipient – a “Dreamer” – tantalizingly close to getting his papers in order for permanent residency, but first he had to navigate old speeding tickets, lawyer fees, court dates and filing costs. He had a newborn and two toddlers at home. He could not even afford a cellphone. Outside of work, he reached me through Facebook Messenger when he could find Wi-Fi.

The fees accumulated the way fees do: the lawyer, the filings, the court dates that cost him wages he couldn’t replace, the paid leave that drained away appointment by appointment. Everything was a small thing.

But Michael had no margin for small things.

The weight of it followed him onto the shop floor. He grew distracted, made mistakes — costly ones in a manufacturing environment — and we had to let him go. I think about that a lot.

The word I keep coming back to is margin. In business, margin is everything. The difference between a company that survives a bad few years and one that doesn’t is not always the size of the problem. It is the cushion beneath it.

Families have margins, too.

A salaried employee who gets a DUI posts bond and goes home. She takes a long lunch for a dental appointment and loses nothing. When life disrupts her, it disrupts her. When life disrupts Randy or Michael, there is no category called disruption. There is functioning, and there is collapse. A car breaks down, the flu strikes, child care closes unexpectedly — attendance points rack up, the job is suddenly in jeopardy, and the carefully assembled structure of a life starts to come apart.

What I find remarkable is not that Randy and Michael sometimes stumble. It’s that they hold everything together as long as they do, maintaining a level of daily discipline against a backdrop of distress that most of us will never be tested to match.

My 8-year-old and I have been reading about black holes. The closer you get, the more energy you need to escape – until escape becomes physically impossible. That is what I witnessed. Not a failure of will. A gravitational pull that compounds with every setback, every fee, every missed day. 

There is a threshold, call it escape velocity, below which the system’s small relentless extractions become unsurvivable. My former college professor Lisa Dodson, who spent years embedded with low-income workers across the country, calls this the “house of cards” – the architecture of poverty where there is no redundancy, no reserve, no margin for the ordinary turbulence of a human life.

So what can we do? At Wisconsin Aluminum Foundry, we’ve introduced daily pay so workers can access wages as they earn them rather than waiting two weeks. We offer $400 per month in child care reimbursement, structured specifically to help newer, younger employees.

Most traditional benefits – vacation time, tenure-based wage levels, pension plans – naturally favor workers already on solid footing. Our most expensive benefit, health care, is the one our youngest and lowest-paid employees use the least. We can design benefit structures with that reality in mind, and we are trying.

These are imperfect responses to a structural problem. They are what one employer can do.

On policy, cash bail reform deserves serious attention. In theory, judges already weigh risk when setting bail. In practice, a $500 bail amount means freedom for one person and months in jail for another. A system that makes that distinction irrelevant might have kept Randy’s life from nearly unraveling.

The full set of public policy answers is beyond my grasp. But what I do know is that the national conversation about affordability — housing, gas, airfares — is largely about the middle class. Randy and Michael aren’t worried about buying a house. They are fighting for the basic foothold that most of us take entirely for granted.

My parents came to this country with very little and found the American Dream to be real. I believe it can still be real. Randy believed in it enough to leave Milwaukee and start over in a city where no one knew him. Michael believed in it enough to show up every single day while his entire future hung on a bureaucratic decision somewhere.

Just this week, JPMorgan Chase announced its “American Dream Initiative” aimed at strengthening small businesses, homeownership and economic mobility – a recognition that the American Dream is not self-sustaining and requires constant effort from institutions large and small.

At our holiday party earlier this year, my wife and I spotted Randy across the room — arm around his girlfriend, at a table full of co-workers, dressed in his best, laughing. 

Michael messaged me last week. He’s been out of work for two months, getting by on his wife’s income. He said he’s going to reapply at the foundry. When he does, we’ll take him back.

Neither story is finished yet. They haven’t reached escape velocity. But they are defying gravity, every single day.

Sachin Shivaram is the chief executive officer of Wisconsin Aluminum Foundry in Manitowoc.

