It was a mother’s intuition. Sara, 32, and her son, Oscar, 8, had been at the South Texas Family Residential Center in Dilley, Texas, for months by the start of the summer of 2020.* They were each deep in the day-to-day uneasiness of immigration detention: Sara waited to hear news on their slow-moving asylum case; Oscar tried to adjust to a new childhood reality in a maze of trailers in South Texas. Detention was unimaginably hard, but they were surviving.

One night, though, Oscar couldn’t sleep. His stomach hurt too much. Oscar was never sick. Concerned, Sara took him to the detention center’s medical facilities. After waiting for hours, the detention nurses told them that nothing was wrong. Oscar just had bad gas—he needed to drink water. A few days later, however, his pain had not subsided. When Oscar woke up in the middle of the night with what felt like a fever, Sara brought him back to the medical facilities. She knew something was wrong. The medical staff offered to watch him for a few days, but again refused to give him medicine. Water remained the only treatment for a new diagnosis: constipation. Sara could not provide Oscar with anything else. Her maternal instinct was hindered by their location. Her intuition, of course, was right.

A week after Sara first took Oscar to the medical facilities, he was rushed to the hospital in San Antonio over an hour away. It was appendicitis—he needed emergency surgery.

Sara and Oscar are two of many. Drawn to the “nation of immigrants” out of hope for a better life, they arrived to find an immigration system rife with neglect and abuse. For some, the presidency of Donald Trump brought the inhumane nature of immigration detention to the forefront. But, while critics of the country’s immigration scheme have looked to policymakers for change, they have missed a powerful force driving and capitalizing on immigration policies behind the scenes: corporate power.

Since 2008, the United States government has spent billions of dollars on contracts with GEO Group and CoreCivic, two of the largest for-profit detention companies. In 2008, CoreCivic and GEO received $307 million dollars in revenue to run immigration detention facilities. That amount doubled within seven years. In 2019, the United States government held over 500,000 people in immigration detention, 81% of whom—up from 60% in 2017—were held in privately operated or privately owned facilities. That same year, GEO and CoreCivic spent over $3 million combined on lobbying expenditures, roughly the same amount its affiliates donated to candidates in the 2020 elections.

The increased dependence on corporations for detention is no accident— it is the result of a pro-corporate ideology that prioritizes privatization, supported by corporations and legitimized by economic and legal elites.

Since the 1980s, for-profit detention facilities have been a mainstay of U.S. immigration policy, pushing government officials toward self-serving policies through lobbying efforts and campaign donations. They have presented government officials with a seemingly low-cost alternative—both administratively and financially—to running the nation’s massive detention infrastructure.

This partnership, however, comes at a human cost. For people like Sara and Oscar, asylum-seekers in Immigration and Customs Enforcement (ICE) detention, nowhere is this cost more apparent than in the grave lack of medical care afforded to those in detention facilities. Health care is a lens through which we can examine the true price of for-profit detention.

Immigration detention is often defended as a protective mechanism, keeping the American public safe from dangerous criminals eager to enter the country. Popular thinking places immigrants into a good-bad, legal-illegal binary—in large part because it helps legitimate the “procedural justice” of the legal scheme, making it seem as if people that follow rules are good, “legal,” and can easily come to the United States if they do so properly. Regardless of their background, individuals’ stories are stripped of the factors that drove them to immigrate—persecution, racial animus, economic displacement—to fit into this framework, and those in detention are almost always consigned to the latter camp. Although immigration detention is civil, not criminal, detention, detention itself suggests wrongdoing. When exacerbated by “dangerous” immigrant rhetoric, detention can seem like just deserts.

When exacerbated by “dangerous” immigrant rhetoric, detention can seem like just deserts.

In large part, the dominant narrative has persisted because it is a source of political gain and monetary profit. By exaggerating the danger posed by immigrants, politicians can claim to protect their constituents from harm through detention, manufacturing victories for themselves by expanding detention’s reach. Take the announcement of the Trump Administration’s “zero tolerance” policy, which mandated detention for all immigrants crossing the southern border. As then-Attorney General Jeff Sessions stated, the policy “finally secure[d] [the] border” to “give the American people safety and peace of mind.” “If you’re going to come to this country,” he added, “don’t come here illegally.”

Beyond wins in the court of public opinion, politicians peddling this narrative benefit their financial backers, too. For corporations like GEO and CoreCivic, every detained person comes with a dollar sign attached. As a CoreCivic spokesman told investors about Trump’s zero tolerance policy: “[T]his is probably the most robust kind of sales environment we’ve seen in . . . 10 years.” While for-profit detention corporations publicly stay quiet, rarely articulating the stereotypical good-bad, legal-illegal narrative themselves, their campaign donations and lobbying expenses speak volumes in the background. This behind-the-scenes action has been centuries in the making.

