Gov. Greg Abbott orders Texas' public hospitals to start reporting costs of treating migrants

Gov. Greg Abbott on Thursday issued an executive order demanding that Texas' public hospitals begin reporting health care costs they incur treating undocumented immigrants.

The order — which the Republican governor said in a statement was prompted the White House's "open border policies" — would apply to University Health System , the public hospital district for the San Antonio metro area and the third-largest public health system in Texas. However, it likely applies to a broader array of medical facilities.

While Abbott's order states that the federal government “may or should be obligated” to reimburse the state for those hospital costs, the document provides no details about how that might happen.

The order would affect roughly 200,000 undocumented immigrants who reside in San Antonio. Many of those people are in the country legally while they await asylum claims to play out. Many also pay taxes to fund University Health.

Texas' undocumented workers paid $4.9 billion in state and local taxes in 2022, according to a recent study by the Institute of Taxation and Economic Policy.

In an online statement, Texas Hospital Association spokeswoman Carrie Williams said her organization is still reviewing the order but added that hospitals are "required by law to provide life-saving treatment to anyone, regardless of ability to pay or status."

Indeed, Texas hospitals don't ask about immigrant status as a condition to providing treatment — something advised under guidelines from by state's own Department of State Health Services.

Dr. Brian Elmore, an emergency-medicine resident physician at University Medical Center of El Paso told news site El Paso Matters that Abbott’s order makes no sense. Most migrants Elmore treats are in the country legally since they have been processed by federal officials and now await immigration hearings.

“Are we going to have to check their visas now?” Elmore asked. “Is [Abbott] effectively deputizing hospital officials to act as immigration agents?”

Elmore told El Paso Matters he worries state officials could use the information for purposes other than seeking federal reimbursement. Abbott's mandate comes weeks after an El Paso judge blocked an effort by Texas Attorney General Ken Paxton — an ally of the governor — to shut down the migrant shelter network Annunciation House.

“In the context of Abbott’s attempted criminalization of humanitarian aid with attacks on Annunciation House, I’m also worried that any information collected for the state could be used for nefarious purposes,” Elmore told the news site.

Civil-rights advocates said the order is another bid by Abbott to demonize and intimidate immigrants for political gain. The governor has made Operation Lone Star, an $11 billion border crackdown key to his political brand , and he's repeatedly invoked rhetoric popular with white supremacists that likens a surge in border crossings to an "invasion."

Abbott also spoke at the recent Republican National Convention in favor of candidate Donald Trump's plan to deploy “the largest domestic deportation operation in American history.”

"This is part of a larger pattern of xenophobia and racial discrimination that we must call out," said Marisa Limón Garza, executive director at Las Americas Immigrant Advocacy Center. " Instead of taking steps to improve access to adequate healthcare for all Texans, Abbott is wasting time and resources by directing medical staff to focus on the status of the person in their care, proving once again that the governor is comfortable scapegoating migrants for failed public services across Texas.”

Public hospitals must begin collecting the data Nov. 1 of this year, while direct-covered hospitals would have until March of next year, according to the governor's order. Private-sector hospitals are unaffected.

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