The Dictatorship
Without insurance, immigrant patients may face unregulated ‘medical deportation’
ALLENTOWN, PA. (AP) — Junior Clase’s cluttered kitchen table paints a picture of his life in the United States. Scattered across it are bottles of deodorant and conditioner that he sends back to the Dominican Republic, a Spanish-language Bible and a plastic medical brace for his wife, Solibel Olaverria.
Olaverria began having intense headaches and vomiting five months after she joined her husband in the U.S. In the emergency room, she was diagnosed with a brain aneurysm; during surgery to stop it from rupturing, she suffered a stroke and was induced into a coma.
She left the couple’s Allentown row house in December 2022 and has yet to return. Clase worries she never will.
In February 2023, Clase said, hospital administrators suggested transporting his still-comatose wife to a facility back in the Dominican Republic – an option he refused.
“They told me that they could send her back to my country,” he said – even without his consent. “At that moment, she was missing a piece of her skull. … If they put her in an airplane or a helicopter, it was possible that she would die.”
Though the federal government is the only entity with the jurisdiction to remove people from the U.S., hospitals across the nation sometimes return uninsured noncitizen patients in need of long-term care to their countries of origin.
Advocates call this “medical deportation.” Hospitals and medical transport companies refer to it as “medical repatriation.” By either name, the practice exists in ethical and legal gray areas – without specific federal regulations, widespread public knowledge or a national tracking system.
Facing limited options for care, some immigrant patients and family members may voluntarily decide to continue treatment outside of the U.S. Other times, experts say, the process occurs without full consent.
Lori Nessel, a professor at Seton Hall University who supervised a 2012 report about medical repatriation, said the practice amounts to “private deportation.”
“They were essentially being deported,” she said, “but outside of the legal process for deportation, because there was no immigration court involved.”
While some foreign governments track these repatriations, data is inconsistent and doesn’t reflect whether patients wanted to return, felt they had no other option or were forced to leave.
Over the past two decades, academics, advocates and reporters have struggled to put a number on the phenomenon, which involves a tangled network of hospitals, air transport companies and consulates that work in different states and countries.
Since 2020, the Philadelphia-based Free Migration Project has tracked 19 cases of patients facing medical deportation, through referrals and a telephone hotline it runs. Six of those came in the first six months of 2025, from cities in Pennsylvania but also Florida, New Jersey and New York, according to Adrianna Torres-García, deputy director of the organization.
“We’ve had a higher volume of cases in the same span of time than any other given year,” Torres-García said. “It’s also more complex cases.”
Experts believe medical deportation happens more than tracking efforts account for, and some worry cases could now increase, given that the practice sits at the intersection of health care and immigration – two systems undergoing drastic change in the second Trump administration.
Early on, Olaverria was able to get treatment under a federal law that requires Medicare-participating hospitals to provide stabilizing care to anyone with an emergency condition, regardless of insurance, ability to pay or immigration status. Hospitals can then file for reimbursement through Emergency Medicaid.
But the tax and spending cut bill President Donald Trump signed in July significantly reduces how much the government will pay into Emergency Medicaid. The law also makes some immigrants, including refugees and asylees, ineligible for traditional Medicaid and Medicare.
Immigrants without legal status have long been ineligible for these programs, and even green card holders have to wait five years before they are eligible for Medicaid.
In effect, experts said, the changes will leave even more immigrants uninsured and provide less funding for emergency care if they need it.
“If immigrants are unable to get as much coverage, then they’re not going to be able to get as much care,” said Andrew Cohen, an attorney with Health Law Advocates, a public interest law firm in Boston. “That’s where medical deportations could really grow.”
The legal requirement to treat anyone with an emergency condition won’t go away, said Benjamin Sommers, a health policy researcher at Harvard University. But with the federal government paying less toward Emergency Medicaid, states could also decide to reduce how much funding goes to emergency care, shifting the burden to hospitals – or individuals.
Patients “get sent bills that they often can’t pay, that often are going to go to collections,” Sommers said, adding that some may even go bankrupt. “Sometimes we see hospitals diverting patients. … I think there’ll be more of that.”
