Key Takeaways
• Texas hospitals reported $121.8 million in unpaid care for undocumented immigrants in November 2024.
• Governor Abbott’s executive order mandated hospitals to report patients’ immigration status starting November 1, 2024.
• Unpaid care for undocumented immigrants was about 4% of Texas’s annual $3.1 billion in uncompensated hospital costs.
Texas hospitals faced a large financial burden in November 2024, reporting $121.8 million in unpaid health care costs linked to patients who are in the United States 🇺🇸 illegally. This amount, made public by the Texas Health and Human Services Commission (THHSC), highlights the ongoing debate about the effect of undocumented immigrants on state health systems. The data collection, required by an executive order from Governor Greg Abbott, has sparked new conversations about who pays for hospital care and how these costs shape healthcare for all Texans.
Governor Abbott’s Order and the Start of Tracking
The push to track these expenses began in August 2024, when Governor Greg Abbott signed a new executive order. This new rule told hospitals to ask patients about their immigration status and report that information to state health officials. Hospitals had to start this process on November 1, 2024, and needed to send their data to the Texas Health and Human Services Commission by March 1, 2025. Out of 600 hospitals in Texas, 558 submitted their reports on time. This wide response gives the state a nearly complete picture of the first month’s spending.
Governor Abbott explains that this step is about making sure Texas 🇺🇸 taxpayers do not bear these costs alone. He wants to use the data to ask for reimbursement from the federal government, which handles immigration policy. His press secretary, Andrew Mahaleris, shared that “Texas now possesses reliable data illustrating the significant financial strain that illegal immigration imposes on our hospital system.”
Breaking Down the November 2024 Numbers
The $121.8 million bill came from 31,012 visits by undocumented patients to Texas hospitals in November 2024 alone. The largest share, over $62 million, was for inpatient stays of people who did not have Medicaid or CHIP (Children’s Health Insurance Program). These programs help cover health care for some low-income people, but many without legal status are not eligible. Another $36 million was for emergency room visits, which anyone can get regardless of immigration status. The rest of the total included outpatient care.
Policy experts say while these numbers may seem high, they are only a small piece of the overall unpaid care Texas hospitals provide each year. The Texas Hospital Association has said hospitals spend about $3.1 billion each year caring for uninsured patients who cannot pay their bills. Most of that cost is actually for American citizens, not for illegal immigrants. Texas 🇺🇸 has more than 4 million people without health insurance, giving it one of the highest rates of uninsured people in the country. This means that, while undocumented immigrants do account for some unpaid care, they are not the main driver of the hospitals’ financial problems.
Here is how the monthly figure compares to annual unpaid care costs:
- Total unpaid care for one month from undocumented immigrants: $121.8 million
- Total unpaid care for one year (all uninsured): $3.1 billion
This means the cost linked to illegal immigrants was about 4% of the state’s yearly unpaid care for just that month.
How Hospitals Collect and Use Patient Information
Federal law requires hospitals to treat everyone who comes to the emergency room, no matter their immigration status or ability to pay. When collecting this new data, hospitals must tell patients that they do not have to share their immigration or citizenship status. In addition, patients are informed that their answers will not change the care they receive. The Texas Hospital Association has made it clear that just because hospitals now collect this information does not mean they will turn away patients or treat them differently.
One hospital spokesperson said, “The fact that hospitals are required to collect this data should not be a deterrent for people in need of care. Hospitals remain open and ready to serve Texans’ acute care needs.” This approach follows federal law, known as EMTALA (Emergency Medical Treatment and Labor Act), which guarantees emergency care for everyone.
Hospitals use the information only for reporting to state officials. They do not share it with immigration enforcement agencies. This policy is meant to protect patients’ privacy and also encourage those who need help to visit the hospital without fear.
Uncompensated Care and the Challenges for Texas Hospitals
“Uncompensated care” is the term hospitals use for care that they do not get paid for. It includes bills for anyone who cannot pay, including both citizens and undocumented patients. This problem is bigger in Texas 🇺🇸 than in most other places, mainly because so many residents lack health insurance. Hospitals end up providing billions of dollars in care for which they receive no payment. This can cause financial problems, especially for small and rural hospitals.
State Representative Mike Olcott pointed to this struggle when talking about his bill to address the issue. He said that since 2005, 181 small, rural hospitals have closed in Texas, often because they could not survive after years of unpaid care. Olcott stated, “The goal is simply to know what percentage of that uncompensated care are due to people here illegally.”
House Bill 2587, which Olcott put forward, would make Governor Abbott’s executive order a permanent law. If passed, the bill would require hospitals to keep collecting and reporting this information in the future. As of the most recent update, the bill has not yet left the committee.
Political Perspectives and Policy Goals
The move to track costs related to illegal immigrants comes at a time of political pressure on immigration policy. Governor Abbott has been a strong critic of the federal government’s approach to border security and immigration management. By collecting and sharing the hospital data, Governor Abbott says the goal is to show how local Texas communities are affected and to push the federal government to pay more for these costs.