In the fall of 1980, immigration rose again to the forefront of American minds thanks to the Mariel boatlift, a massive influx of Cuban asylum-seekers to the coast of Florida. In tandem with an increase in Haitian immigrants, this episode prompted a severe xenophobic backlash. For the newly elected President Reagan, images of Black and brown people arriving on the country’s shores en masse were an easy way to fearmonger and gain political support. Reagan presented detention as a solution to the immigration problem, using rhetoric of “dangerousness” to justify his proposal.

For Reagan, government-run immigration detention presented a problem. His administration had wholeheartedly embraced the Chicago School’s economic and legal agenda, including its two core ideas: shareholder primacy and deregulation. The first proposed that by increasing shareholder profit, corporations could best contribute to the public good. The second argued that industry could best succeed without government-imposed limitations. A main mantra was “profit-good, regulation-bad.”

While Reagan sought to slash government oversight of the environment, labor, and banking, his administration wanted to increase government operations in the immigration space. In addition to the Cuban and Haitian immigrants who had come to the United States at the start of his presidency, his support of civil wars in Central America led to an influx of new Latinx and indigenous immigrants crossing the southern border. This inundation overwhelmed immigration officials. To cope, the executive branch asked Congress for funding.

Private corporations were standing by. Although there had been a steady increase of immigration since the mid-twentieth century—as well as a number of legal changes to the legal scheme—large-scale immigration detention did not yet exist, but the space had long been ripe for public-private partnership. The 1980s were no different.

Contracting with for-profit immigration detention corporations was an easy out: For a small fee, politicians could push popular policies without responsibility for the day-to-day work of detention. Moreover, the corporations promised to run the facilities at lesser cost. The Reagan Administration signed contracts with CoreCivic—then the Corrections Corporation of America—and GEO in 1983 and 1984, respectively, to run immigration facilities.

In the budding immigration detention space, Reagan’s mantra was flipped on its head. The regulation of immigration was good when outsourced: it enabled shareholder profit. For Reagan and his congressional supporters, privatization was an end-run around his support of small government. They could eschew scrutiny by regulating immigration in such a way that would benefit its financial backers without appearing to increase governmental infrastructure.

CoreCivic founder Thomas W. Beasley, a well-connected former Tennessee Republican Party leader, put the nature of these contracts bluntly: “Their first impulse is to say only the government can do it, because only the government’s ever done it. But their second reaction is that the government can’t do anything very well. . . .[From there] you just sell it like you were selling cars or real estate or hamburgers.”

For-profit immigration detention was off to the races.

In the last two decades of the twentieth century, the marriage of conservative, “tough-on-crime” politics and deregulation allowed a web of politics and corporate money to shape immigration policy, expanding the use of immigration detention and, in turn, of corporate influence.

Congress quickly passed laws that allowed executive officials to detain and deport noncitizens. Bills such as the Anti-Drug Abuse Act, the Illegal Immigration Reform and Immigration Responsibility Act, the Antiterrorism and Effective Death Penalty Act, and Personal Responsibility and Work Opportunity Reconciliation Act shifted immigration detention to local authorities. They were supported by a GEO- and CoreCivic-backed think tank, the American Legislative Exchange Council, which had broad enough influence in state legislatures to all but guarantee that localities would contract with for-profit corporations. CoreCivic and GEO became massive recipients of government dollars, both for immigration detention and private prison facilities.

Following September 11, 2001, strict immigration policy gained even more momentum, leading to the creation of the Department of Homeland Security (DHS), and, in turn, ICE. The national ethos left open the door to big pushes on immigration policy, and GEO and CoreCivic were there to help craft them. For these corporations, pushing pro-detention polices and backing pro-detention politicians benefited their bottom line. From 2002 to 2003, CoreCivic’s lobbying expenditures nearly doubled, jumping to over $1.5 million.

The national ethos left open the door to big pushes on immigration policy, and GEO and CoreCivic were there to help craft them.

In 2004, Congress passed the Intelligence Reform and Terrorism Prevention Act, establishing a bed quota that set a floor for the number of people to be detained on a given night in detention and guaranteed contract minimums for for-profit facilities. The first quota was set at 8,000 people per night. In 2005, CoreCivic’s lobbying costs reached over $3.2 million. Unsurprisingly, between 2006 and 2014, the amount of money spent by private detention corporations on lobbying increased at almost the same astronomical rate as the quota for detention beds.

