On July 4, 2025, President Donald Trump signed the “One Big Beautiful Bill”—a sweeping 900-page overhaul that reshapes immigration, healthcare, and social policy. The legislation includes major investments in immigration enforcement, deep cuts to healthcare and nutrition programs, and significant shifts in tax policy.
At Doctors of the World, we’ve seen firsthand how shifts in immigration enforcement directly impact the health and well-being of migrants and asylum seekers. Based on our work providing care to communities affected by displacement and exclusion, we are deeply concerned about the implications of this legislation. While enforcement efforts are often framed as targeting “violent criminals,” our work on the ground tells a different story: asylum seekers living in fear, families being separated, and access to critical healthcare is being disrupted.
The bill allocates an unprecedented $100 billion to Immigration and Customs Enforcement (ICE), $45 billion for detention centers, and $46.5 billion for border wall construction, representing a massive escalation in anti-immigrant enforcement. Meanwhile, the massive cuts to Medicaid, a public health program for low-income families, older adults, and people with disabilities, threaten the already fragile healthcare safety net, leaving NGOs stretched and strained.
Enforcement Surge Deepens Barriers to Care
With ICE’s budget ballooning to $100 billion, arrest rates are expected to soar, further overcrowding these facilities. Alarmingly, the administration has revoked protections for churches, schools, and hospitals, making even these spaces unsafe for undocumented migrants.
“We have seen decreases in migrants seeking emergency room care and an increase in appointment cancellations at the low-cost clinics,” says Megan Bayes, program manager for Doctors of the World in El Paso, Texas. “People whom we have spoken with have expressed fear to seek medical care, fearing the possibility of Immigration and Customs Enforcement presence in these spaces.”
Doctors of the World has been active in El Paso, providing care and advocacy for newly arrived migrants. Even before this legislation, harmful border policies were already jeopardizing migrant health and safety. Now, with $170 billion earmarked for immigration enforcement, the consequences will only deepen.
The ‘Big Beautiful Bill’ sets aside $45 billion to fund detention centers targeting a capacity of 100,000, including family units. Already, existing facilities face widespread criticism for inhumane conditions—lack of food, clean water, hygiene, and basic medical care.
Detention causes serious harm—worsening mental health, triggering trauma, and limiting access to care. A recent study by Harvard and UC Berkeley links prolonged detention to higher rates of PTSD and other mental illnesses. Overcrowding, staff shortages, and accelerated deportations intensify these effects, while inadequate infrastructure leaves critical health needs unmet, endangering lives.
Furthermore, a recent Supreme Court ruling has paved the way for ICE to resume deporting migrants to countries other than their own—without giving them the opportunity to contest the potential dangers they may face. This decision removes due process and puts people at risk of violence and abuse. We saw similar harm under Title 42, which led to over 10,000 reports of violence against migrants expelled to Mexico.
From El Paso to the Darien Gap: A New Phase of Humanitarian Need
As legal pathways close and support systems are dismantled, those fleeing violence, persecution, and health emergencies are met with shrinking options and growing danger.
At our clinic in El Paso, we’ve met people doing whatever they can to secure a future for their families — women like Maria, a mother and nurse from Venezuela who crossed the Darién Jungle to secure life saving medical treatment for her two sons, who suffer from a rare disorder, and Noor, an Afghan refugee who escaped the Taliban and traveled the treacherous path while pregnant, fleeing violence. Now, with rising deportations, increased border enforcement, and expanded barriers, families like theirs are left with nowhere to turn.
Migrants are turning back from the South Texas border, often in worse condition than when they left—physically, emotionally, and financially depleted. Doctors of the World has worked with partners to establish clinics along key points of the migrant route, including in Colombia and Mexico. Our field teams report that conditions along the route are rapidly worsening.
Many migrants report experiencing torture, sexual violence, and persecution in Mexico, all with profound effects on their health. A new phase of the humanitarian crisis is unfolding, as countries along the route struggle to meet basic needs like healthcare, mental health support, food, and transportation.
“We provide direct health care, including sexual and reproductive health and mental health and psychosocial support,” says Irene Menterola, Doctors of the World’s general coordinator in Colombia. “We advocate for rights and work against xenophobia, particularly supporting women, children, and LGBTQ+ people in high-risk areas.”
Despite these efforts, our ability to respond is being undermined by severe cuts to humanitarian aid, including the dismantling of USAID. The consequences will be devastating, especially for women and girls, who are more exposed to exploitation, gender-based violence, and unsafe conditions as they wait at the border or in transit. They are disproportionately affected by funding cuts, according to the United Nations sexual and reproductive health agency, UNFPA.
Erosion of the Social Safety Net: Straining NGOs and Healthcare Access
In the U.S., cuts to Medicaid, scheduled to go into effect in 2028, are expected to erode an already fragile social safety net—with disproportionate impacts on immigrants and low-income women. The bill imposes new work requirements and restricts eligibility for legal immigrants, refugees, and survivors of domestic violence. It also bans Medicaid reimbursements to key nonprofit providers like Planned Parenthood, limiting access to essential sexual and reproductive healthcare for those already facing systemic barriers to care.
Bayes warns that the impact will be felt on multiple fronts: low-income families who currently rely on Medicaid may lose their coverage, and community clinics—especially Federally Qualified Health Centers that depend on Medicaid reimbursements which may be forced to scale back services. As demand for low-cost care rises, these cuts risk deepening the already stark healthcare access gaps for migrant communities.
This combined with the dismantling of USAID and federal support slashed, NGOs face growing demand for care but shrinking resources. As access to federal programs disappears, more people will turn to charity care—just as NGOs are least equipped to respond.
This will have cascading effects on primary care, mental health, and reproductive services. Without access to preventive care, chronic conditions will go untreated, mental health crises will intensify, and communities may see a rise in preventable diseases.
Stepping Up as Systems Fray
Doctors of the World has long witnessed how harmful policies—like Title 42—devastate migrant health. But the “Big, Beautiful Bill” may be the most damaging yet. Its far-reaching consequences threaten the health, dignity, and safety of millions across the U.S. and Latin America.
Doctors of the World will continue to provide care along the migrant route and in El Paso, but charity alone cannot fill the gap left by sweeping cuts to U.S. foreign aid and domestic healthcare funding. As the safety net unravels, it’s the most vulnerable—migrants, women, and low-income families—who will bear the brunt. This is a moment to not only care—but to mobilize. In the face of these challenges, we’re doubling down on creative, community-based partnerships to meet urgent needs and defend the right to health.
The policies taking shape today will define who gets to live safely and with dignity tomorrow.
Sources:
- 4 ways Trump’s big bill could change the U.S. immigration system | PBS News
- Green Card Holders Impacted by Trump’s One Big Beautiful Bill – Newsweek
- How the GOP spending bill will fund immigration enforcement
- Fact-checking Trump’s immigration and One Big Beautiful Bill claims
- How Trump’s tax cut and policy bill aims to ‘supercharge’ immigration enforcement
- President Trump’s One Big Beautiful Bill: A Win for Workers, Farmers, and America’s Future
- What Trump’s ‘Big, Beautiful Bill’ Means for the Americas
- How Trump’s tax bill will affect Medicaid, ACA plans and hospitals : Shots – Health News : NPR