Raymond Lahoud, a Pennsylvania lawyer who represents hospitals and health networks in cases related to immigration, said hospitals fulfill their obligations to treat all patients but often need to consider further options once those patients are stabilized.
“There comes a point where the hospital has done everything it medically could do, and now that person has to move on to their next step in rehabilitation or certain kinds of end-of-life care,” he said.
U.S. citizens might be discharged to other hospitals, long-term care facilities or their families. Noncitizens, with limited access to health insurance, might instead get sent to a facility in their country of origin.
Hospitals sometimes pay private medical transport companies to conduct repatriations and provide in-air care. These services routinely cost tens of thousands of dollars but may still be cheaper than long-term or indefinite care; in the U.S., inpatient hospital care cost an average of $3,132 per day in 2023, according to health policy research firm KFF.
“Unfortunately, it becomes a financial burden to the hospital,” said Craig Poliner, president of MedEscort, an Allentown-based medical air transport company that works with hospitals to facilitate medical repatriations.
Poliner insisted that MedEscort would never repatriate a patient without consent and said company officials work with hospitals to follow the American Medical Association’s discharge guidelines.
“The patients really do better in their own countries, in their own culture,” he said. “We’re not forcing anybody back. We convince them why we think it’s better. If we have the right approach, it usually resolves itself.”
However, advocates noted that immigration status, a lack of insurance, the injury or illness itself, unfamiliarity with the health care system and language barriers can hinder someone’s ability to give informed consent.
In 2013, John Sullivan, a social worker based in Tempe, Arizona, traveled to Mexico to study medical repatriation as part of a Fulbright scholarship. He interviewed patients who had been sent back, along with family members, health workers and Mexican officials.
Sullivan said the circumstances surrounding consent in some of those cases were “unclear.” “It was almost like migrants would describe feeling like they had no other choice,” he said.
Olaverria entered the U.S. on a temporary tourist visa, and when she sought treatment, she was uninsured. In the first days of March 2023, Clase said, hospital administrators gave him an ultimatum: Find care for his wife elsewhere, or they would follow through with her transfer to the Dominican Republic.
Clase said the only option he felt he had was to keep his wife where she was. He didn’t believe she would survive the flight to the Dominican Republic, and if she did, he didn’t trust that she’d receive the care she needed there. He couldn’t properly care for her at home, and she didn’t have insurance to cover the cost of another facility in the U.S.
Local advocates connected Clase with the Free Migration Project, which organized protests against Olaverria’s transfer. Outside the hospital, protesters carried homemade signs on neon-colored posters calling for an end to medical deportation.
After local media coverageClase said, hospital administrators agreed to hold off on the transfer if they could work together to find another long-term care option. The hospital did not respond to requests for comment.
Media coverage of Olaverria’s case helped bolster interest in a bill before the Philadelphia City Council to stop nonconsensual medical repatriations, and in December 2023, it became the nation’s first and only law banning the practice, according to experts.
The policy requires hospitals in the city to obtain patients’ written consent and provide information about their rights and options for care before transferring them out of the U.S. It also requires hospitals to determine whether patients are eligible for programs that could pay for their care – and, if so, help them enroll.
Philadelphia hospitals also must now report medical repatriations to the city’s Department of Public Health. Agency spokesman James Garrow said hospitals submitted five repatriation reports in 2024, the first full calendar year for which data was collected.
Claudia Martínez participated in the campaign to pass the law after her uncle faced medical repatriation. The personal photos, wedding memorabilia and Bible quotes that decorate her living room walls hang alongside a “Community Power Award” from the Pennsylvania Immigration Coalition.
“I don’t want anyone to go through what I went through,” Martínez said.
In May 2020, a motorcycle struck Martínez’s uncle, an immigrant from Guatemala. When Martínez arrived at the hospital, she found him comatose and intubated, with injuries that rendered him almost unrecognizable.
Weeks later, Martínez said, a hospital social worker asked for her uncle’s immigration status. She later learned the hospital and MedEscort planned to transfer him to a facility in Guatemala.
“I was in shock,” Martínez said. “He was intubated. … He was not in a condition to travel.”
