Terrified of risking their jobs, jeopardizing state funding for his or her institutions, and further politicizing health care, Florida hospital leaders have been reluctant to talk out against a latest law that requires them to ask about patients’ immigration status.

While Florida joins Kansas, Texas, Mississippi, and a handful of other states in proposing crackdowns on immigrants lacking legal residency, no other state has mandated that hospitals query patients about their citizenship.

Doctors, nurses, and health policy experts say the law targets marginalized individuals who have already got difficulty navigating the health care system and can further deter them from searching for medical help.

Olveen Carrasquillo, a practicing physician and professor on the University of Miami’s Miller School of Medicine, said he’s dismayed that more health care professionals aren’t speaking out against the harm the law may cause.

“Imagine if all of the hospitals said, ‘That is mistaken. We will not do it.’ But they simply stay silent because they might lose state funding,” Carrasquillo said. “We do have political leaders who’re very vindictive and who come after you.”

Touted by Republican Gov. Ron DeSantis as “essentially the most ambitious anti-illegal immigration” laws within the country, Florida’s law was enacted in July and requires, amongst other things, that hospitals ask on their admission forms whether a patient is a U.S. citizen and lawfully present within the country.

Hospitals are required to submit the knowledge quarterly to the state’s Agency for Health Care Administration, which is able to then report total admissions, emergency room visits, and the fee of look after unauthorized residents to Florida lawmakers annually.

Bailey Smith, communications director for the agency, said in an email the knowledge will deliver “much needed transparency on the burden of illegal immigration on Florida’s health system. Collecting this data allows taxpayers to grasp where their hard-earned dollars are being exploited.”

But immigrants generally, particularly those without legal residency, use little or no health care, said Leighton Ku, a professor of health policy and management at George Washington University and an authority in immigrant health. Ku added that some studies suggest immigrants pay taxes and premiums that help subsidize the health care of other U.S. residents — countering the narrative that they deplete health care resources.

“Immigrants do help support the system,” he said.

Nearly 80 health care professionals signed a public letter in April opposing Florida’s laws. Despite this strongly felt but muted opposition to the law, some public hospitals in immigrant-rich Miami-Dade and Broward counties in South Florida are downplaying the effect on patients or their institutions.

“This element of the brand new law may have almost no impact on Jackson Health System or its patients,” said Krysten Brenlla, a spokesperson for Miami-Dade’s network of 4 public hospitals.

Brenlla said the hospital asks patients to voluntarily disclose their country of birth and, for those born outside the USA, their immigration status.

Yanet Obarrio-Sanchez, a spokesperson for Memorial Healthcare System, which operates six public hospitals in Broward County, said that while staffers are asking patients about their immigration status at registration using digital forms, the hospital will “proceed to look after all.”

But that is not the message getting through to many immigrants, said Rosa Elera, a spokesperson for the Florida Immigrant Coalition, a nonprofit network of community organizations, farmworkers, and other immigrant advocacy groups.

“It’s creating fear,” she said. “It’s creating concern.”

Besides the necessities for hospitals, the law invalidates out-of-state driver’s licenses for immigrants who lack legal residency in Florida, establishes criminal penalties for transporting such immigrants into the state, and empowers state police to implement immigration laws.

These sweeping measures have fomented distrust and fueled misinformation, said Elera.

In a single instance, Elera said, a girl who went in for her regular checkup at a clinic was turned away because administrative staff members were confused concerning the latest law. “And we have been getting questions from parents of U.S.-born children who at the moment are afraid to take their children to pediatric offices,” she said.

Elera said that within the weeks leading as much as the law’s effective date on July 1, the coalition launched a “Decline to Answer” campaign. There isn’t any penalty for not answering, advocates say.

Florida’s immigration law follows an executive order DeSantis issued in 2021 compelling state agencies to find out the fee of health look after immigrants lacking legal status. The next 12 months, the state’s Agency for Health Care Administration said that such immigrants had cost Florida hospitals nearly $313 million, with facilities receiving reimbursement for about one-third of the expense. In 2021, Florida hospitals with emergency rooms reported $21.7 billion in total patient care costs, in keeping with state data.

Although the brand new requirement in Florida law applies only to hospitals that accept Medicaid, administrators at some free and low-cost community health centers fear they might be next. Recent Florida laws restricting abortion, prohibiting instruction of gender identity and sexual orientation in schools, and limiting gender-affirming look after youth all began with a smaller scope and later expanded, noted Laura Kallus, CEO of Caridad Center, a nonprofit clinic serving uninsured people in Palm Beach County.

Caridad Center doesn’t ask patients about immigration status, Kallus said. But she worries the state could add conditions to a state grant the clinic receives to supply HIV testing and counseling.

“What in the event that they said, ‘You aren’t getting this funding when you don’t take this information?'” she said.

Community health centers don’t wield much influence within the state Capitol, Kallus added, and lots of count on the Florida Legislature to extend funding without cost clinics to supply dental and behavioral health, which suggests they will not wish to risk upsetting lawmakers by criticizing the immigration law.

In his second term as governor, DeSantis has demonstrated a proclivity for punishing his perceived political opponents somewhat than negotiating with them.

The governor blocked state funding for a latest training facility for Major League Baseball’s Tampa Bay Rays when the team posted a tweet calling for gun safety laws following mass shootings in Buffalo, Latest York, and Uvalde, Texas. He removed an elected state attorney from office, partly, since the Hillsborough County-based prosecutor signed public statements that said prosecutors shouldn’t criminalize abortion and gender-affirming look after transgender people. And DeSantis has sought to punish Disney for opposing a Florida law that prohibited discussion of sexual orientation in certain classrooms.

Kevin Cho Tipton, a critical care nurse practitioner who works at two public hospitals in South Florida, said the irony of hospitals’ muted opposition to the state’s immigration law is that the governor ratified one other law this 12 months that protects health care staff’ free speech.

The law was partly intended to shield physicians from disciplinary motion in the event that they advocate for alternative treatments for covid-19 or query the security of covid vaccines, but it surely also protects speech about public policy, including postings on social media.

Tipton said he traveled to Tallahassee in April to induce Florida lawmakers to oppose the immigration bill, and he posted a video on Twitter of his testimony. He also conducted an off-the-cuff survey of 120 co-workers at a public hospital in Broward County.

“Ninety-eight percent of nurses, doctors, pharmacists, surgeons — all across the spectrum — signed a survey on my phone that claims, ‘We disagree with this, its intent, and it is not what we should always do,'” he said.

Nobody desired to put their name out in public, though. So, Tipton posted a blurred screenshot of their signatures on Twitter to make a degree.