Texas Governor Greg Abbott is taking a bold step to measure the true cost of illegal immigration.
On August 8, 2024, he signed an executive order requiring all Texas hospitals to collect and report data on healthcare provided to undocumented immigrants. The order takes effect on November 1, 2024. Annual reports will begin January 1, 2026.
Governor Abbott’s goal is clear: track the financial burden placed on Texas hospitals and hold the federal government accountable for its border policies.
He argues that Washington’s failure to control the southern border has left Texas footing the bill for healthcare services provided to individuals who are in the country illegally.
The new rule applies to all public and private hospitals in the state.
Facilities will be required to record the immigration status of patients and document the costs of care provided to undocumented immigrants.
These figures will be submitted to the Texas Health and Human Services Commission (HHSC), which will report the findings to state leaders.
A Question of Responsibility
Federal law still requires hospitals to treat emergency patients, regardless of immigration status. This obligation falls under the Emergency Medical Treatment and Active Labor Act (EMTALA).
In addition, Medicaid rules allow undocumented immigrants to receive emergency coverage, which helps explain why many rely on emergency rooms for treatment. According to the HHSC, emergency Medicaid spending for undocumented patients in Texas reached $90 million in fiscal year 2023.
Supporters of the executive order believe it brings needed clarity to a murky issue.
They argue that without accurate data, it’s impossible to assess the full impact of illegal immigration on the state’s healthcare system. More importantly, they say, it lays the groundwork to demand reimbursement or action from the federal government.
Critics warn that the order may discourage undocumented immigrants from seeking medical care, especially for urgent issues.
They also worry about the burden this places on hospitals, which may now need to dedicate staff and resources to track data that is difficult to verify.
The Data Tells a Complex Story
A September 2024 study by the Kaiser Family Foundation (KFF) sheds light on the broader picture. It found that undocumented immigrants tend to have lower overall healthcare spending than U.S.-born individuals. This is mostly because they use fewer services and often skip routine care.
Still, the rate of uncompensated care (medical services not paid for by the patient or insurance) is similar between the two groups. That’s because undocumented patients often depend on emergency care, where hospitals are required by law to provide treatment.
Nationally, KFF estimates that uncompensated care for undocumented immigrants costs between $10 and $20 billion a year. Texas, with its long border and large immigrant population, likely bears a significant share of that total.
A Broader Policy Push
This executive order is part of Governor Abbott’s wider border strategy. Through initiatives like Operation Lone Star, Texas has moved to assert more control over border security and highlight what state leaders see as federal inaction.
This new healthcare order fits within that approach. It doesn’t change the medical services hospitals provide, but it does add a new layer of accountability.
Some healthcare leaders have voiced concern about the order’s practical challenges.
Immigration status is not always clear or easily verified, and hospitals may have to rely on indirect signs, like insurance status. This could lead to inconsistent or incomplete reporting.
Even so, the principle is one many Texans support: the state has a right to know how taxpayer dollars are being used, especially when those costs stem from federal decisions. Gathering data is a first step toward better policy, and it may help build the case for stronger immigration enforcement and a more balanced system that puts legal residents first.
This article was written with the assistance of AI. Please verify information and consult additional sources as needed.