A change in political party made no difference. Immigration detention and deportation skyrocketed during the Obama administration, earning Obama the moniker “Deporter-in-Chief.” As a result, so did spending on private detention. Although the Obama Administration focused its deportation efforts mainly on those with criminal convictions, under its auspices Congress passed an increased bed quota of 34,000 per night in 2009.

In 2014, DHS signed a $1 billion deal with CoreCivic, in large part to build the facility where Sara and Oscar were held. This facility was constructed for a group of individuals—mothers and their children—who until 2014 “had rarely been held in detention,” demonstrating for-profit detention’s sway.

In its 2014 annual report, CoreCivic wrote, “The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts.” Although the connections between these corporations and the government do not always readily appear at the surface, once the smoke of lobbying expenses and campaign donations clears, it requires willful blindness to think they do not exist. As a 2017 United Nations report stated, these corporations have a clear “economic incentive” to encourage detention use because it increases their contractual profit. They are keenly aware that changes to immigration policies impact their revenue, and they have warned shareholders as much.

GEO defends its political donations as nonpartisan, stating in 2017 that “[its] political activities focus entirely on promoting the use of public-private partnerships.” A close look at their lobbying expenses and the corresponding rise in government spending on detention suggests the falsity of that statement.

As GEO and CoreCivic have gained money from federal contracts, they have had an outsized ability to increase their political spending, and, in turn, to manipulate immigration enforcement. In 2015, GEO and CoreCivic spent $1.6 million on federal lobbying efforts, hiring firms with deep D.C. connections, including two alumni of Jeff Sessions’ Senate office. Between 2010 and 2015, CoreCivic spent 75% of its lobbying dollars on the DHS appropriations subcommittee, which controls the bed mandate. In the 2016 election cycle, GEO- and CoreCivic-affiliated groups spent $3.1 million and $1 million, respectively, on political contributions. In return, by the end of Trump’s presidency, the average number of people in ICE detention increased to an all-time high of 50,000 people per day. At centers with flat-rate contracts, the government may pay an average cost of $95 to 100 per day for each person detained.

While the government’s exercise of harsher immigration policies and enforcement measures increases these corporations’ profits by increasing the number of immigrants who are detained, corporations can further increase their profits by decreasing the amount that they spend on those in detention. Nowhere is this clearer than in the paltry health care provided to those in detention.

Corporate influence does more than increase the use of detention, it also shapes what the detention experience is like. Inadequate medical treatment is one drastic consequence of for-profit detention.

Limited medical care in immigration detention is the result of a both parties’ desire to cut costs: the government wants to reduce its spending on immigration, and corporations benefitting from government contracts want to retain as much money as possible, spending the bare minimum on subcontracts and services.

In theory, four standards regulating detention conditions for detained persons safeguard against the potential adverse effects of these cost-cutting motivations: the National Detention Standards of 2000 and the Performance-Based National Detention Standards of 2008, 2011, and 2019. But while these standards are incorporated into most government contracts, none are really enforceable.

First, although the standards provide for base-minimum health care—such as initial screenings, routine care, and timely responses to medical issues—there is no articulation of how oversight will be achieved. Further, the broad language they employ—for example, requiring “[t]imely responses to medical complaints”—means that even if there were oversight standards, it would be nearly impossible to demonstrate that a provider had failed in its duties.

Moreover, private litigants seeking to bring lawsuits against these corporations find themselves in difficult situations. Although these corporations act in the place of the government, because they are private, they are shielded from discovery requests filed under the Freedom of Information Act (FOIA)––requests that are crucial for identifying proof that harm occurred. ICE inspections, which could be FOIA-able, are conducted with little to no scrutiny, and are thus unlikely to provide potential litigants with useful information

Furthermore, suits brought by detained persons, who are third parties to the contract between the government and for-profit detention corporations, are notoriously hard to bring. A right to sue for failure to comply with the standards contained in a detention center’s contract is only protected by statute in California. ICE has no incentive to sue either—a successful suit would increase their costs. To add to the difficulty, DHS and ICE contracts are not always made directly with the corporations operating private detention centers. Often, these contracts are made by the U.S. Marshals Service or local governments, making government expenditures more difficult to track.

Health care in detention centers is coordinated by ICE Health Service Corps, and some federal money is spent directly on contracts with medical service providers. More often, medical providers are subcontracted by corporations like GEO and Core Civic, or provided by their subsidiaries. Whichever way care is provided, the corporatization of detention means that every day substandard medical care causes harm to immigrants detained by ICE.

