Digital IDs Put Health Care Privacy at Risk

Digital ID systems are often promoted by tech vendors and police as a convenient and necessary solution for accessing private and, more recently, public services. While marketed as simply a “modernized” version of physical identification, these systems can enable invasive data collection, constant tracking, and profiling that replicates and intensifies existing inequalities—and yet they have been mostly implemented without democratic debate. These systems become even more dangerous within the context of a broader project to consolidate informational power, altogether limit or avoid privacy legal safeguards, and restrict bodily freedom across federal and state governments.

Reproductive and gender surveillance are by no means new. Law enforcement and anti-abortion activists have long used surveillance techniques and user data to harass, investigate, prosecute, and punish pregnant people. Digital ID systems that support mobile driver’s licenses or mDL would facilitate a new level of comprehensive tracking and behavioral control by states, corporations, and private actors. The expansion of digital ID without democratic debate and enforceable legal safeguards in place could accelerate mandatory biometric data collection (face recognition, voice, fingerprints), real-time tracking, selective denial of public services, and increased exposure to surveillance for those seeking essential medical care.

Digital ID Systems Can Transform ID Checks Into a Tracking System

Instead of showing a physical ID to a “verifier,” like a police officer or liquor store clerk, a digital ID holder either taps their smartphone to another machine or gets a notification that someone was requesting information. In addition, digital ID systems are used to verify identity online. A 2023 Louisiana law requires people trying to access adult websites to verify age using the state’s digital ID. At the end of June, the Supreme Court rejected a constitutional challenge to a Texas law that requires adults to verify their age with adult websites, affirming more than a dozen similar state laws. Whether used to verify identity in person or online, digital ID systems are a way for states to control movement of people, access to services, and access to information online. At the moment, many of these systems promote facial recognition or another biometric as a shortcut to identity verification, bypassing the need to recall or retrieve other identifiers, and perceived as more secure despite being far more invasive. Yet with the rise of generative AI tools that can easily spoof license images or faces, biometrics are becoming an increasingly weak foundation for identity verification and now rely on escalating, error-prone countermeasures like facial liveness testing.

Consider how many times someone traveling for medical care already might have to verify their identity to book travel, hotels, doctors, and much more. Using a digital ID at any or all of those points could create a digital trail. While many states have launched digital ID or mDL programs via legislation or fiat, no state has enacted legislative guardrails to limit how digital ID systems track, secure, or use data. Further, many of the states launching digital ID programs have neither passed baseline consumer privacy laws nor codified protections against emergent digital and data broker loopholes that undermine our constitutional protections from search and seizure. Without protections in place, a digital ID program could be an easy way for law enforcement to circumvent our privacy and constitutional protections.

Additionally, digital ID systems give states the power to gatekeep access to vital information—imagine if states extended age verification requirements to websites with medical information about abortion and gender-affirming care. Any topic that book bans have targeted could be targeted by online age verification requirements, and even individualized information control. This is not a hypothetical: given lawmakers’ efforts to ban not only books, but also abortion, transgender (“trans”) health care, access to information online, and drag performances, digital ID systems could be required to verify age across a multitude of online spaces, including social media and sites for reproductive and gender-affirming care. This would grant the government expansive power to control access to information and to surveil and criminalize those who access it, whether that information be about art, literature, health care, or anything else.

Digital ID Systems Create a De Facto National ID

In its final days, the Biden Administration issued an executive order that encouraged federal agencies to accept privacy-preserving digital identity documents (like mDLs and electronic passports) for benefits delivery, and instructed federal agencies with grant-making authority to consider funding state programs to develop mDLs with basic privacy protections, such as data minimization and prohibiting tracking of users. Due to the lack of state laws prohibiting tracking through digital IDs, some advocacy organizations welcomed this guidance, although the order clearly promoted state digital ID systems and was strongly pushed by industry groups like the Better Identity Coalition. While the Trump Administration rescinded the mDL executive order in June 2025, it has announced several policies that reveal its intentions to leverage data to enforce the priorities outlined in Project 2025.

Trump’s “border czar” Tom Homan has demanded that New York State start handing over data from drivers who have licenses under the recent “Green Light” laws—laws which allow drivers to have a plastic, physical license without sharing information with the federal government—and from sanctuary cities with municipal identification programs. These threats preview the role that the new administration expects data surveillance from digital ID systems to play in law enforcement. In addition to tracking targets and “eliminating data silos,” the Trump administration has leveraged the full force of the administrative state to manipulate attributes associated with identity across existing data systems to deny benefits (by removing people based on immigration status) and denying self-determination (by denying folks the option to identify as transgender on their passports).

Even without digital ID systems, it is true that the US government, via data brokers, already has access to a great deal of its residents’ data. The Trump Administration also ended the Consumer Financial Protection Bureau’s efforts to curb some of the harm caused by the data broker industry. This allows police to continue circumventing constitutional protections to purchase comprehensive data about people’s movements, relationships, and money; it also allows anyone with a credit card to purchase the same digital details about people’s lives. The man suspected of shooting Minnesota lawmakers in their homes in June found their addresses through data broker sites. Digital IDs add a valuable layer of authenticated and unique identifying information that will further facilitate tracking and control of people through technology.

