Gov. Greg Abbott’s executive order requiring the state to track the costs to hospitals for treating people in this country illegally, could have a chilling effect on people seeking medical care, public health and immigrant advocates say.
“Just hearing the news makes our community feel fearful of being able to share their information or go to the hospital,” said Alain Cisneros, campaign coordinator for immigrant rights organization FIEL Houston.
Abbott’s Aug. 8 executive order requires the Texas Health and Human Services Commission to direct public hospitals in the state to track patients’ immigration status and report the cost of providing in-patient and emergency room care to people in the country illegally.
Starting Nov. 1, affected hospitals will be required to collect the information and report it to the commission on a quarterly basis. The first report is due to the state on March 1, 2025.
Abbott said the state would seek to have the federal government reimburse those costs.
“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 press release. “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants.”
Some health care for immigrants already is compensated by private health insurance or federal funding, including Medicaid.
Erin O’Malley, senior health care law and policy analyst for the nonprofit Every Texan, said Texas’ own policies are responsible for these remaining uncompensated cost burdens.
“We have a lot of uncompensated care in Texas. This is true,” O’Malley said. “But it is true because Texas law excludes so many people from accessing health coverage by not expanding Medicaid, by making it hard to keep public coverage, by not creating any options for non-US citizens to access insurance.”
A similar law was enacted in Florida in 2023. State data from June to December 2023 found that undocumented immigrants accounted for less than 1 percent of total operating costs when accounting for compensated care.
Houston hospital officials said they are awaiting additional guidance on how to implement the order.
“We did receive the order and are reviewing the language and waiting for instruction from HHSC to understand what information on our patients is to be reported,” said Gale Smith, director of public relations and internal communications for Houston Methodist Hospital. “We will, of course, continue to provide care to all of our patients and comply with applicable state law requirements.”
Representatives of the Harris Health System, which operates the safety net hospital and clinic system for hundreds of thousands of Harris County residents, did not respond to requests for comment Friday.
According to the hospital district’s 2020-2025 strategic plan , 25 percent of its patients in 2020 were undocumented immigrants. And 56 percent of its patients that year were uninsured. The plan does not indicate what portion of Harris Health’s costs associated with undocumented immigrants was covered by Texas or the federal government.
Hospitals are required by federal law to screen and provide stabilizing treatment to any individuals who show up in their emergency rooms, regardless of immigration status.
Hospitals and other health care facilities long have been considered oases from immigration enforcement. Even the controversial state law known as SB 4, which would make it a state crime to enter Texas illegally from Mexico, considers hospitals a place safe from enforcement .
That could change under Abbott’s order.
Immigration and health care advocates compared the announcement to changes to the “public charge” rule under the Trump administration, which sought to limit eligibility for lawful permanent resident status based on the use of public benefits and social programs. Advocacy groups said many immigrants withdrew from food benefits and dropped out of health programs as a result.
“We anticipate potential for a major chilling effect on populations across Texas — even people who have lawfully present status may view being asked these questions as something to be wary of because of how inconsistent public charge policy has been over the past several years,” said O’Malley.
O’Malley added that families with mixed immigration status could face additional deterrent effects that stop U.S. citizens from seeking health care in an effort to protect family members.
Chiqui Sanchez-Kennedy, executive director of Galveston-Houston Immigrant Representation Project, said the new measure will make children even more vulnerable.
“This will create fear for everyone, particularly parents who don’t have lawful status,” Sanchez-Kennedy said. “That fear is going to cause them to refrain from taking their children to the doctor, even if they are U.S. citizen children eligible for medical services.”
Cisneros questioned the legality of the measure in the face of the federal Health Insurance Portability and Accountability Act Privacy Rule, which protects the privacy of sensitive health care information. He predicted legal challenges before it takes effect.
In the meantime, Cisneros stressed that immigrants should continue seeking health care.
“We keep trying to communicate to people that their health is a priority and it isn’t in effect yet,” Cisneros said.
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