Editor’s Note: The following article was originally published by Terri Langford from the Texas Tribune on October 17, 2024.
When Gov. Greg Abbott ordered hospitals this summer to start asking patients for their citizenship status, the intent was clear: to take the cost of caring for undocumented immigrants to the Biden administration and demand Texas taxpayers be reimbursed.
“Due to President Joe Biden and Vice President Kamala Harris’ open border policies, Texas has had to foot the bill for medical costs for individuals illegally in the state,” Abbott said in a statement in August. “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants.”
Beginning Nov. 1, hospital patients will be asked their citizenship status. Abbott’s order does not say patients are legally bound to answer the question. However, the care of patients who answer this question, or don’t, will not be interrupted, according to the Texas Hospital Association.
“The bottom line for patients is that this doesn’t change hospital care,” said Carrie Williams, an association spokesperson.
Several hospitals contacted by The Texas Tribune declined to talk about how they will comply with the order. Next March, they will turn over data collected or risk losing their payments from the state’s Medicaid health insurance plan for low-income individuals.
“Hospitals across the state are working to determine how to comply with the reporting guidance and meet the state’s deadlines,” Williams said.
The move by Abbott’s office is the latest by Texas officials to prove an uneven financial burden on states because of illegal immigration, a move supported by the conservative think-tank Texas Public Policy Foundation, also known as TPPF.
“The governor himself wanted to see what costs are now onto the businesses and the hospitals themselves,” said Ammon Blair, a senior fellow for TPPF’s Secure and Sovereign Texas Initiative. “This should not fall on the shoulders of private businesses.”
But there are doubts as to whether Texas will be able to come up with a solid cost figure without a lot of caveats to understand.
Data has shown for years that undocumented immigrants who lack access to health insurance plans, Medicaid included, typically use hospitals less than American citizens who are uninsured – Texas hospitals spend $3.1 billion a year on uninsured care that is not reimbursed, according to THA. Even emergency Medicaid spending, which by design, covers undocumented immigrants’ hospital costs in limited circumstances, has gone down in the last five years. And efforts by Florida to answer the same undocumented patient care question have fallen short.
“This executive order is intended to scare people into not using any kind of public benefits program,” said Lynn Cowles, health and food justice programs manager at Every Texan, which advocates for better health care in Texas. “It’s pretty classic anti-immigrant rhetoric that will not lead to any new understandings from data collected by (Texas) Health and Human Services.”
Texas’ uninsured and uninsured undocumented immigrants
Texas leads the nation in the number of uninsured residents and most of them are citizens. Data also already shows that immigrants seek health care treatment at a lower rate than U.S. citizens.