Supporters of this effort argue that accurate numbers are needed to shape fair immigration and health policies. They believe knowing the exact costs can help Texas 🇺🇸 and other states negotiate with federal agencies or lawmakers for extra funds. Some also feel that publicizing these figures could drive future changes on a national level.
But critics say the policy shifts the focus away from deeper problems in Texas’s own healthcare system, such as the high number of uninsured American citizens. They point out that even with the reported $121.8 million bill from one month, the larger problem is the billions hospitals lose each year taking care of all patients who cannot pay. They argue that improved health coverage for Texans would do more to reduce unpaid hospital bills than tracking immigration status ever could.
Impact on Patients and Communities
For people who are in Texas 🇺🇸 without legal permission, the news creates fear and confusion. Even though hospitals tell patients they do not have to answer questions about citizenship, some worry that the information could be used against them later. Others fear that rumors about these rules will keep undocumented people from going to the hospital, even when they need urgent help.
Medical staff say delaying care can be unsafe. When sick people wait too long to seek help, their health problems may get worse. This can end up costing hospitals even more in the long run since emergency treatment is usually more expensive than regular doctor visits. The Texas Hospital Association has tried to calm these worries by repeating that hospitals do not report patient information to immigration officers.
Healthcare advocates say clear community outreach is needed. They want hospitals and local leaders to make sure everyone understands their rights and knows that emergency care is always available. If people stay away from hospitals, it can hurt everyone’s health and put more strain on the system.
Looking at the Bigger Picture: Comparing Texas to Other States
Texas 🇺🇸 has long struggled with high rates of uninsured residents. While states can make their own rules for health reporting, the federal government’s requirement to treat emergency patients regardless of status is the same everywhere. Other states have not made a similar push to collect detailed data on undocumented patients, at least not with the same scope as Texas.
Policy experts say understanding the true cost of uncompensated care may help shape better laws for the future. The federal Emergency Medical Treatment and Labor Act, the law that ensures emergency care for all, applies to every hospital that gets money from the federal Medicare or Medicaid programs. You can read more about that law on the Centers for Medicare & Medicaid Services EMTALA page.
Still, Texas’s report is among the first major efforts to directly connect hospital losses to illegal immigration on a month-by-month basis. Some experts hope that more data could help lawmakers make wiser choices on health spending and immigration policy.
Situational Updates: What Happens Next?
The November report is only the beginning. The Texas Health and Human Services Commission plans to provide quarterly updates that will give a broader picture throughout the year. The first annual report, which will sum up a full year’s data, is planned for release on January 1, 2026. These reports are expected to show how the costs fluctuate and how often Texas hospitals care for undocumented patients over time.
It remains to be seen what action, if any, the federal government will take in response to Governor Abbott’s call for reimbursement. As reported by VisaVerge.com, the ongoing debate may shape both healthcare and immigration rules—not just in Texas 🇺🇸 but across the country.
Summing Up: Texas Hospitals, Immigration, and the Cost of Care
The main facts are clear. In November 2024, Texas hospitals spent nearly $122 million caring for people who were in the United States 🇺🇸 illegally, based on rules set by Governor Greg Abbott’s executive order. This amount is only a small piece of the much bigger problem of unpaid healthcare in the state, which totals more than $3 billion a year for all uninsured patients. Most of these unpaid bills are for American citizens, but the new data gives Texas officials a tool to track costs linked to undocumented patients more precisely.
The issue raises tough questions about who should pay for healthcare when patients cannot afford it. Supporters of the new tracking rules hope it will bring more money from the federal government, while critics worry that it could scare sick people away from seeking necessary help. Hospitals have reassured everyone that care remains available to all, regardless of status or ability to pay.
As the state continues to gather and release more information, both policymakers and the public will have more concrete numbers to consider. The debate over these costs—and who is responsible—will likely continue, shaping the future of healthcare and immigration not just for Texas but for the entire United States 🇺🇸.
Learn Today
Uncompensated Care → Medical services for which hospitals receive no payment, including treatment for patients who are uninsured or unable to pay.
EMTALA → A federal law requiring hospitals to provide emergency medical treatment regardless of immigration status or ability to pay.
Medicaid → A government program that provides health coverage to eligible low-income individuals and families in the United States.
CHIP → Children’s Health Insurance Program, offering health coverage for children in low-income families who do not qualify for Medicaid.
Executive Order → A directive issued by a government executive, like a governor, that has the force of law within the executive branch.
This Article in a Nutshell
Texas hospitals reported a staggering $121.8 million in unpaid care for undocumented immigrants in November 2024. Governor Abbott’s executive order now requires hospitals to collect patients’ immigration status. This policy has sparked debate on healthcare funding, federal responsibility, and whether such transparency helps or hurts overall access to medical care.
— By VisaVerge.com
Read more:
• North Carolina bill seeks tougher sentences for illegal immigrants
• Trump administration blocks food stamps for undocumented immigrants
• USCIS warns immigrants their online activity may affect national security
• Immigrants are vital to Canada’s healthcare system
• Crime rates lower among undocumented immigrants than US natives