She said she rejected the transfer in conversations with hospital officials and MedEscort, but Poliner said MedEscort got authorization for the repatriation from family members in Guatemala. Martínez disputes that.
Eventually, Martínez connected with the Free Migration Project, which organized a protest outside the hospital on the day of her uncle’s scheduled trans fer.
In the end, the medical deportation was scrapped. Ultimately, with the help of community advocates, Martinez’s uncle was able to access a form of state-sponsored insurance. He moved into a rehabilitation center and stayed for three years, until his insurance ran out.
In May 2024, his family decided it would be best for him to return to Guatemala to be at home with his wife. He can walk again but has significant memory impairments.
“He is someone who loves to joke,” Martínez said. “This, I think he didn’t lose.”
Consulates are often involved in the medical transport of their citizens, helping to secure travel documents and occasionally paying for airfare on less expensive commercial flights.
Between 2014 and 2024, the Mexican General Directorate of Consular Protection and Strategic Planning reported 8,227 medical repatriations; 328 of those took place in 2024. The data does not distinguish between patients who wanted to return and those who felt pressured or coerced.
“Sometimes the level of care that they are going to receive in their hometowns … is not going to compare to the one they receive here, and they know that – so it’s very rare that a patient says, ‘I want to leave,’” said one Mexican consular official, who did not want to be named to avoid repercussions in their ongoing work with hospitals.
If patients want to stay in the U.S., they may not know what options are available to them. Hospitals, too, may be unaware of alternatives, said Cohen, who runs a program that helps eligible immigrant patients access insurance.
In some states, immigrants who don’t qualify for federal insurance programs may be able to access certain state-funded programs instead.
“(Hospitals are) preemptively doing something that they wouldn’t even need to do if they knew about these pathways into better coverage,” Cohen said.
In May 2023, Olaverria was transferred into a long-term care facility in Allentown. Two months later, she woke up from the coma. She still cannot walk or use the bathroom on her own, and she can speak only a few words.
Later that year, Clase and his wife obtained medical deferred action, which allowed them to temporarily remain in the country. It also allowed Clase to get a work permit and Olaverria to access emergency medical assistance from the state.
Between working two jobs and attending church services three times a week, Clase keeps his ritual of visiting his wife every day. Flower bouquets rest on the bookshelf in her room.
He wipes her mouth, adjusts her neck and massages her curled-in hands. And he still tells her stories that can make her laugh.
For him, life outside this routine is virtually nonexistent. When he gets home each night, he sleeps and occasionally cries.
“This country consumes you,” he said.
Clase and Olaverria are working to apply for a visa that would allow them to stay longer. But her ability to continue in long-term care is uncertain.
Despite this, Clase carries forward, focused on the familiar paths of his daily routine, all of which lead to Olaverria.
“The majority of my time,” he said, “I dedicate it to my wife.”
___
This report is part of “Upheaval Across America,” an examination of immigration enforcement under the second Trump administration produced by Carnegie-Knight News21. For more stories, visit https://upheaval.news21.com/
The Senate Judiciary Committee postponed a vote on acting Attorney General Todd Blanche’s nomination, a spokesperson said late Wednesday, as two retiring Republicans on the panel dug in over President Donald Trump’s personal “anti-weaponization” deal with the government he runs.
Sen. Chuck Grassley’s decision to delay the committee vote that had been set for Thursday marks a setback for one of Trump’s highest-profile Cabinet nominees, at the hands of Texas Sen. John Cornyn and Sen. Thom Tillis of North Carolina, a pair of Republicans set to leave the chamber next year.
“Chairman Grassley works to set President Trump’s nominees up for success in committee, not failure. Senators Cornyn and Tillis want written assurances from the Department of Justice regarding the Trump-IRS settlement,” the committee spokesperson said.
Blanche’s nomination to permanently head the Department of Justice needs the support of either Cornyn or Tillis to make it out of the committee to a vote by the full Senate, assuming all Democrats remain opposed.