Opinion: How poverty’s gravity pulls workers under is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Pressured by businesses on the importance of immigrant labor, some Republican states are backing off plans to require all employers to check for legal employment status before hiring workers.

State and federal legislation to require that employers use E-Verify, a federal system to check legal status, has been limited this year as a push grows from business interests that say checking status could hurt state economies. Business groups have cited the cost of complying with the laws and the potential loss of crucial immigrant workers who don’t have legal work authorization.

Millions of worksites around the country use E-Verify to ensure new hires are legal to work in the United States, but it isn’t required in all states or for every industry. Going after employers has not been as popular with Republicans as immigration enforcement aimed at detaining and deporting people living here illegally.

In Idaho, for instance, legislation that would require all employers to use E-Verify, crafted with help from the conservative Heritage Foundation, is awaiting state House consideration — while a more limited mandate for large state and local government contractors passed the state Senate Feb. 19.

“I think we should tread lightly, and private businesses should not be enforcement agencies,” said state Sen. Mark Harris, a Republican and rancher who sponsored the less-stringent bill, on the Senate floor before the vote.

Idaho Republican state Sen. Brian Lenney, who voted for the bill, spoke resentfully of business leaders who came to the state Capitol to lobby against the broader mandate for all employers to use E-Verify.

“There were men in suits holding a press conference downstairs to let the world know and tell Idaho which industries cannot survive without illegal labor,” Lenney said before the vote. “They’re trying to protect a system that keeps human beings cheap, compliant and silent. … Is this bill making a dent, like it should? Not really.”

An industry-funded report said a sharp drop in unauthorized labor from deportations could cost the state economy billions of dollars and reduce state tax revenue by almost $400 million. The report, funded by the Idaho Alliance for a Legal Workforce and prepared by regional economists, emphasized the importance of immigrants to certain industries: As much as 90% of the workforce in dairy production is foreign-born, for example, and half of those individuals might not be authorized to work in the U.S.

There were 21 states with E-Verify requirements for contracts or business licenses as of 2024, federal data showed. Seventeen states had pending legislation to begin or expand E-Verify mandates as of Feb. 5, said Mick Bullock, a spokesperson for the National Conference of State Legislatures.

Some bills have not progressed after business opposition, such as an E-Verify mandate in Kansas opposed by the Kansas Chamber and the League of Kansas Municipalities. The chamber said the bill “would create an aggressive, invasive, and costly system of employment verification on all Kansas businesses” in 2025 testimony.

“The goal of this bill is to prevent illegal immigration, however with the bill’s broad definitions and severe penalties this legislation would suppress business operations,” the chamber wrote in submitted testimony.

Another example of a limited E-Verify mandate is a recent Ohio law. It applies only to nonresidential construction, despite testimony about illegal labor in residential construction. After Republican Gov. Mike DeWine signed the measure in December, it takes effect March 20.

An earlier version of the same Ohio bill passed the state House in 2024 but did not pass the state Senate. In a hearing at the time, Richard Ochocki, an organizer for the state plumbers and pipefitters union, said he spent three hours at an apartment and condo construction site in Columbus without finding even one person with the legal work status required to join the union.

“The flow of undocumented workers to Ohio has been steadily increasing over my five and a half years as an organizer. I have personally encountered undocumented workers in Cleveland, Canton, Ashland, Lima, Cincinnati, Dayton, and Columbus,” said Ochocki, speaking in favor of E-Verify, in prepared remarks.

Madeline Zavodny, a professor at the University of North Florida who has researched the effects of E-Verify on the labor market, said exemptions for short-term work such as agriculture or small business is common, but limiting it to part of one industry such as nonresidential construction is unusual.

“The more limited the law is, the less impact it would have,” Zavodny said. “And nonresidential construction may be heavily unionized in Ohio such that there’s not a lot of unauthorized workers anyway. Unauthorized workers are often day laborers who work primarily in residential construction, not nonresidential.”