Digital ID Systems Can Facilitate a Dragnet for Police

Technologies to surveil our travel already exist; for example, police across the country share traveler data through license plate readers. Without specific guardrails in place, it’s easy for law enforcement, at their own discretion, to use digital identification tools in ways beyond their intended purpose. Recently leaked emails show that Immigration and Customs Enforcement (ICE) is using facial recognition technology to identify people by tapping into other tools used by the Department of Homeland Security (DHS). Digital ID systems would add to the vast surveillance systems ready to monitor travel across state lines. 

This is particularly concerning as cross-state travel is becoming increasingly necessary to access health care. Anti-abortion law and policy makers are responding to this heightened need with criminalization and threats. In 2023, Idaho was the first state to criminalize adults who assist a minor traveling out of state for an abortion without parental or guardian permission. This ban on abortion support would allow penalties of up to five years in prison (the part of this law, namely the provision that bars providing a minor with information about abortion, has been temporarily blocked by ongoing litigation, but the portion of the law that prohibits sheltering or transporting a minor for abortion care remains in effect). In Alabama, an abortion fund and providers filed a lawsuit in response to threats by the state’s Attorney General, who claimed that helping anyone leave the state to seek abortion care could be prosecuted. The Alabama court, however, stated that the state cannot prevent its residents from going to another state to engage in lawful conduct.

Surveillance Fuels the Criminalization of Reproductive Care

This is part of a broader trend where states around the country are increasing criminalization, surveillance, and restrictions on abortion access and gender affirming care. Reproductive surveillance and criminalization have long existed. Pregnant people have been investigated, harassed, prosecuted, and punished for self-managing their abortion, experiencing stillbirth or miscarriage, or consuming controlled substances while pregnant. Texas passed SB8 (while Roe v. Wade was still in effect), an abortion ban that encourages vigilantism by allowing civilians to file a civil complaint against someone who provides abortion care or helps a pregnant person access abortion care. This law encourages so-called “abortion bounty hunters” by granting a minimum of $10,000 to those who succeed in such lawsuits. Police in the state have also used a system connecting thousands of license plate readers to search for the travel history of a woman who drove out of state for an abortion. 

Since the Supreme Court erroneously overturned decades’ worth of legal protections of abortion care in its decision, Dobbs v. Jackson Women’s Health Organization, criminalization has increased. According to a report by Pregnancy Justice on ongoing pregnancy criminalization research, the pregnancy criminalization cases tracked the year after the Dobbs decision marked “the largest single-year number since researchers began tracking these cases.” These numbers may increase given a June 2025 decision by a federal judge invalidating a Biden administration rule prohibiting health care providers from sharing reproductive health care information with law enforcement. 

Digital identification systems globally have already blocked access to health care for many people. In Uganda, where a national digital ID is mandatory to access private and public services, women and elders have been excluded from accessing health and social security systems. In India, the national digital ID system is now entwined with a digital centralized health care database. Women who do not want to share their national ID have been prevented from receiving abortions and other reproductive care. In 2018, a pregnant woman in labor who did not disclose her Aadhaar card was forced to give birth outside a hospital. Similarly, people living with HIV in India have been forced to choose between stigmatized treatment and sharing their national ID card at medical centers. 

If we do nothing? In the near future, someone seeking information about how to get medical care in another state may be forced to show a digital ID online to access that information—and then again as they travel, stay at hotels, and visit doctors’ offices. As states heighten surveillance and criminalization of care—and without laws restricting tracking, storage, or use—digital ID systems could allow police to monitor state residents’ transactions online and on the road. 

Resisting Digital ID Systems to Preserve Bodily Autonomy

In New York City and Detroit, immigrant communities and economic justice advocates successfully led opposition to digital municipal IDs in 2019 and 2022 respectively, based on concerns about digital surveillance and extractive financial services. The Campaign to Preserve IDNYC, led by the Surveillance Resistance Lab (then a project of Immigrant Defense Project), along with New Economy Project and the New York Immigration Coalition, interrupted a plan by the administration of then–Mayor Bill de Blasio to “digitize” the municipal identification that had been created to give immigrant communities access to schools, hospitals, and other government services. The De Blasio administration’s plan to incorporate financial technology (by issuing a Request for Proposals for vendors to create a version of the ID with a “smartchip”) would have dangerously connected records about city services, including public transit, and minimized cash-based transactions across the city. The campaign fought back through research and public education, and as a result, New Yorkers continue to have cash-accessible transit cards.

It is time we bring that fight to the states. We must demand that digital driver’s license programs be subject to democratic debate. We must push for protections for access to physical driver’s licenses and to the internet, data generated by verifying identification, and protections that prevent expansion of when and where government identification must be presented. Momentum is building: New Jersey’s governor signed legislation introducing the first set of guardrails on digital ID systems in July 2025.

The time to act is now. Lawmakers must take action. Everyone deserves to live a life with dignity and without fear of surveillance. We must not allow digital ID systems to become yet another tool of the surveillance state that increases the precarity of those seeking essential health care.

Featured image by Kimmie Dearest