“Why don’t you call over the Department of Justice and tell them they have one hour and 50 minutes to get me what I asked for,” Cornyn told reporters Wednesday afternoon amid the hardening standoff over his demand that Blanche and the DOJ put in writing a commitment never to pursue the president’s prized “anti-weaponization” fund, and to clarify the terms of Trump’s personal deal with the Internal Revenue Service.
Tillis told MS NOW that the conversations were complicated by the need for the Justice Department to get “several parties” to agree on the language of the statement Cornyn and Tillis are seeking.
“What I’ve advised the chair, and I would assume Senator Cornyn said something similar, is that we’re not prepared to vote yes yet,” he added.
“The Department has been in regular communication with Committee members for weeks, and we look forward to continuing to work productively with Senators to address any concerns,” a Justice Department spokesperson said in response to the decision to postpone the committee vote.
Cornyn was set to meet with Blanche on Wednesday morning, but the meeting was called off after Blanche failed to meet the senator’s demand for written proposals to modify the controversial settlement agreement he brokered between Trump and the IRS. The Republican senator is set to leave Congress when his term ends in January after a bruising May primary loss to Texas Attorney General Ken Paxton, Trump’s chosen candidate.
“Maybe John Cornyn’s upset with me because I didn’t endorse him,” Trump told reporters Wednesday afternoon in the Oval Office. “I don’t know what it is, but I haven’t heard that there’s a problem. I heard (Blanche) is going through quite nicely.”
Cornyn made clear to Blanche during his confirmation hearing that he will not get his support until he agrees to reopen and modify the settlement. Due to the committee’s narrow Republican majority, one GOP “no” vote is enough to sink Blanche’s nomination.
The senator has asked Blanche to provide proof that the proposed nearly $1.8 billion “anti-weaponization” fund established as part of the deal between Trump and the IRS is formally dead, and he has also demanded Blanche narrow the tax audit immunity provisions the settlement afforded to Trump and his family.
Blanche has publicly stated that his department has dropped the fund, but he and the DOJ have dodged requests from Cornyn and a federal judge to put that in writing.
After announcing his meeting with Blanche would not take place Wednesday morning, Cornyn told reporters that changes from Blanche “in a modified release form” would be acceptable, but that “for some reason … they simply refuse to do it,” referring to the DOJ.
Shortly after the meeting was called off, a Justice Department official told MS NOW that the department “provided a written proposal to Senator Cornyn’s staff yesterday following ongoing discussion with both the Committee and the Senator’s office.”
Cornyn said that proposal was “not responsive” to his demands because it did not address the tax audit immunity provisions in the settlement, one of his key demands.
In May, Blanche signed an addendum as part of the deal that granted Trump, his family and his businesses immunity from pending IRS tax audits. That agreement, which has been decried by former IRS officials and legal experts as unlawful self-dealing, is being contested in federal court.
Cornyn noted that Blanche testified under oath that he could meet the request during his confirmation hearing.
“Maybe they think I’m just going to give up or you know, go along, but they’re mistaken,” Cornyn said when asked why he thinks the DOJ could be slow-walking his request.
Kevin Frey contributed to this report.
Sydney Carruth is a breaking news reporter covering national politics and policy for MS NOW. You can send her tips from a non-work device on Signal at SydneyCarruth.46 or follow her work on X and Bluesky.
Mychael Schnell is a reporter for MS NOW.
Ebony Davis is a breaking news reporter for MS NOW based in Washington, D.C. She previously worked at BLN as a campaign reporter covering elections and politics.
When Israeli Prime Minister Benjamin Netanyahu arrived this week for his tour of Washington, he may have had a mission in mind.
Netanyahu needed to overcome his newly diminished stature and waning influence over his once close friend President Donald Trump as both leaders grapple with the unpopularity of a war they started together and is escaping their control.
His meeting at the White House with Trump on Tuesday, which was closed to the press, was the first face-to-face encounter between the two allies since the U.S. and Israel launched a joint attack against Iran on Feb. 28.
Trump gave him a muted welcome and afterwards simply described the meeting as “very good.” “Obviously, many important subjects were discussed,” the president wrote on Truth Social.