Meg Rietschlin, majority owner of a construction firm that bids on schools, roads, culverts and other nonresidential construction projects in rural Crawford County, Ohio, said she requires her workers to have a valid driver’s license, which should be enough to show they have legal status. An E-Verify mandate would drive her out of business because of the additional paperwork, she wrote in 2024 testimony.

“If you inundate me with the requirement to collect so much information, I will cease to be,” Rietschlin wrote. “This proposed law is meant to drive the small contractor out of public works opportunities.”

A report Zavodny co-authored in 2015 found E-Verify mandates appeared to help some workers who compete with unauthorized workers, such as Mexican immigrants who became citizens and U.S.-born Hispanic people, but did not measurably help U.S.-born non-Hispanic white people.

A 2020 working paper published by the National Bureau of Economic Research found no evidence that E-Verify mandates improve the native-born labor market in general, and no evidence that people without work authorization moved away because of the mandates. Unauthorized workers may move from large businesses to small businesses that are less likely to comply with the mandates, the paper concluded.

As the Trump administration’s immigration crackdown ramped up last year, restaurants and construction lost the largest number of immigrant laborers compared with 2024, according to a Stateline analysis of federal data. Landscaping, building services and warehousing industries also lost tens of thousands of laborers.

Rick Naerebout, who represents about 350 Idaho dairy farmers as CEO of the Idaho Dairymen’s Association, said his members depend on unauthorized labor to run their farms that together produce more than 18 billion pounds of milk in 2025, behind only California and Wisconsin.

Idaho farms have not seen large-scale raids by Immigration and Customs Enforcement officers, Naerebout said, though there was one last year in South Dakota and one in New Mexico in June, among others. Naerebout said he believes President Donald Trump has paused most ICE raids on agriculture and tourism, as has been reported by The New York Times and Stateline.

Idaho should limit E-Verify mandates to government as the state Senate bill would do, and shouldn’t pass more stringent mandates as the other bills would do, Naerebout added.

“The president couldn’t be more clear that he wants there to be space for critical industries like agriculture to try and get to where we find the solution,” Naerebout said. “The irony is Idaho voted overwhelmingly for President Trump, and you’ve got Idaho Republicans now saying what the president’s doing isn’t good enough.”

Among other states, Tennessee has a broad E-Verify mandate for all businesses with at least 35 employees, though the exact number of employees has shifted over the years. Republican Gov. Bill Lee signed a law effective in 2023 that lowered the threshold from 50 to 35, and one proposed bill this year could shift it back to 50 employees.

The mandate has faced business opposition but “other than a brief period of adjustment implementation has gone very smoothly,” Republican Lt. Gov. Randy McNally said in a statement to Stateline. McNally and other state officials have collaborated with the Trump administration on a package of proposed state legislation this year, including making E-Verify mandatory for state and local government hires.

Florida also has an E-Verify mandate for employers with 25 or more employees, with a bill under consideration to expand it to all employers. It passed the state House in January and is now in a state Senate committee.

In Democratic-led California, employers starting this month must notify employees about their rights under state law, including a prohibition on using E-Verify in a discriminatory way to screen only some employees. A bill in Democratic-led New York, with 12 Democratic sponsors, would prohibit use of E-Verify to screen job applicants or check on existing employees, which is  already prohibited by federal law. E-Verify can only be used legally after a job offer and before an employee has started work.

Meanwhile, some conservative-leaning states are moving to tighten rules. An Indiana bill would hold public works subcontractors accountable as part of an E-Verify mandate for public agency contracts and a West Virginia bill would require all employers to use E-Verify.

Federal legislation to mandate E-Verify for all employers has bogged down in recent years. A Senate bill last year did not progress beyond a committee, and a similar House bill bogged down in 2018.

Last year, Pennsylvania Republican U.S. Rep. Ryan Mackenzie introduced a bill that would require E-Verify for federal contractors only, saying it was “an area where mandatory E-Verify makes clear sense” in prepared testimony.

Mackenzie said he had sponsored an E-Verify law as a state lawmaker in 2019, and that it “has ensured there is a lawful workforce in the construction industry in my home state of Pennsylvania, protecting American workers from unfair competition, providing a level playing field for businesses, and helping to confirm all appropriate taxes are paid.”

