25-04-2025
More than 31,000 undocumented patients sought medical care in Texas in November, state data shows
AUSTIN (KXAN) — More than 31,000 undocumented people sought medical care in Texas in November 2024 after an executive order by Gov. Greg Abbott directed hospitals to start collecting data on patients' immigration status.
Abbott signed Executive Order No. GA-46 on Aug. 8, 2024. The order directed hospitals to start collecting information 'regarding patients who are not lawfully present in the United States,' beginning Nov. 1, 2024, including the number of patients and the cost of care provided to those patients.
The governor said the executive order was in response to then-President Joe Biden and Vice President Kamala Harris' 'open border policies.'
'What we are trying to do is we are trying to gather information so first we can determine the magnitude of the challenge that we face,' Gov. Abbott told KXAN in an April 3 interview. 'Assuming the magnitude is large, I think there would be every reason why the state of Texas would have the right to sue the United States government, because it is the United States government's responsibility to pay for any of the costs concerning illegal immigration, and Texas and Texas healthcare facilities should not bear that burden.'
Data released by the Texas Health and Human Services Commission (HHSC) Friday shows 31,012 undocumented patients visited an emergency department or were discharged as an inpatient in November, costing the state more than $121 million. HHSC provided little context to those numbers, so it's unclear the total share of patients that were undocumented.
A similar law in Florida requires hospitals in that state to collect the same information. Data released by Florida's Agency for Health Care Administration shows that in 2024, only 0.76% of patients self-identified as undocumented, while 92.5% said they were either a U.S. citizen or in the country lawfully. About 6.7% of patients declined to answer the question.
While hospitals in Texas are required to ask each patient their immigration status, patients are not required to answer. In addition, hospitals are required to inform patients that responding to the question will not affect their care.
Still, immigrant advocate groups are concerned about the executive order's impact. The American Civil Liberties Union of Texas previously told KXAN it was worried the order would discourage undocumented Texans from seeking necessary medical care.
'This order should not impact anybody's access to care — period,' David Donatti, senior staff attorney with the ACLU of Texas, said. 'Whether you are native-born, a U.S. citizen, an immigrant, whatever your status should be, you should be able to access the healthcare that you need, and the facility should not have the ability to block you from receiving that kind of care. That is crystal clear as a matter of federal law.'
Texas has the highest uninsured rate in the nation at 17% — more than double the national average. Five million Texans had no insurance as of 2022, the Texas Hospital Association (THA) reported. In 2023, hospitals provided more than $8.1 billion in 'charity care' for uninsured people, with more than $3 billion not reimbursed.
Most uninsured Texans are citizens, however. While 1.6 million undocumented immigrants live in Texas, they go to the hospital at lower rates than U.S. citizens and make up a minority of the uninsured cost burden on state hospitals, the Texas Tribune reported.
Hospitals are required to report the data to HHSC each quarter, and the first set of data was due by March 1, 2025. As part of the executive order, the data will be reported annually, beginning next year, to the governor, lieutenant governor and speaker of the House.
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