Health Care Sanctuaries

67 Pages Posted: 11 Nov 2021

See all articles by Medha D. Makhlouf

Medha D. Makhlouf

Pennsylvania State University, Dickinson Law

Date Written: August 30, 2021


It is increasingly common for noncitizens living in the United States to avoid seeing a doctor or enrolling in publicly funded health programs because they fear surveillance by immigration authorities. This is the consequence of a decades-long shift in the locus of immigration enforcement activities from the border to the interior, as well as a recent period of heightened immigration enforcement. These fears persist because the law incompletely constrains immigration surveillance in health care.

This Article argues that immigration surveillance in health care is a poor choice of resource allocation for immigration enforcement because it has severe consequences for health and the health care system; additionally, it compromises the legitimacy of the state vis-à-vis its noncitizen residents. The consequences include public health threats, health care system inefficiency, ethical dilemmas, and increased vulnerability in immigrant communities. Laws permitting immigration surveillance in health care also create legitimacy harms by obstructing noncitizens’ access to health care and undermining their privacy and rights to public benefits. The COVID-19 pandemic starkly illustrates these dangers, but they exist even in the absence of a novel disease outbreak.

Health care access for noncitizens has largely been left to the vagaries of immigration policy. Immigration surveillance in health care should prompt us to consider the scope and limits of health law and the role of discretion in immigration law. Health care sanctuaries — durable legal protections against immigration surveillance in health care — recover some of the lost equilibrium between immigration enforcement and other goals and values of public policy.

Funding Information: Funding support was provided by Penn State Dickinson Law.

Declaration of Interests: None to declare.

Keywords: Health Law, Immigration Law, Access to Health Care, Sanctuary, Immigrants, Noncitizens, Immigration Enforcement, Public Charge, Surveillance, System Avoidance

JEL Classification: K32, K37, I1, I14, K00

Suggested Citation

Makhlouf, Medha, Health Care Sanctuaries (August 30, 2021). 20 Yale J. Health Pol'y, L. & Ethics 1 (2021), Available at SSRN: or

Medha Makhlouf (Contact Author)

Pennsylvania State University, Dickinson Law ( email )

150 S College St
Carlisle, PA 17013
United States

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