Texas hospitals spent $121.8 million in November 2024 on health care for individuals in the United States illegally, the Texas Health and Human Services Commission (HHSC) reports.
Noncitizens without legal status made more than 31,000 hospital visits across Texas that month alone, the report states. The data was collected in compliance with Gov. Greg Abbott’s Executive Order 46, which directed the HHSC to report on the financial impact of illegal immigration on the state’s health care system.
Abbott said the report was intended to hold the Biden administration accountable for what he calls its “open border” policies and to demand federal reimbursement for those costs. Texas taxpayers ultimately shoulder the financial burden through higher taxes, Abbot noted.
“Now, Texas has reliable data on the dramatic financial impact that illegal immigration is having on our hospital system,” said Andrew Mahaleris, Abbott’s press secretary, on the report’s release in April. Mahaleris credited President Donald Trump’s border policies for significantly reducing illegal crossings and expressed hope future enforcement would curb health care costs.
Imprecise Accounting
Hospital cost estimates may lack precision, says John C. Goodman, president of the Goodman Institute and co-publisher of Health Care News.
“Texas may know who was undocumented, but it doesn’t have reliable data on what those patients actually cost,” said Goodman. “Hospital accounting systems are notoriously bad at estimating what anything really costs.”
Abbott’s broader point is nonetheless accurate, says Goodman.
“There is no doubt we are providing medical care to people who have no legal right to be here,” said Goodman.
ERs for ‘Primary’ Care
Criminal immigrants know where to get free medical care under federal law, says John Dale Dunn, M.D., a retired Texas emergency medicine physician and attorney.
“Where do you think they go when they need care?” Dunn asked. “They go to the ER.”
The Emergency Medical Treatment and Labor Act mandates hospitals to treat all patients regardless of insurance or immigration status. Over time, Medicaid and other public programs began covering more of these costs, though illegal immigrants still make up a significant portion of the uninsured patient population, says Dunn.
“The uninsured illegal immigrants became a major share of the beneficiaries,” said Dunn.
‘Unsustainable’ Losses
As the population of nonpaying patients grows, hospital profit margins shrink, says Linda Gorman, director of the Health Care Policy Center at the Independence Institute.
“Hospitals and doctors need to be paid,” said Gorman. “In theory, the federal government reimburses states for uncompensated care, and states pay hospitals—but that money often disappears into general Medicaid budgets. Even when payment occurs, it’s typically below cost. Medicaid expansion has increased demand for services, driving provider losses that are becoming unsustainable.”
Kenneth Artz ([email protected]) writes from Tyler, Texas.
Artz has more than 20 years’ experience in nonprofit organizations, publishing, newspaper reporting, and public policy advocacy.
