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Texas hospitals must now report illegal immigrant healthcare costs


Gov. Greg Abbott has issued an executive order (EO) to “collect information on illegal immigrants who use Texas public hospitals for inpatient and emergency care and to report incurred healthcare costs due to the Biden-Harris Administration’s reckless open border policies.”

“Texans should not have to foot the bill for illegal immigrants['] healthcare,” Abbott stated on social media.

The EO will direct hospitals and other providers to collect information on the cost of medical care for illegal immigrants starting November 1 and report this data quarterly to the Texas Health and Human Services Commission, with initial submissions due by March 1, 2025. 

Abbott’s EO adds that the reports from hospitals and any responses from patients “will not affect patient care.”

Reporting on costs accrued for care provided to illegal immigrants will continue on an annual basis starting on January 1, 2026.

“Due to President Joe Biden and Vice President Kamala Harris’ open border policies, Texas has had to foot the bill for medical costs for individuals illegally in the state,” said Abbott in the EO release. “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants. That is why today I issued an Executive Order requiring the Texas Health and Human Services Commission to collect and report healthcare costs for illegal immigrants in our state.”

He added, “Texas will hold the Biden-Harris Administration accountable for the consequences of their open border policies, and we will fight to ensure that they pay back Texas for their costly and dangerous policies.”

Rural Texas hospitals are especially dependent on government funding for providing care to patients. A bipartisan coalition of Texas lawmakers has organized in an effort to push back against a Biden administration move to stop the long-standing practice of using private funds to support hospitals that rely heavily on Medicaid, which could cost the state billions of dollars.

In 2021, the Biden administration made a similar attempt by revoking approval of Texas' Medicaid Section 1115 waiver, which outlines federal reimbursement to the state for certain types of uncompensated care. It was valued at $30 billion.

Abbott’s EO states that one of the reasons for its issuance is the “more than 11 million people … entering this country illegally in less than four years under the Biden-Harris Administration.”

The EO adds that “the Biden-Harris Administration has consistently adopted open-border policies that invite this mass illegal entry into Texas and other States, including by ignoring federal laws that require the federal government to secure the border, construct barrier infrastructure, detain illegal immigrants, vet would-be entrants, and swiftly remove aliens pressing frivolous asylum claims.”

In January, Abbott asserted that Texas has a “constitutional right to defend and protect itself” in the face of this rise in illegal immigration. Over the past few years, many Texas counties have taken to declaring an “invasion” on the southern border.

This past month, the U.S. Court of Appeals for the 5th Circuit allowed Texas to keep its buoy barrier in the Rio Grande, and Judge James Ho supported Governor Greg Abbott's claim that the state is being “invaded” by illegal immigrants.

“A sovereign isn’t a sovereign if it can’t defend itself against invasion. … States did not forfeit this sovereign prerogative when they joined the Union,” Ho wrote.

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