Rather than an intimate one-on-one setting, the Oval Office was full of top U.S. officials — Vice President JD Vance, Secretary of State Marco Rubio, Treasury Secretary Scott Bessent, Secretary of Defense Pete Hegseth, Chairman of the Joint Chiefs of Staff Gen. Dan Caine, and special envoy Steve Witkoff.
But Netanyahu continued the full court press on the Trump administration.
Over the course of two days, in addition to seeing Trump and attending Sen. Lindsey Graham’s funeral at the Capitol, Netanyahu also met separately with Vance, Hegseth, and Rubio, White House and Israeli officials confirmed to MS NOW.
The Israeli prime minister’s slate of meetings with key U.S. national security officials comes at a pivotal moment in the Iran conflict as tensions escalate in the region and Americans increasingly sour on the war. A recent Quinnipiac poll shows 60% of American voters opposing U.S. military action against Iran and 74% against sending U.S. ground troops into Iran.
Not only does Trump face pressure as Republicans face an uphill battle to retain congressional control in this fall’s midterms, Netanyahu’s fate as prime minister is at stake in Israel’s upcoming September elections – and he can’t afford to lose Trump’s favor.
The talks largely focused on what to do next as Iran continues to menace shipping in the Strait of Hormuz and retaliate against American bases in the region and launch attacks on Gulf allies.
According to a senior Israeli official who was granted anonymity to describe the closed-door meeting, President Trump and Israeli Prime Minister Netanyahu did not come to a final decision after discussing three paths forward: get a “good deal” focused on Iran’s nuclear program and enriched material, have no deal and instead continue the blockade and economic pressure, or take escalated military action.
But Netanyahu did not tell Trump what he should do – nor did he express a preference.
The senior Israeli official noted Netanyahu has not ruled out diplomacy – as long as it is coupled with “very strong pressures,” calling the push to dismantle Iran’s nuclear program “a contest of will and a contest of force.”
“There are ways of squeezing them and squeezing them and squeezing them and negotiating at the same time,” the official said.
Netanyahu did not present President Trump with new intelligence regarding the underground Iranian nuclear facility Pickaxe Mountain, per the senior Israeli official, noting the U.S. and Israel already are constantly sharing intelligence – and know where Iran’s highly enriched material is. “We don’t think it’s moved, and I think we have a pretty good grasp on that,” the official said.
During their meeting on Tuesday, Trump and Netanyahu discussed ways Israel and the U.S. can work together to stop Iran’s nuclear program and get the Strait of Hormuz open to maritime trade, the senior Israeli official said.
The two leaders also discussed a third goal: to continue to undermine the Iranian regime and “possibly create future conditions for a change in that area.” U.S. officials have backed away from pursuing paths that would overthrow the current leadership, but Netanyahu still believes that could happen.
“The chasm that has been created between the people and the regime is not about to be closed,” the senior Israeli official said of Netanyahu’s thinking.
Netanyahu advised Trump in February that Israeli intelligence indicated launching strikes against Iran would lead to the toppling of the Islamic Republic’s regime – and five months later, the slain ayatollah’s son retains power with a close circle of hardliners, calling into question the accuracy of Israel’s intelligence apparatus.
But the senior Israeli official said at the time, Netanyahu did not promise the Iranian people would take fate into their own hands following a coordinated attack. Rather, he chose his words carefully and said that an attack could create conditions to “advance the probability or the possibility that that would happen.”
The conditions needed for the Iranian regime to fall, “did not materialize,” the official told MS NOW, adding, “not for lack of insight, but for either operational failure or decisions that were made.”
Despite Netanyahu insisting Israel and the U.S. are on the same page, differences still remain: the sale of F-35 fighter jets to Turkey and the Saudi nuclear arrangement did not come up during Wednesday’s White House meeting, according to a second Israeli official granted anonymity to describe sensitive discussions.
Meanwhile, the conflict continues to spread, with an Iranian drone attacking a U.S. gas storage tanker off the coast of Egypt on Wednesday.
Trump indicated he would not let Iran’s latest action slide, telling reporters on Wednesday that the U.S. would retaliate against Iran even as he leaves room for diplomatic talks to resume.
“It’s our turn, and we’ll see if we get there with an agreement at some point,” Trump said. “But we’re going to hit them very hard.”
