AUSTIN (KXAN) — More than 30,000 undocumented people sought medical care in Texas in November 2024 — about 2.5% of all patients — 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.
Data released by the Texas Health and Human Services Commission (HHSC) Friday shows of the more than 1.2 million emergency department patients and hospital inpatients across Texas in November, 30,265 self-identified as being in the country unlawfully, 2.47% of the total. Almost 1 million patients said they were either a U.S. citizen or in the country lawfully, 81.56% of the statewide total.
While hospitals in Texas are required to ask each patient their immigration status, patients are not required to answer. About 195,000 patients — 15.96% — did not answer the question.
The cost of care provided in November to patients reported as undocumented totaled $118,521,065.08, according to the HHSC data.
The numbers are slightly lower than those initially reported by HHSC in a Friday morning press release. KXAN's analysis of the data shows some hospitals also reported patient totals and associated costs for September and October 2024, and it appears HHSC inadvertently included those numbers when reporting the totals for November. KXAN also found data from one of the hospitals was duplicated and included twice.
KXAN reached out to HHSC after the data release. A spokesperson said they could not accommodate our request for an interview.
"Now, Texas has reliable data on the dramatic financial impact that illegal immigration is having on our hospital system," said Andrew Mahaleris, Abbott's spokesperson, adding that undocumented immigrants have been straining the Texas hospital system.
The governor said the executive order was in response to then-President Joe Biden and Vice President Kamala Harris' "open border policies" which he says brought in more than 11 million people illegally.
"Because of President Trump’s swift action in securing the southern border, illegal crossings have dropped to record lows. Texas is hopeful that his efforts to remove those who entered unlawfully may also cause these healthcare costs to decline," Mahaleris explained in a statement to KXAN investigators.
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.
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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