The Threat of Florida’s New Legislation on Undocumented Individuals—A Call for Action

For many, the United States is a renowned nation full of opportunity, as explicated by the moniker the “land of the free.”¹ Yet, when we think of this phrase, we recognize that that this opportunity is a luxury that is mostly reserved for the privileged group. For any minority group, whether related to race, ethnicity, gender, sexual orientation, socioeconomic status, religious belief, or documentation status, the reality is much different, and their freedom comes at an inflated cost. This is particularly true and more evident in some regions and states within the US such as Florida.

The population of Florida is diverse. According to the US 2020 census bureau, 1.1% of the people in Florida identify as American Indian and Alaska Native alone, 6% as Asian, 12.4% as Black alone, 18.7% as Hispanic, 0.2% as Native Hawaiian and Other Pacific Islander alone, and 61.6% as White.² The makeup in South Florida is even more distinct, with Hispanic individuals accounting for up to 69% of the Miami-Dade County population.³ Florida comprises diverse cultures, cuisines, and artistry. Its unique makeup is part of what makes the state appealing for those seeking “the American Dream,” including immigrants from Latin America.

Florida has the highest population increase in the US to date.⁴ As of 2021, immigrants composed 21.2% of the total population in Florida, a substantial growth from 16.7% in 2020 and 12.9% in the 1990s. Approximately 75% of the non–US-born immigrants residing in Florida come from Latin America and 58% self-identify as Hispanic or Latino.⁵ As of 2019, 40% of the immigrants in Florida were not citizens.⁶ It is estimated that there are approximately 772 000 migrants who have migrated to Florida without legal permission, mainly from Mexico, Venezuela, Guatemala, Honduras, and Colombia.⁶ Most undocumented immigrants are an essential part of the labor force, frequently occupying positions including construction; health care; janitors and building cleaners; agriculture, food, and beverage manufacturing; and transportation.⁶

July 1, 2023, was a date feared by non–US-born undocumented immigrants. The date stood for the implementation of a landmark immigration bill targeting this population in the US. Florida governor, Ron DeSantis’ Bill 1718 provides a $12 million initiative to deport undocumented immigrants. Effective from July 1, 2023, the bill enforces documentation policies and threatens to fine and incarcerate employers who hire and transport unauthorized individuals. The new law also demands hospital systems to report the costs used to supply health care for unauthorized patients.⁷ The proposed bill could have a negative impact on health care for a population that has already been vulnerable and underserved. Because national databases do not currently account for documentation status, the specific incidence and mortality of cancer for non–US-born undocumented immigrants are unknown. However, the statistics for non–US-born Hispanic immigrants could be carefully extrapolated to assess cancer trends in this population. Historically, Hispanic individuals have higher rates of gastric and cervical cancers and associated mortality than non-Hispanic White individuals.⁸ Hispanic individuals are the highest uninsured racial and ethnic group in the US, which is associated with lower rates of screening, more advanced cancer diagnoses, staged diagnosis of cancer and, for many, worse overall mortality rates.⁹

Amidst concerns of deportation due to the enforced immigration laws from Bill 1718, there will be a greater delay in the urgency of seeking medical care. The incidence of late-stage diagnosis and overall mortality is foreseen to worsen. Even patients who seek prompt medical care might still face greater barriers in access, and health care in general can be more limited as the bill acts on fear and requires medical centers to report health care costs used for undocumented immigrants.

I recall a story from a patient that illustrates the reality that current undocumented individuals living in Florida are experiencing due to Bill 1718. The patient was an adult man, native of Colombia, who immigrated to Miami 20 years ago. Despite multiple attempts, he was unable to receive residency and, therefore, lived without legal documents. Due to his undocumented status, he had not seen a physician for the 20 years that he lived in the US until he started experiencing hoarseness that eventually led to a diagnosis of cancer. The patient presented to my office with a rapidly growing but curable laryngeal cancer, for which treatment with chemoradiation was recommended. However, the patient was uninsured and intended on covering all the cancer-directed care as self-pay. He had reached out to local health organizations known to provide low-cost cancer-directed treatment to uninsured individuals but was turned away due to his documentation status and the implementation of the new bill. Such organizations now had to collect information about patients’ immigration status and report it to the state, forcing them to steer away from providing oncological care to undocumented patients.

I felt helpless and carried a heavy burden in my heart for the upcoming days. I had pursued this career to help patients in their most vulnerable states and devoted my best efforts to supply adequate treatment and hope for all. Yet, my calling was now affected by situations outside my control. The emotional and physical turmoil that accompanies a cancer diagnosis is troubling enough for patients to also endure the uncertainties of their cancer treatment and survival due to this senseless bill. I moved to Miami to care for people like myself by providing cancer-directed care to patients from minority groups with shared background and culture that had experienced discrimination and marginalization. I vowed to be a voice for the voiceless, to care for those without the luxury of having a physician who looks and speaks like them, to advocate for them in their native language, and to be a physician who shares similar values and beliefs.

As physicians, we take an oath to do no harm and vow to care for all patients in need without bias or judgment. Yet that is now influenced by outside forces beyond us. We fear that the impact of Bill 1718 will only widen preexisting disparities that have been present for decades. The government is instructing us, as physicians, to overturn our professional responsibilities of providing care to all and perpetuate the targeting and criminalization of marginalized populations. As a call to action, I propose physicians in Florida to have a dialogue with their health care institution about ways to cope with having to report health care services for undocumented individuals. We must discuss with our institutions and leadership about how to develop and create algorithms to provide care for those affected. One workable way is to designate staff, like nurse navigators and coordinators, to aid in implementing adequate cancer-directed care for undocumented patients with cancer by using institutionally designated resources allotted to this population. Additionally, all Floridians should call legislators to demand the overruling of this anti-immigrant and unconstitutional bill that could potentially lead to a public health crisis. Moreover, as a nation, we cannot turn a blind eye and must unite to overcome this discrimination. Despite not being directly affected, individuals from other states should stand with the state of Florida and demand justice by writing letters to the federal government and conducting town meetings demanding federal action. The state of Florida is discriminating against immigrants who migrated from their native countries to escape inhumane living conditions, including extreme poverty leading to hunger, political wars, and gang violence. We must act with empathy and compassion toward those in need. We must join as one and fight for equity, equality, and the ability to live without fear.

Humanitarian Mary McLeod Bethune once stated “If we accept and acquiesce in the face of discrimination, we accept the responsibility ourselves and allow those responsible to salve their conscience by believing that they have our acceptance and concurrence. We should, therefore, protest openly everything…that smacks of discrimination or slander.”¹⁰