As for what it would take for Israel to join the U.S. strikes, the senior Israeli official said that if Israel is attacked by Iran, “We will respond very, very forcefully and very quickly. And I think Iran would make a great mistake.”
Julia Jester covers politics for MS NOW and is based in Washington, D.C.
International rage over FIFA’s close ties to President Donald Trump has reached a fever pitch after soccer’s governing body announced a plan to sell a significant stake to an investor group led by Joshua Kushner, the brother of Trump’s son-in-law.
The president and his family have all but turned the White House into their personal piggy bank. And FIFA — which has its own sordid history of corruption — seems to have made itself a party to Trump’s self-enrichment under Gianni Infantino’s leadership, such as by paying for space inside Trump Tower in New York. (The organization has defended the office rental as a World Cup outpost.)
Soccer is seen by many as a unifying game. But Trump’s incorporation of FIFA into his political dynasty is threatening that idea.
FIFA has announced plans to sell a large minority stake in a new company that will run its main events, including the World Cup and Club World Cup, as part of a plan to triple the amount of development money it dishes out to its 211 member associations.
Under the proposals — which are subject to approval by a majority of those national associations and FIFA’s 37-member council — a new entity called FIFA Forward Enterprises (FFE) will take over all commercial operations, while FIFA remains the game’s global governing body and retains a majority stake in FFE.
A press release from FIFA confirmed the plans and said Thrive Eternal, which was launched by Joshua Kushner, is expected to lead the investment group that would control FIFA Forward Enterprise. FIFA did not clarify why Thrive Eternal was selected, and Kushner was already dabbling in sports.
But Trump basically has already given son-in-law Jared Kushner carte blanche to dictate U.S. foreign policy in the Middle East while simultaneously hatching business plans in the region. (Jared Kushner has denied any conflicts of interest.)
Joshua Kushner reportedly has been a major donor to Democrats. But, predictably, the idea of another Kushner becoming financially entwined with the World Cup — the world’s most popular sporting event — and basically being dropped into a position of global significance isn’t going over well. Several other soccer governing bodies have expressed concerns, including Europe’s UEFA.
“This crosses a line that football’s governing institutions should never cross,” UEFA said in a statement about The Athletic’s report, adding: “The soul and governance of football are not assets to trade — especially with zero transparency as to who gains financially. None of us are the owners of football. It is not FIFA’s to sell.”
Democrats on the House Judiciary Committee also rebuked the plan, writing on X: “Apparently the fake Peace Prize and giant lease with Trump Tower weren’t enough — now Infantino performs a kickback hat trick by pursuing a multibillion-dollar deal with Jared Kushner’s brother to sell ownership stakes in the World Cup to private investors.”
FIFA, Donald Trump’s favorite corrupt racketeering enterprise in world sports, is now going directly into business with the Trump family!
Apparently the fake Peace Prize and giant lease with Trump Tower weren’t enough—now Infantino performs a kickback hat trick by pursuing a… https://t.co/knSZibuMea
— House Judiciary Dems (@HouseJudiciary) July 28, 2026
Rep. Jamie Raskin, D-Md., has already launched an investigation into the FIFA leader’s relationship with the Trump administration, while dozens of European lawmakers — citing concerns about “potential breaches of political neutrality” — have called for the FIFA Ethics Committee to investigate Infantino. This new proposal seems unlikely to assuage those concerns.
But what it does seem likely to do is fuel global anger toward the U.S. — the kind that has been growing since Trump retook office.
And when you consider that, it’s truly remarkable how the same MAGA movement whose members whined for years about politics mixing with sports is now in lockstep with a president who seems dead-set on casting his shadow over every sports event he can.
This post on X basically sums up the foul stench around FIFA’s latest proposal.
Sepp Blatter was Infantino’s predecessor as FIFA president and oversaw the organization amid some of its many scandals. When heof all people, is warning about how Trump and Infantino’s relationship is “deeply damaging” soccer, it’s a sign of how far FIFA has descended into the gutter.
Ja’han Jones is an MS NOW opinion blogger. He previously wrote The ReidOut Blog.
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