On Aug. 8, Gov. Greg Abbott signed GA-46, which is an executive order requiring Texas hospitals to collect information regarding a patient’s immigration status. Although this policy is intended to help hospitals track the costs of providing care to undocumented immigrants, it can become another barrier for undocumented immigrants attempting to access lifesaving health care.
Previously, hospitals were not required to track a patient’s immigration status. Their primary focus was to provide a patient with care . However, starting Nov. 1, hospitals must track the care expenses of undocumented immigrants and report the data to the state health commission.
Abbott justified this move by citing the financial strain Texas faces because of what he describes as President Joe Biden and Vice President Kamala Harris’ “open border policies.” He argued the state should not have to bear the additional medical debt associated with providing health care to undocumented immigrants. If Abbott is concerned enough to track a patient’s immigration status, then why hasn’t he expanded the state’s Medicaid policies? Texas is one of 11 states to not expand its Medicaid policies under the Obama administration’s Affordable Care Act. When states expand their Medicaid polices the federal government pays for the majority of the expansion coverage. As more people become eligible for coverage, hospitals endure less uncompensated care costs. Had the Texas government expanded Medicaid, the state’s health care costs would not have increased as much as they did and Abbott would have had less financial strain to worry about.
Texas is not the first state to track patients’ immigration status. In 2023, Gov. Ron DeSantis established a law requiring Florida hospitals that receive Medicaid to ask for patients’ immigration status. The law disproportionately affects children and pregnant women, who require routine medical care but may forgo treatment out of fear their immigration status could be revealed. The law is even affecting clinics and organizations that receive no federal funding. For example, the Consulate of Mexico in Orlando offers free health care to migrants from all over the world. However, since the law took effect in May 2023, fewer migrants showed up for free checkups and care. The Floridian migrants’ fear of revealing their immigration status foreshadows the fate of migrants in Texas in response to the law. Even though hospitals nationwide are bound to provide care regardless of a patient’s ability to pay or their immigration status, the perceived risk of disclosing personal information can deter many from stepping foot in a hospital at all.
Undocumented immigrants, already wary of interacting with government agencies or institutions that may share information with immigration authorities, now face additional anxiety over something as fundamental as accessing health care. This can lead to avoidance of hospitals and clinics, even in emergency situations, placing individuals at greater risk of serious health complications or death. For families with mixed immigration statuses, where some members may be U.S. citizens while others are undocumented, this law creates fear and confusion over whether they can safely access medical services without repercussions.
This fear persists despite the fact that many undocumented immigrants contribute meaningfully to the U.S. economy, including toward state health care costs. Even without legal status, they often pay taxes through payroll deductions, property taxes — either directly or through rent — and sales taxes. According to the Institute on Taxation and Economic Policy, undocumented immigrants contribute billions in state and local taxes annually. In Texas alone, undocumented immigrants paid an estimated $4.9 billion in taxes in 2022. For context, in 2021, the average health care cost per capita for immigrants was $4,875 while the cost for U.S citizens was much higher at $7,277. Even if undocumented immigrants did not “pull their weight” or demanded significant funding, they still deserve access to health care because they’re people too.
Ultimately, while the stated goal of the executive order is to track health care costs associated with undocumented immigrants, its effect in practice is to push an already vulnerable population further into the margins. Tracking the costs associated with undocumented immigrants could lead to the Texas legislature using those numbers as an excuse to try and find new ways to escape having to pay for undocumented immigrants’ health care. For many immigrants, the fear of being targeted outweighs the critical need for health care, leading to dangerous consequences both for individuals and a community at large.