At its most extreme, the lack of health care in these facilities can lead to death. During the Trump Administration, before the COVID-19 pandemic hit, 27 people died during or immediately after ICE detention due to nonsuicidal causes. Death, however, is just one manifestation of this neglect. Although statistics are unsurprisingly hard to find, personal stories indicate that mistreatment is rampant. Medical facilities are slow to deliver health care, whether on- or off-site, and are either insufficiently prepared or do not wish to provide it when they can. As one Guatemalan woman in detention at a CoreCivic-operated facility in California wrote of the deficient medical care: “If you have pain, you will not be treated.”

At Richwood Correctional Facility in Louisiana, it could take at least a week for a doctor to fix a broken bone. At CoreCivic–run Stewart Detention Center in Georgia, a man who had seriously injured his arm prior to his detention only saw a doctor twice during his six-month stay at the facility. When he was finally taken to see a doctor off-site, he was told that he needed a specialist. The specialist never came.

Beyond sheer delay, inadequate treatment—often presented as sufficient—is the general standard. For a sore throat, one might get packets of salt at La Palma Correctional Facility. In 2010, the ACLU sued CoreCivic healthcare providers who wired a man’s jaw shut and left the wiring in place for 10 weeks. Because he received no adequate treatment, he was left to “remove the wiring with nail clippers as a guard watched.”

At the South Texas Family Residential Center where Sara and Oscar were held, water, Pedialyte, and Vicks Vaporub were the only treatments provided for almost any ailment. The mother of Mariee, a two-year-old girl who died after leaving the facility, testified before Congress on the inadequate treatment:

[Mariee] got sick… [When] [w]e were able to get in and see a physician’s assistant… [the nurse] said she had a respiratory infection. She gave her Tylenol, honey for her cough and told me to follow up in six months. But the next day, Mariee was worse. … When I finally managed to have Mariee seen in the clinic again she’d lost 2 full pounds – almost 8 percent of her body weight – in just 10 days… [A] third physician’s assistant just gave me Tylenol and Pedialyte, and told me to come back in a week… [A week later she was seen by a doctor, who] told me to give her Pedialyte, ibuprofen, Zyrtec and Vicks VapoRub. I didn’t learn until after she died that you aren’t supposed to give Vicks VapoRub to kids under 2-years-old because it could cause respiratory problems.

When Mariee was finally supposed to see a specialist, Mariee and her mother were discharged from the facility and sent to live with their sponsor in New Jersey. Mariee died shortly thereafter, likely the result of her mistreatment in detention.

When COVID-19 infections began occurring in immigration facilities, it started what one federal judge called a “fire.” At numerous CoreCivic- and GEO-run facilities, case rates reached almost 100% of the population. By providing the lowest grade of care possible, these corporations have profited at the expense of human beings—people whose health concerns they have ignored and whose lives they have treated as disposable.

GEO, CoreCivic, and other corporations have capitalized on detention, and, in turn, have shaped federal policy—under both Republican and Democratic administrations—in the government’s own quest to trim its spending. Their massive campaign and lobbying expenditures have paid off: the government has facilitated the “commoditiz[ation] [of] human bodies for an industry in militant pursuit of profit.”

As the stories of Oscar, Sara, and others show, this partnership has led to drastic consequences. In the language of corporations, immigration detention is an area of policymaking where a battle of rights shapes up neatly: the rights of corporations and their shareholders to profit are pitted against the rights of people––not just their right to migrate, or to be free from detention, but also the right to be guaranteed decent health care in accordance with international standards.

After Oscar’s surgery, Sara and Oscar were released from detention. Oscar is healthy and happy, navigating a new school in the COVID era. While their journey to asylum is not close to an end, Sara is happy to be out of detention and to have access to real health care just a short drive away. Many other immigrants in detention who suffer the same neglect in the face of similar health crises do not experience such a “happy” ending. Their stories, often untold, are the price of the corporate drive for profit.

In March 2021, The Atlantic’s Adam Sewer wrote about the so-called crisis at the border: “What is the border crisis? Is it the recent surge of migrants, or is it the treatment of those migrants in detention facilities?”

Corporations have made the answer clear.

As the Biden Administration seeks to reform the exceptionally inhumane practices of the Trump Administration—which it has thus far failed to do—it should pay close attention to the blind spots of administrations past. Corporate profit cannot and should not come at the expense of human needs. While an executive order early in the Biden Administration announced the end of private prison use in the federal criminal system, it did not extend to private immigration detention facilities—demonstrating both the reliance of the federal government on private corporations in this space and their outsized influence on policymaking itself.

The Biden Administration should get out of detention altogether, either by using its executive discretion or by pushing for congressional reform. Falling short of that, however, it should consider expanding its private prison order to the immigration space and ensure that humanitarian safeguards are in place to prevent general abuse and healthcare-related neglect. 

_{*Some names and other details have been changed to preserve anonymity.}