#implementation

labor and delivery wards have become immigration checkpoints

imagine you're a hospital administrator on July 27, 2025, when this policy goes live. what the actual fuck do you do?

THE MORNING MEETING FROM HELL

Hospital CEO: "So... we need to check immigration status before issuing birth certificates now"

Legal Counsel: "But EMTALA says we can't"

HR Director: "Staff are threatening to quit"

IT Director: "Our systems literally can't do this"

Risk Management: "We're going to get sued either way"

THE IMPOSSIBLE PAPERWORK

For EVERY birth, hospitals now need:

Mother's documents:

Immigration status

Visa type and expiration

Entry date

Legal status at conception(?!)

Father's documents:

Same as above

But what if father unknown?

What if father disputes?

What if multiple possible fathers?

THE SYSTEMS THAT DON'T EXIST

Hospitals need to:

Verify immigration documents (how??)

Check federal databases (which ones??)

Confirm authenticity (are we ICE now??)

Do this during LABOR AND DELIVERY

Nobody has these systems!

THE ETHICAL NIGHTMARE FOR DOCTORS

Hippocratic Oath: "First, do no harm"

Doctor's new reality:

Deliver healthy baby ✓

Deny them citizenship ✗

Create stateless person ✗

Violate medical ethics ✗

THE NURSE REBELLION

Labor & Delivery nurses across the country:

"We're healthcare workers, not immigration agents"

Reports of:

Mass resignation threats

Refusing to collect status info

"Forgetting" to check documents

Civil disobedience in scrubs

THE LEGAL LIABILITY CHAOS

Hospitals can be sued for:

Following federal order (by states)

Not following federal order (by feds)

Discrimination (by families)

Malpractice (by everyone)

Legal departments in meltdown.

THE REAL SCENARIOS PLAYING OUT

Scenario 1: Woman in active labor arrives Husband fumbling for documents Baby crowning "MA'AM WE NEED YOUR VISA"

Scenario 2: Teen mother, no ID Father unknown Baby born Now what? Stateless by default?

Scenario 3: Parents have different statuses Divorce proceedings ongoing Who counts as "father"? Legal clusterfuck

THE DATABASE REQUIREMENTS

Hospitals need access to:

USCIS systems

State Department visa records

ICE databases

Birth parent verification

NONE OF THESE EXIST FOR HOSPITALS

THE PRIVACY VIOLATIONS

HIPAA vs. Immigration enforcement:

Medical privacy protected

But must share for citizenship

Conflicting federal laws

Lawsuits inevitable

THE EMERGENCY ROOM CRISIS

EMTALA (Emergency Medical Treatment Act):

Can't turn away emergencies

Can't ask status before treatment

But must ask for birth certificate?

Federal law fighting federal law.

THE TECHNOLOGY DISASTER

Hospital IT systems:

Built for medical records

Not immigration verification

Integration costs: $10-50M per hospital

Timeline: 2-3 years minimum

But policy starts NOW.

THE STAFF TRAINING IMPOSSIBILITY

Need to train:

Doctors on immigration law

Nurses on document verification

Registrars on visa types

Security on document fraud

With what budget? What time?

THE ACTUAL FORMS BEING CREATED

"Birthright Citizenship Determination Form"

15 pages

200+ fields

Requires legal attestation

In active labor???

THE STATE VS. FEDERAL FORMS

California: "Use our citizenship certificate" Feds: "Use our non-citizen certificate" Hospital: "WE HAVE BOTH NOW WHAT"

THE INSURANCE CHAOS

Insurance companies:

Cover citizens differently

Need status for billing

Denying coverage for stateless

Creating healthcare apartheid

THE PUBLIC HEALTH DISASTER

Women avoiding hospitals:

Home births skyrocketing

Prenatal care plummeting

Maternal mortality rising

Infant deaths increasing

All predictable. All preventable.

THE SECURITY CONCERNS

Hospitals becoming targets:

Protests at entrances

ICE wanting access

Families desperate

Violence potential high

THE WHISTLEBLOWER CASES

Hospital workers reporting:

"We're falsifying documents"

"Administration ordering discrimination"

"Babies being trafficked"

"This is genocide"

THE INTERNATIONAL DOCTORS

Foreign-trained doctors on visas:

Their own kids affected

Treating stateless babies

Moral injury off charts

Many leaving medicine

THE COST EXPLOSION

Implementation costs per hospital:

Legal compliance: $5M

IT systems: $20M

Training: $3M

Security: $2M

Lawsuits: ???

THE CATHOLIC HOSPITAL CRISIS

Catholic hospitals (15% of US beds):

Religious duty to protect life

Moral obligation to dignity

Can't participate in creating stateless

Facing federal punishment

THE MEDICAL RECORDS NIGHTMARE

How to record:

"US Born: Yes"

"US Citizen: No"

Makes no sense

Systems can't handle

THE PEDIATRIC FOLLOW-UP

Pediatricians asking:

Can stateless babies get vaccines?

School physical forms?

Medicare eligibility?

Nobody knows

THE TRANSFER PROBLEMS

Baby needs NICU at different hospital:

Transfer requires documentation

What documents for stateless?

Insurance coverage?

Legal guardian rights?

THE UNION RESPONSE

Healthcare unions:

Filing grievances

Refusing unsafe work

Protecting members from liability

Considering strikes

THE DAILY ABSURDITY

Actual hospital conversation: "Congratulations on your baby girl!" "Is she American?" "Well, that depends on your visa expiration date" "...what?" "Welcome to 2025"

THE BOTTOM LINE

Hospitals are being forced to:

Become immigration enforcers

Violate medical ethics

Create impossible systems

Destroy patient trust

All to harm babies

This isn't healthcare. This is healthcare held hostage.

And everyone knows it's insane.

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POTUS, please quickly implement your Executive Order promoting access to voting!

550 so far! Help us get to 1,000 signers!

In 2021, President Biden issued an executive order to promote access to voting. Among other things, the order required the heads of federal agencies to come up with strategic plans for promoting voter registration and voter participation, including by directing people to an improved vote.gov. In a February 20, 2024, letter to the U.S. General Services Administration more than a dozen senators requested an update on progress in implementing the executive order. And I agree with them—this needs to get done! I want the administration to fully and swiftly implement the executive order. Specifically: Please honor the senators’ request for the GSA’s implementation plans, including updates, timelines, and deadlines, and the date that the modernization of Vote.gov will be completed. And please make sure, pursuant to the executive order, that federal agencies have increased access to information about voter registration and elections, maximized participation under the National Voter Registration Act, and designed recommendations to help maximize participation from various communities. We must do all we can to protect Americans’ right to vote. Thanks.

▶ Created on February 28 by Jess Craven

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