Mackenzie’s bill on federal contractors had a committee hearing in January, during which California Democratic U.S. Rep. Zoe Lofgren said the bill would need an exemption for agriculture, since the government buys food and milk produced by undocumented workers for the military and schools on military bases.

“If we don’t exempt ag, we will have a very serious problem throughout the federal government, especially in our military that relies on ag products in feeding our soldiers,” Lofgren said. Her request to amend the bill was voted down.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Staff members at two Wisconsin mental health clinics are seeking union representation after what some employees describe as policy changes that have increased client caseloads and reduced one-on-one care for clients.

The clinics — one in Madison and one in West Allis — are owned by Wisconsin-based Rogers Behavioral Health. The Oconomowoc-based nonprofit organization operates a network of mental health hospitals, residential treatment clinics and outpatient clinics in 10 states.

Starting Monday, officials with the National Labor Relations Board will hold a hearing in Milwaukee to set union election dates for 63 employees in West Allis and 35 in Madison.

The hearing is expected to take up to three days, according to documents filed with the NLRB by a lawyer representing Rogers. The case will entail “extensive testimonial and documentary evidence” about which employees at each location should be included in the vote, the attorney stated in a motion to schedule the hearing and reserve the dates.

Workers at the West Allis and Madison locations want to join the National Union of Healthcare Workers. The California-based NUHW already represents Rogers employees at three locations in California as well as one in Pennsylvania.

Three employees at the West Allis clinic have been fired, according to the union, which has filed an unfair labor practice charge with the NLRB. The union is accusing Rogers of violating federal labor law by retaliating against the terminated health professionals for supporting the union.

The Wisconsin Examiner sent email messages to Rogers Friday morning, Feb. 20, seeking comment about the union drive, and at the invitation of the organization’s communications office sent five questions Friday afternoon. Rogers has not responded; this report will be updated with comments Rogers supplies.

Clinic employees cite increased caseloads

Employees involved in the union drive said in interviews that they and their colleagues enjoyed their jobs and caring for their patients. But recent changes, they said, have made their work more difficult and didn’t benefit patients.

“When I first started, people were pretty happy and satisfied with their roles,” said T’Anna Holst, a therapist who works at the West Allis clinic. “As time goes on, caseloads kept increasing for therapists.”

Other program changes reduced patients’ ability to have individual time with their clinicians, which “was really unfortunate for us, but also for the patients, who were expecting that when they come to our program,” Holst said.

“All of the changes were about increasing the number of patients that were coming into the building,” said Stephanie Lohman, a nurse practitioner. “It did not seem to have a cohesive plan and no plan would be communicated.”

Lohman said she is one of the three employees fired from the West Allis clinic, and that her termination came the Monday after she and nearly a dozen other coworkers had presented a petition seeking union recognition. When she directly asked the upper level executive who fired her, she said, she was explicitly told  she was being dismissed “without cause.”

“Our local leaders, including my direct boss, were not aware this was happening,” Lohman said, adding that she was not given time to prepare notes in order to transfer coverage for the patients in her care.

Patient advocacy

At the Madison clinic, Erin Quinlan is a behavioral specialist whose job includes assisting therapists and helping to conduct group therapy sessions.

“The people that I work with are incredible,” Quinlan said. “They care very, very deeply about the work that they do and having a positive impact on the lives of patients.”

After she was hired in July 2024, “Caseloads increased and individual time with patients was decreasing,” Quinlan said. “I just became concerned about how that was impacting our being able to support those patients.”

Coworkers shared those concerns, she said.

Employees said they were left with the impression that the changes that concerned them were coming from higher up in the organization’s hierarchy, not their local managers.

Lohman said that in measuring staff productivity, the organization moved to relying on “metrics like visits per day.” That replaced a system that took into account that some patients needed more time than others, she said.

Increased caseloads were presented as ways to increase the number of patients being served, Lohman said, but instead, employees were working “to their maximum capacity, ignoring actual patient or worker needs.”

At the clinic level, “Rogers is run by caring professionals,” she said. “Despite the corporate push to do metric care, patient-centered care continues to be done.”

All three employees said they and their coworkers believed forming a union and being able to bargain collectively would give them a stronger voice as advocates for their patients.

“I take being an advocate and speaking up as a very important part of my job,” Quinlan said. She added that she routinely sought to raise concerns with “anyone who would listen, including management.”

She said she got no response, however. “It was because I didn’t really see any return communication, that was when I made the decision to go to the union,” Quinlan said.

Both the Madison and West Allis groups initially petitioned for Rogers to voluntarily recognize the union, citing large majorities of supporters. The organization rejected those requests, and union supporters then sent petitions for elections to the NLRB.

Union represents other Rogers workers

The NUHW grew out of a California health care union that was founded in the 1930s and subsequently joined what would later become the Service Employees International Union. After an acrimonious split from SEIU in 2009, the National Union of Healthcare Workers formed as an independent union.

An unsigned memo from the organization urging employees to vote against the union was briefly posted at the Madison clinic in the days after members petitioned for union representation Jan. 23. The Wisconsin Examiner obtained a photograph of the memo, which employees said was later taken down.

The memo describes the union as having “no experience or connection in Wisconsin.” It does not state that Rogers employees in four other U.S. clinics are now represented by the union.

Employees at a Rogers mental health and addiction services clinic in Walnut Creek, California, voted for the union to represent them in 2023 and settled a first contract in 2024.

“It’s an excellent contract,” said NUHW’s communications director, Matt Artz, and included “substantial salary increases and caseload limits,” according to the union’s website.

After employees at Rogers clinics in Los Angeles and San Diego petitioned for union representation, the union was recognized voluntarily at those locations, which then negotiated contracts similar to the agreement at Walnut Creek, Artz said. In December 2025, a Rogers clinic in Philadelphia also voluntarily recognized the union after being petitioned by employees there. 

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WASHINGTON — The second partial government shutdown in 2026 began at 12:01 a.m. Saturday, after lawmakers left the nation’s capital without reaching a deal on changes to immigration enforcement tactics at the Department of Homeland Security. 

The department’s shutdown is also likely to go on for some time. With Congress out next week for the Presidents Day recess, lawmakers are not expected back on Capitol Hill for votes until Feb. 23. 

A procedural vote to approve funding for the Homeland Security bill for fiscal year 2026 failed Thursday to gain support from Senate Democrats because constraints to immigration enforcement were not included, such as an end to agents wearing face coverings. 

Even with the president’s border czar Tom Homan announcing Thursday  the withdrawal of the thousands of federal immigration officers from Minneapolis, Democrats argued it’s not enough. 

“Without legislation, what Tom Homan says today could be reversed tomorrow on a whim from (President) Donald Trump,” Senate Minority Leader Chuck Schumer, D-N.Y., said on the Senate floor Thursday.

Asked by the press pool Friday about cutting a deal on the shutdown,  Trump said, “We’ll see what happens. We always have to protect our law enforcement.”

After the Senate vote failed 52-47, members of Congress emptied out of Washington for the recess. Some were off to Munich, Germany for a major security conference. 

ICE still has cash at hand

While the agency Trump tasked with carrying out his mass deportation campaign of immigrants will shut down, enforcement will continue because Congress allocated a separate stream of money, about $75 billion for U.S. Immigration and Enforcement Services. 

During last fall’s government shutdown, which lasted a record-breaking 43 days, immigration enforcement continued.

The other agencies within DHS that will be shut down but continue to operate because they include essential workers include the Federal Emergency Management Agency, the Secret Service, the Coast Guard and the Transportation Security Administration, and Cybersecurity and Infrastructure Security Agency, among others.

In general, any employees who focus on national security issues or the protection of life and property would continue to work through a shutdown, while federal workers who don’t are supposed to be furloughed. 

Neither category of employees will receive their paychecks during the funding lapse, though federal law requires they receive back pay once Congress approves some sort of spending bill. 

Democratic mayors call for GOP to accept proposals

Democrats have pushed for policy changes after federal immigration officers killed two U.S. citizens in Minneapolis, where a deportation drive is set to wind down after the city faced more than two months of aggressive immigration enforcment. 

Renee Good was shot and killed by an immigration officer on Jan. 7, which prompted a bipartisan agreement to enact some guardrails, such as $20 million in funding for immigration agents to wear body cameras. 

But a second killing by federal immigration officers, that of Alex Pretti on Jan. 24, prompted the Senate to decouple the Homeland Security measure from a package of spending bills, as Democrats floated proposals meant to rein in enforcement tactics, and prompted a four-day partial shutdown. A two-week funding patch was set for negotiations and it expires at midnight Friday.

Democratic mayors hailing from the major cities of Baltimore, Boston, Chicago, Denver, Los Angeles, Minneapolis, New Orleans and Portland, Oregon, Friday issued a letter that called on the top Republicans in Congress, Senate Majority Leader John Thune of South Dakota and House Speaker Mike Johnson of Louisiana, to accept the proposals before DHS entered a shutdown. 

“When federal agents operate in our streets without identification, without warrants, and without accountability, that trust is shattered,” they wrote. “All of us agree that for so long as the agency exists, new funding for the Department of Homeland Security must be conditioned on the comprehensive 10-point framework released last week.”

Those policy suggestions include requiring immigration officers to not wear masks and identify themselves, which has drawn strong opposition from Republicans and the leaders of ICE and Customs and Border Protection who argue the face coverings prevent their agents from being doxxed. 

Schumer and House Minority Leader Hakeem Jeffries, D-N.Y., sent the proposals over to the White House, but said the Trump administration’s response was “incomplete and insufficient in terms of addressing the concerns Americans have about ICE’s lawless conduct.” 

According to the contingency plan for DHS, the agency expects about 20,000 employees out of 271,000 to be furloughed in the event of a government shutdown.

Last month, the parents of a 7-year-old girl whose nose wouldn’t stop bleeding took her to Portland Adventist Health in Portland, Oregon, for urgent care. Before the family could get through the doors, federal immigration agents reportedly detained them in the parking lot and took them to a detention center in Texas.

At Hennepin County Medical Center in Minneapolis, workers say U.S. Immigration and Customs Enforcement officers hang around the campus, asking patients and employees for proof of citizenship. Last month, tensions came to a head when ICE agents used handcuffs to shackle a 31-year-old Mexican immigrant to his hospital bed. ICE claimed the man, who had broken bones in his face and a fractured skull, had run headfirst into a wall on purpose while handcuffed and trying to flee.

And last summer, ICE agents chased an immigrant into the Ontario Advanced Surgery Center in Ontario, California, precipitating a confrontation with two surgery center workers wearing scrubs. The two workers were later indicted by a federal grand jury, charged with assaulting and interfering with federal immigration officers.

As the Trump administration intensifies its immigration crackdown, health care workers in multiple states say ICE is increasing its presence in health care facilities, deterring people from seeking medical care and creating chaos that jeopardizes the safety of their patients.

Even before Trump took office last year, Republican-led states such as Florida and Texas began mixing health care and immigration enforcement by requiring hospitals to ask patients about their immigration status. Now that ICE has extended its enforcement activities to hospitals and health care facilities — areas that were largely off-limits during the Biden administration — an increasing number of Democratic-led states are pushing back.

Last month, Massachusetts Democratic Gov. Maura Healey filed legislation “to keep ICE out of courthouses, schools, child care programs, hospitals and churches,” and signed an executive order to limit ICE actions on state-owned property.

In December, Illinois Democratic Gov. JB Pritzker signed a measure that bars health care providers from sharing sensitive health information with federal immigration agents and requires hospitals to develop policies around how they will interact with agents.

And in September, California Democratic Gov. Gavin Newsom signed legislation that makes immigration status and place of birth protected health information, and prohibits agents from entering nonpublic, patient-sensitive areas of health care facilities without a warrant signed by a judge.

Other Democratic states — including Maine, New Jersey, New York, Oregon and Washington — are considering similar bills.

Meanwhile, Republican lawmakers in Arizona are pushing legislation that would require hospitals accepting Medicaid patients to include a question on intake forms about immigration status.

Skipping medical care

Whether or not ICE presence is actually increasing at health care facilities, it’s clear that people living in the country illegally are being deterred from seeking medical care, said Drishti Pillai, director of immigrant health policy at the health policy research group KFF.

A KFF and New York Times survey released last November showed that 43% of respondents identifying as immigrant parents living in the country illegally skipped or delayed health care for their children over a 12-month period because they were concerned about immigration enforcement. Even among lawfully present immigrants,10% said that they avoided seeking medical care for their children due to immigration-related concerns.

Pillai also pointed to the Trump administration’s efforts to consolidate the bits of personal data held across federal agencies, creating a single trove of information on people who live in the United States.

“We are expecting that these fears have further been exacerbated this year since the data sharing agreement was made public, and there are certain concerns around privacy of data going forward,” Pillai told Stateline.

Dr. Paula Latortue, an OB-GYN in Washington, D.C., who volunteers with the Migrant Clinicians Network, a nonprofit group that provides health care to immigrants, said it’s unclear how many people are avoiding health care, and how often.

“The one part that is really hard to know is people who are not showing up to the hospital when they usually would for some sort of urgent or emergency complaint,” Latortue said in an interview. “But I think there’s a concern for many physicians in the community that has happened.”

States step in to protect sensitive locations

The Biden and Obama administrations directed ICE to avoid enforcement activities in “sensitive” places such as hospitals, schools and churches unless it received permission from top leaders at the U.S. Department of Homeland Security.

In January 2025, however, the Trump administration rescinded those guidelines, opening up these spaces to immigration enforcement.

Stateline reached out to the White House and the Department of Homeland Security multiple times but did not receive a response. When the administration changed the guidelines, the Department of Homeland Security said that opening up “sensitive” areas to agents “empowers the brave men and women in CBP [Customs and Border Protection] and ICE to enforce our immigration laws.”

The previous guidelines didn’t prohibit ICE from operating in those locations, but it did “strongly discourage” them, according to Sophia Genovese, a legal fellow specializing in immigration law at Georgetown University.

She added, however, that states and cities can enact laws to protect such spaces, even though they are limited in their capacity to “infringe and engage in immigration lawmaking.”

“Warrants are always needed to conduct searches or investigations in private, nonpublic areas, and these warrants need to be signed by a judge. This is just a basic Fourth Amendment right,” Genovese said. “When it comes to ICE entering hospitals and gaining access to private areas of hospitals, that’s an issue of individual hospital policy.”

Genovese said states also can require that hospitals standardize their policies on where law enforcement agents can go within a medical facility and create protocols to ensure agents are presenting a warrant before entering the premises.

Health care workers want protections

Those moves are exactly what health care workers in many states are asking for.

“There’s a high level of fear and anxiety. Nurses see the videos of what’s happening around the country, and nurses have experienced it themselves,” Peter Starzynski, spokesperson for the Oregon Nurses Association, told Stateline.

Last month’s incident involving the 7-year-old girl and her parents in Portland highlighted the importance of protecting health care spaces from ICE, he said.

“That should never happen. That’s disgusting,” Starzynski said.

The Oregon Nurses Association also has condemned ICE’s presence at Legacy Emanuel Medical Center in Portland, claiming agents are violating hospital policies, including on access to patients. Legacy has disputed the union’s allegations, saying that no ICE officers have entered its facilities “unless accompanying a patient in custody.”

“Nurses in emergency rooms deal with local law enforcement on a regular basis, and those relationships are built on mutual respect, where law enforcement understands what they need to do once they enter a hospital,” Starzynski said. “That has changed with the increase in federal agents in Oregon.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.